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Clark JD, Kraft SA, Dervan LA, Di Gennaro JL, Hurson J, Watson RS, Zimmerman JJ, Meert KL. "I Didn't Realize How Hard It Was Going to Be Just Transitioning Back into Life": A Qualitative Exploration of Outcomes for Survivors of Pediatric Septic Shock. J Pediatr Intensive Care 2024; 13:63-74. [PMID: 38571982 PMCID: PMC10987221 DOI: 10.1055/s-0041-1736547] [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: 07/01/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
Abstract
Recovery following pediatric critical illness is multifaceted and complex. While most critically ill children survive, many experience morbidities in physical, emotional, cognitive, and social function. We aimed to deeply explore and describe the multidimensional impact of pediatric septic shock for affected children and their families at the granular level using exploratory qualitative methodology. We performed semistructured telephone interviews of adolescents and caregivers of children admitted with community-acquired septic shock to two tertiary pediatric intensive care units in the United States. Interviews were conducted within two years of hospital admission, and were recorded, transcribed, and analyzed using thematic analysis. Two adolescents and 10 caregivers were interviewed. Participants described meaningful and long-lasting outcomes of septic shock on multiple dimensions of their lives. The adolescents and caregivers described substantial negative consequences on physical health and function which resulted in increased medical complexity and heightened caregiver vigilance. The physical impact led to substantial psychosocial consequences for both the child and family, including social isolation. Most caregivers expressed that septic shock was transformational in their lives, with some caregivers describing posttraumatic growth. This preliminary study provides a novel, granular view of the multidimensional impact of septic shock in pediatric patients and their families. Exploring these experiences through qualitative methodology provides greater insight into important patient and family outcomes. Deeper understanding of these outcomes may support the development of meaningful interventions to improve quality of life for children and their families following critical illness.
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Affiliation(s)
- Jonna D. Clark
- Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, United States
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, United States
- Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Stephanie A. Kraft
- Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, United States
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, United States
| | - Leslie A. Dervan
- Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Jane L. Di Gennaro
- Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Jill Hurson
- Medable, Inc., New York, New York, United States
| | - Robert S. Watson
- Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Jerry J. Zimmerman
- Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Kathleen L. Meert
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University (formerly affiliated with Wayne State University), Detroit, Michigan, United States
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Weiss EM, Porter KM, Sullivan TR, Sotelo Guerra LJ, Anderson EE, Garrison NA, Baker L, Smith JM, Kraft SA. Equity Concerns Across Pediatric Research Recruitment: An Analysis of Research Staff Interviews. Acad Pediatr 2024; 24:318-329. [PMID: 37442368 PMCID: PMC10782814 DOI: 10.1016/j.acap.2023.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Difficulty recruiting individuals from minoritized and underserved populations for clinical research is well documented and has health equity implications. Previously, we reported findings from interviews with research staff about pediatric research recruitment processes. Respondents raised equity concerns related to recruitment and enrollment of participants from minoritized, low resourced, and underserved populations. We therefore decided to perform a secondary coding of the transcripts to examine equity-related issues systematically. METHODS We conducted a process of secondary coding and analysis of interviews with research staff involved in recruitment for pediatric clinical research. Through consensus we identified codes relevant to equity and developed a conceptual framework including 5 stages of research. RESULTS We analyzed 28 interviews and coded equity-related items. We report 6 implications of our findings. First, inequitable access to clinical care is an upstream barrier to research participation. Second, there is a need to increase research opportunities where underserved and under-represented populations receive care. Third, increasing research team diversity can build trust with patients and families, but teams must ensure adequate support of all research team members. Fourth, issues related to consent processes raise institutional-level opportunities for improvement. Fifth, there are numerous study procedure-related barriers to participation. Sixth, our analysis illustrates that individuals who speak languages other than English face barriers across multiple stages. CONCLUSIONS Research staff members identified equity-related concerns and recommended potential solutions across 5 stages of the research process, which may guide those endeavoring to improve research recruitment for pediatric patients from minoritized and underserved populations.
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Affiliation(s)
- Elliott Mark Weiss
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash.
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash
| | | | - Laura J Sotelo Guerra
- Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Emily E Anderson
- Neiswanger Institute for Bioethics (EE Anderson), Loyola University Chicago Stritch School of Medicine, Maywood, Ill
| | - Nanibaa' A Garrison
- Institute for Society and Genetics (NA Garrison), University of California Los Angeles; Institute for Precision Health (NA Garrison), David Geffen School of Medicine, University of California Los Angeles; and Division of General Internal Medicine and Health Services Research (NA Garrison), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Laura Baker
- Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Jodi M Smith
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Stephanie A Kraft
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash
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Gilmore MJ, Knerr S, Kraft SA, Bulkley JE, Biesecker BB, Feigelson HS, Hunter JE, Jenkins CL, Kauffman TL, Lee SSJ, Liles EG, Mittendorf KF, Muessig KR, Porter KM, Rolf BA, Rope AF, Zepp JM, Anderson KP, Devine B, Joseph G, Leo MC, Goddard K, Wilfond BS. Improving Care for Marginalized Populations at Risk for Hereditary Cancer Syndromes: Innovations that Expanded Reach in the CHARM Study. Public Health Genomics 2023; 27:16-22. [PMID: 38142673 DOI: 10.1159/000535610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA,
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | | | - Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Charisma L Jenkins
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | | | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bradley A Rolf
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle, Washington, USA
| | - Alan F Rope
- Genome Medical, South San Francisco, California, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | - Beth Devine
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Katrina Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
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Kraft SA, Duenas DM, Shah SK. Patient priorities for fulfilling the principle of respect in research: findings from a modified Delphi study. BMC Med Ethics 2023; 24:73. [PMID: 37735658 PMCID: PMC10512546 DOI: 10.1186/s12910-023-00954-5] [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] [Received: 11/01/2022] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. METHODS We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of agreement among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item's mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. RESULTS Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. CONCLUSIONS Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 1900 Ninth Ave., M/S JMB-6, Seattle, WA, 98101, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 1900 Ninth Ave., M/S JMB-6, Seattle, WA, 98101, USA
| | - Seema K Shah
- Lurie Children's Hospital, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Bland HT, Gilmore MJ, Andujar J, Martin MA, Celaya-Cobbs N, Edwards C, Gerhart M, Hooker GW, Kraft SA, Marshall DR, Orlando LA, Paul NA, Pratap S, Rosenbloom ST, Wiesner GL, Mittendorf KF. Conducting inclusive research in genetics for transgender, gender-diverse, and sex-diverse individuals: Case analyses and recommendations from a clinical genomics study. J Genet Couns 2023:10.1002/jgc4.1785. [PMID: 37667436 PMCID: PMC10909936 DOI: 10.1002/jgc4.1785] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/26/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
A person's phenotypic sex (i.e., endogenous expression of primary, secondary, and endocrinological sex characteristics) can impact crucial aspects of genetic assessment and resulting clinical care recommendations. In studies with genetics components, it is critical to collect phenotypic sex, information about current organ/tissue inventory and hormonal milieu, and gender identity. If researchers do not carefully construct data models, transgender, gender diverse, and sex diverse (TGSD) individuals may be given inappropriate care recommendations and/or be subjected to misgendering, inflicting medical and psychosocial harms. The recognized need for an inclusive care experience should not be limited to clinical practice but should extend to the research setting, where researchers must build an inclusive experience for TGSD participants. Here, we review three TGSD participants in the Family History and Cancer Risk Study (FOREST) to critically evaluate sex- and gender-related survey measures and associated data models in a study seeking to identify patients at risk for hereditary cancer syndromes. Furthermore, we leverage these participants' responses to sex- and gender identity-related questions in FOREST to inform needed changes to the FOREST data model and to make recommendations for TGSD-inclusive genetics research design, data models, and processes.
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Affiliation(s)
- Harris T. Bland
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Justin Andujar
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Makenna A. Martin
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Natasha Celaya-Cobbs
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Clasherrol Edwards
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville TN
| | - Meredith Gerhart
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Gillian W. Hooker
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Concert Genetics, Nashville TN
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA 98101
- Department of Pediatrics, Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, WA
| | - Dana R. Marshall
- Department of Pathology, Anatomy and Cell Biology, Meharry Medical College, Nashville TN
| | - Lori A. Orlando
- Duke University, Center for Applied Genomics and Precision Medicine, Durham, NC
| | - Natalie A. Paul
- Rainbow Advocacy Inclusion and Networking Services, Longview, WA
- Lavender Spectrum Health, Vancouver, WA
| | - Siddharth Pratap
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville TN
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Georgia L. Wiesner
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Duenas DM, Riddle L, Guerra C, Caruncho M, Lewis H, Porter KM, Kraft SA, Anderson KP, Biesecker B, Gilmore MJ, Zepp JM, Leo MC, Wilfond BS, Joseph G. Refining a Multifaceted Model of Perceived Utility of Genomic Sequencing Results. Public Health Genomics 2023; 26:135-144. [PMID: 37607497 PMCID: PMC10614499 DOI: 10.1159/000531782] [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] [Received: 12/10/2022] [Accepted: 06/22/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Research on the perceived utility of genomic sequencing has focused primarily on pediatric populations and on individuals and families with rare genetic diseases. Here, we evaluate how well a multifaceted perceived utility model developed with these populations applies to a diverse, adult population aged 18-49 at risk for hereditary cancer and propose new considerations for the model. METHODS Participants received clinical genomic sequencing in the Cancer Health Assessments Reaching Many (CHARM) study. Semi-structured qualitative interviews were conducted with a subset of participants at 1 and 6 months after results disclosure. We used an approach influenced by grounded theory to examine perceptions of the utility of genomic sequencing and analyzed how utility in CHARM mapped to the published multifaceted perceived utility model, noting which domains were represented or absent and which were most salient to our population. RESULTS Participants' discussions of utility often involved multiple domains and revealed the variety of ways in which receiving sequencing results can impact one's life. Results demonstrated that an individual's perception of utility can change over the life course when sequenced at a relatively young age and may be influenced by the resources available to them to act on the results. CONCLUSION Our findings demonstrate the relevance of a multifaceted perceived utility model for a diverse adult population at risk for hereditary cancer. We identified refinements that could make the model more robust, including emphasizing the overlapping nature of the domains and the importance of life stage and personal resources to the perception of utility.
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Affiliation(s)
- Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Claudia Guerra
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Mikaella Caruncho
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hannah Lewis
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine P. Anderson
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO, USA
| | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Michael C. Leo
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - On behalf of the CHARM Study
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO, USA
- Analytics, RTI International, Washington, DC, USA
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Wilfond BS, Toraman Turk S, Kraft SA, Weiss EM, Tarr PI, Schnadower D, Freedman SB. Distinguishing Clinical and Research Risks in Pragmatic Clinical Trials: The Need for Further Stakeholder Engagement. Am J Bioeth 2023; 23:39-42. [PMID: 37450523 DOI: 10.1080/15265161.2023.2217146] [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: 07/18/2023]
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Porter KM, Kraft SA, Speight CD, Duenas DM, Niyibizi NK, Mitchell A, O’Connor MR, Gregor C, Liljenquist K, Shah SK, Wilfond BS, Dickert NW. Research recruitment through the patient portal: perspectives of community focus groups in Seattle and Atlanta. JAMIA Open 2023; 6:ooad004. [PMID: 36751464 PMCID: PMC9897173 DOI: 10.1093/jamiaopen/ooad004] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/16/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Objective Research recruitment through patient portals (ie, patient-facing, web-based clinical interfaces) has the potential to be effective, efficient, and inclusive, but best practices remain undefined. We sought to better understand how patients view this recruitment approach. Materials and Methods We conducted 6 focus groups in Atlanta, GA and Seattle, WA with members of patient advisory committees and the general public. Discussions addressed acceptability of patient portal recruitment and communication preferences. Focus groups were audio-recorded, transcribed, and analyzed using deductive and inductive codes. Iterative team discussions identified major themes. Results Of 49 total participants, 20 were patient advisory committee members. Participants' mean age was 49 (range 18-74); 59% identified as non-Hispanic White and 31% as Black/African American. Participants were supportive of patient portal recruitment and confident that messages were private and legitimate. Participants identified transparency and patient control over whether and how to participate as essential features. Concerns included the frequency of research messages and the ability to distinguish between research and clinical messages. Participants also discussed how patient portal recruitment might affect diversity and inclusion. Discussion Focus group participants generally found patient portal recruitment acceptable and perceived it as secure and trustworthy. Transparency, control, and attention to inclusiveness were identified as key considerations for developing best practices. Conclusion For institutions implementing patient portal recruitment programs, continued engagement with patient populations can help facilitate translation of these findings into best practices and ensure that implemented strategies accomplish intended goals.
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Affiliation(s)
- Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Candace D Speight
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Nyiramugisha K Niyibizi
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
| | - Andrea Mitchell
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
| | - M Rebecca O’Connor
- Child, Family & Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Charles Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Seema K Shah
- Bioethics Program, Lurie Children’s Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Neal W Dickert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
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Kraft SA. Centering Patients' Voices in Artificial Intelligence‒Based Telemedicine. Am J Public Health 2023; 113:470-471. [PMID: 36926958 PMCID: PMC10088953 DOI: 10.2105/ajph.2023.307270] [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: 03/18/2023]
Affiliation(s)
- Stephanie A Kraft
- Stephanie A. Kraft is with the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, and the Department of Pediatrics, School of Medicine, University of Washington, Seattle
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Kraft SA, Russell H, Bensen JT, Bonini KE, Robinson JO, Sahin‐Hodoglugil N, Renna K, Hindorff LA, Kaufman D, Horowitz CR, Waltz M, Zepp JM, Knight SJ. Conducting clinical genomics research during the COVID-19 pandemic: Lessons learned from the CSER consortium experience. Am J Med Genet A 2023; 191:391-399. [PMID: 36341765 PMCID: PMC9839535 DOI: 10.1002/ajmg.a.63033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/27/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Clinical research studies have navigated many changes throughout the COVID-19 pandemic. We sought to describe the pandemic's impact on research operations in the context of a clinical genomics research consortium that aimed to enroll a majority of participants from underrepresented populations. We interviewed (July to November 2020) and surveyed (May to August 2021) representatives of six projects in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, which studies the implementation of genome sequencing in the clinical care of patients from populations that are underrepresented in genomics research or are medically underserved. Questions focused on COVID's impact on participant recruitment, enrollment, and engagement, and the transition to teleresearch. Responses were combined and thematically analyzed. Projects described factors at the project, institutional, and community levels that affected their experiences. Project factors included the project's progress at the pandemic's onset, the urgency of in-person clinical care for the disease being studied, and the degree to which teleresearch procedures were already incorporated. Institutional and community factors included institutional guidance for research and clinical care and the burden of COVID on the local community. Overall, being responsive to community experiences and values was essential to how CSER navigated evolving challenges during the COVID-19 pandemic.
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Affiliation(s)
- Stephanie A. Kraft
- Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA,Treuman Katz Center for Pediatric BioethicsSeattle Children′s Research InstituteSeattleWashingtonUSA
| | - Heidi Russell
- Department of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Jeannette T. Bensen
- Department of EpidemiologyUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Katherine E. Bonini
- Institute for Genomic HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jill O. Robinson
- Center for Medical Ethics and Health PolicyBaylor College of MedicineHoustonTexasUSA
| | - Nuriye Sahin‐Hodoglugil
- Institute for Human GeneticsUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Kathleen Renna
- Division of Genomic MedicineNational Human Genome Research InstituteBethesdaMarylandUSA,Division of Genomics and SocietyNational Human Genome Research InstituteBethesdaMarylandUSA
| | - Lucia A. Hindorff
- Division of Genomic MedicineNational Human Genome Research InstituteBethesdaMarylandUSA
| | - Dave Kaufman
- Division of Genomics and SocietyNational Human Genome Research InstituteBethesdaMarylandUSA
| | - Carol R. Horowitz
- Institute for Health Equity ResearchIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Margaret Waltz
- Department of Social MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Jamilyn M. Zepp
- Department of Translational and Applied GenomicsCenter for Health Research, Kaiser Permanente NorthwestPortlandOregonUSA
| | - Sara J. Knight
- Department of Internal Medicine, Division of EpidemiologyUniversity of UtahSalt Lake CityUtahUSA
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11
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Kraft SA, Rohrig A, Williams A, Shah SK. Better recognition for research participants: what society should learn from covid-19. BMJ 2023; 380:e071178. [PMID: 36649969 DOI: 10.1136/bmj-2022-071178] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, USA
| | - Abie Rohrig
- Department of Philosophy, Swarthmore College, Swarthmore, Pennsylvania, USA
- Research Ethics Team, 1Day Sooner, Delaware, USA
| | - Anthony Williams
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA States
| | - Seema K Shah
- Lurie Children's Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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12
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Kraft SA, Porter KM, Sullivan TR, Anderson EE, Garrison NA, Baker L, Smith JM, Weiss EM. Relationship building in pediatric research recruitment: Insights from qualitative interviews with research staff. J Clin Transl Sci 2022; 6:e138. [PMID: 36590359 PMCID: PMC9794958 DOI: 10.1017/cts.2022.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Clinical research staff play a critical role in recruiting families for pediatric research, but their views are not well described. We aimed to describe how pediatric research staff build trusting research relationships with patients and their families. Methods We interviewed research staff at one pediatric research institution and its affiliated academic medical center between November 2020 and February 2021. Staff were eligible if they conducted participant recruitment, consent, and/or enrollment for clinical research. We developed our semi-structured interview guide based on a framework for trusting researcher-community partnerships. Results We interviewed 28 research staff, with a median age of 28 years (range 22-50) and a median of 5 years of experience (range 1-29). Interviewees identified factors relevant to relationship building across three levels: the individual staff member, the relational interaction with the family, and the institutional or other structural backdrop. Individual factors included how staff developed recruitment skills, their perceived roles, and their personal motivations. Relational factors spanned four stages of recruitment: before the approach, forming an initial connection with a family, building the connection, and following up. Structural factors were related to access and diversity, clinical interactions, and the COVID-19 pandemic. Conclusions Research staff discussed tensions and supports with various actors, challenges with the integration of research and clinical care, the importance of voluntariness for building trust, and multiple contributors to inequities in research. These findings reveal the importance of ensuring research staff have a voice in institutional policies and are supported to advocate for patients and families.
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Affiliation(s)
- Stephanie A. Kraft
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
| | | | - Emily E. Anderson
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Nanibaa’ A. Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Laura Baker
- Research Integration Hub, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Jodi M. Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Research Integration Hub, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Elliott M. Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
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13
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Lindberg NM, Mittendorf KF, Duenas DM, Anderson K, Koomas A, Kraft SA, Okuyama S, Shipman KJ, Vandermeer ML, Goddard KAB, Wilfond BS, McMullen C. Engaging Patient Advisory Committees to Inform a Genomic Cancer Risk Study: Lessons for Future Efforts. Perm J 2022; 26:28-39. [DOI: 10.7812/tpp/21.091] [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: 11/30/2022]
Affiliation(s)
- Nangel M Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA, USA
| | | | - Alyssa Koomas
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA, USA
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, Denver, CO, USA
| | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA, USA
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Katrina AB Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA, USA
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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14
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Mittendorf KF, Lewis HS, Duenas DM, Eubanks DJ, Gilmore MJ, Goddard KAB, Joseph G, Kauffman TL, Kraft SA, Lindberg NM, Reyes AA, Shuster E, Syngal S, Ukaegbu C, Zepp JM, Wilfond BS, Porter KM. Literacy-adapted, electronic family history assessment for genetics referral in primary care: patient user insights from qualitative interviews. Hered Cancer Clin Pract 2022; 20:22. [PMID: 35689290 PMCID: PMC9188215 DOI: 10.1186/s13053-022-00231-3] [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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk assessment for hereditary cancer syndromes is recommended in primary care, but family history is rarely collected in enough detail to facilitate risk assessment and referral - a roadblock that disproportionately impacts individuals with healthcare access barriers. We sought to qualitatively assess a literacy-adapted, electronic patient-facing family history tool developed for use in diverse, underserved patient populations recruited in the Cancer Health Assessments Reaching Many (CHARM) Study. METHODS Interview participants were recruited from a subpopulation of CHARM participants who experienced barriers to tool use in terms of spending a longer time to complete the tool, having incomplete attempts, and/or providing inaccurate family history in comparison to a genetic counselor-collected standard. We conducted semi-structured interviews with participants about barriers and facilitators to tool use and overall tool acceptability; interviews were recorded and professionally transcribed. Transcripts were coded based on a codebook developed using inductive techniques, and coded excerpts were reviewed to identify overarching themes related to barriers and facilitators to family history self-assessment and acceptability of the study tool. RESULTS Interviewees endorsed the tool as easy to navigate and understand. However, they described barriers related to family history information, literacy and language, and certain tool functions. Participants offered concrete, easy-to-implement solutions to each barrier. Despite experience barriers to use of the tool, most participants indicated that electronic family history self-assessment was acceptable or preferable in comparison to clinician-collected family history. CONCLUSIONS Even for participants who experienced barriers to tool use, family history self-assessment was considered an acceptable alternative to clinician-collected family history. Barriers experienced could be overcome with minor adaptations to the current family history tool. TRIAL REGISTRATION This study is a sub-study of the Cancer Health Assessments Reaching Many (CHARM) trial, ClinicalTrials.gov, NCT03426878. Registered 8 February 2018.
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Affiliation(s)
- Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Hannah S Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE. Pacific St, Seattle, WA, 98195, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Ana A Reyes
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Sapna Syngal
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Chinedu Ukaegbu
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE. Pacific St, Seattle, WA, 98195, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.
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15
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Morain S, Kraft SA, Wilfond B, McGuire A, Dickert N, Garland A, Sugarman J. Toward Meeting the Obligation of Respect for Persons in Pragmatic Clinical Trials. Hastings Cent Rep 2022; 52:9-17. [PMID: 35763201 PMCID: PMC9704739 DOI: 10.1002/hast.1391] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Research ethics oversight systems have traditionally emphasized the informed consent process as the primary means by which to demonstrate respect for prospective subjects. Yet how researchers can best fulfill the ethical obligations of respect for persons in pragmatic clinical trials (PCTs)-particularly those that may alter or waive informed consent-remains unknown. We propose eight dimensions of demonstrating respect in PCTs: (1) engaging patients and communities in research design and execution, (2) promoting transparency and open communication, (3) maximizing agency, (4) minimizing burdens and promoting accessibility, (5) protecting privacy and confidentiality, (6) valuing interpersonal interactions with clinicians and study team members, (7) providing compensation, and (8) maximizing social value. While what respect requires in the context of PCTs will vary based on the nature of the PCT in question, the breadth of these dimensions demonstrates that respect obligations extend beyond informed consent processes.
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Affiliation(s)
- Stephanie Morain
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - Amy McGuire
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX
| | - Neal Dickert
- Emory University School of Medicine, Atlanta, GA
| | - Andrew Garland
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
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16
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Duenas DM, Shipman KJ, Porter KM, Shuster E, Guerra C, Reyes A, Kauffman TL, Hunter JE, Goddard KAB, Wilfond BS, Kraft SA. Motivations and concerns of patients considering participation in an implementation study of a hereditary cancer risk assessment program in diverse primary care settings. Genet Med 2022; 24:610-621. [PMID: 34906471 PMCID: PMC8939763 DOI: 10.1016/j.gim.2021.11.017] [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] [Received: 08/25/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Understanding the motivations and concerns of patients from diverse populations regarding participation in implementation research provides the needed evidence about how to design and conduct studies for facilitating access to genetics services. Within a hereditary cancer screening study assessing a multifaceted intervention, we examined primary care patients' motivations and concerns about participation. METHODS We surveyed and interviewed study participants after they enrolled, surveyed those who did not complete enrollment, and used descriptive qualitative and quantitative methods to identify motivations and concerns regarding participation. RESULTS Survey respondents' most common motivations included a desire to learn about their future risk (81%), receiving information that may help family (58%), and a desire to advance research (34%). Interviews revealed 3 additional important factors: affordability of testing, convenience of participation, and clinical relationships supporting research decision-making. Survey data of those who declined enrollment showed that the reasons for declining included concerns about privacy (38%), burdens of the research (19%), and their fear of not being able to cope with the genetic information (19%). CONCLUSION Understanding the facilitating factors and concerns that contribute to decisions about research may reveal ways to improve equity in access to care and research that could lead to greater uptake of genomic medicine across diverse primary care patient populations.
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Affiliation(s)
- Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA.
| | - Kelly J Shipman
- Palliative Care and Resilience Research Program, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, CA
| | - Ana Reyes
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
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17
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KA. Corrigendum to “Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations” [Contemporary Clinical Trials 106 (2021) 106432]. Contemp Clin Trials 2022; 114:106682. [DOI: 10.1016/j.cct.2022.106682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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19
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Sawyer KE, Kraft SA, Wightman AG, Clark JD. Pediatric Death by Neurologic Criteria: The Ever-Changing Landscape and the Expanding Role of Palliative Care Professionals. J Pain Symptom Manage 2021; 62:1079-1085. [PMID: 33984463 DOI: 10.1016/j.jpainsymman.2021.04.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
Pediatric palliative care providers are especially suited to support families and medical teams facing a potential diagnosis of brain death, or death by neurologic criteria (DNC), when a child suffers a devastating brain injury. To support pediatric palliative care providers' effectiveness in this role, this article elucidates the clinical determination of DNC and the evolution of the ethical and legal controversies surrounding DNC. Conceptual definitions of death used in the context of DNC have been and continue to be debated amongst academicians, and children's families often have their own concept of death. Increasingly, families have brought legal cases challenging the definition of death, arguing for a right to refuse examination to diagnose DNC, and/or voicing religious objections. We describe these conceptual definitions and legal challenges then explore some potential reasons why families may dispute a determination of DNC. We conclude that working with patients, families, and healthcare providers facing DNC carries inherent and unique challenges suited to intervention by interdisciplinary palliative care teams.
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Affiliation(s)
| | - Stephanie A Kraft
- University of Washington School of Medicine, Seattle Children's Research Institute Seattle, Washington, USA
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20
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Smith HS, Morain SR, Robinson JO, Canfield I, Malek J, Rubanovich CK, Bloss CS, Ackerman SL, Biesecker B, Brothers KB, Goytia CN, Horowitz CR, Knight SJ, Koenig B, Kraft SA, Outram S, Rini C, Shipman KJ, Waltz M, Wilfond B, McGuire AL. Perceived Utility of Genomic Sequencing: Qualitative Analysis and Synthesis of a Conceptual Model to Inform Patient-Centered Instrument Development. Patient 2021; 15:317-328. [PMID: 34658003 PMCID: PMC9013723 DOI: 10.1007/s40271-021-00558-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Successful clinical integration of genomic sequencing (GS) requires evidence of its utility. While GS potentially has benefits (utilities) or harms (disutilities) across multiple domains of life for both patients and their families, there is as yet no empirically informed conceptual model of these effects. Our objective was to develop an empirically informed conceptual model of perceived utility of GS that captures utilities and disutilities for patients and their families across diverse backgrounds. METHODS We took a patient-centered approach, in which we began with a review of existing literature followed by collection of primary interview data. We conducted semi-structured interviews to explore types of utility in a clinically and sociopolitically diverse sample of 60 adults from seven Clinical Sequencing Evidence-Generating Research (CSER) consortium projects. Interviewees had either personally received, or were parents of a child who had received, GS results. Qualitative data were analyzed using thematic analysis. Findings from interviews were integrated with existing literature on clinical and personal utility to form the basis of an initial conceptual model that was refined based on expert review and feedback. RESULTS Five key utility types that have been previously identified in qualitative literature held up as primary domains of utility and disutility in our diverse sample. Interview data were used to specify and organize subdomains of an initial conceptual model. After expert refinement, the five primary domains included in the final model are clinical, emotional, behavioral, cognitive, and social, and several subdomains are specified within each. CONCLUSION We present an empirically informed conceptual model of perceived utility of GS. This model can be used to guide development of instruments for patient-centered outcome measurement that capture the range of relevant utilities and disutilities and inform clinical implementation of GS.
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Affiliation(s)
- Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Stephanie R Morain
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Jill Oliver Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Isabel Canfield
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Janet Malek
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Caryn Kseniya Rubanovich
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Cinnamon S Bloss
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Sara L Ackerman
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | - Kyle B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Crispin N Goytia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, New York, NY, USA
| | - Sara J Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Barbara Koenig
- Program in Bioethics, University of California, San Francisco, CA, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Simon Outram
- Program in Bioethics, University of California, San Francisco, CA, USA
| | - Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Kelly J Shipman
- Palliative Care and Resilience Lab, Seattle Children's, Seattle, WA, USA
| | - Margaret Waltz
- Department of Social Medicine, UNC-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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21
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KAB. Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations. Contemp Clin Trials 2021; 106:106432. [PMID: 33984519 PMCID: PMC8336568 DOI: 10.1016/j.cct.2021.106432] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/21/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
Advances in the application of genomic technologies in clinical care have the potential to increase existing healthcare disparities. Studies have consistently shown that only a fraction of eligible patients with a family history of cancer receive recommended cancer genetic counseling and subsequent genetic testing. Care delivery models using pre-test and post-test counseling are not scalable, which contributes to barriers in accessing genetics services. These barriers are even more pronounced for patients in historically underserved populations. We have designed a multimodal intervention to improve subsequent cancer surveillance, by improving the identification of patients at risk for familial cancer syndromes, reducing barriers to genetic counseling/testing, and increasing patient understanding of complex genetic results. We are evaluating this intervention in two large, integrated healthcare systems that serve diverse patient populations (NCT03426878). The primary outcome is the number of diagnostic (hereditary cancer syndrome) findings. We are examining the clinical and personal utility of streamlined pathways to genetic testing using electronic medical record data, surveys, and qualitative interviews. We will assess downstream care utilization of individuals receiving usual clinical care vs. genetic testing through the study. We will evaluate the impacts of a literacy-focused genetic counseling approach versus usual care genetic counseling on care utilization and participant understanding, satisfaction, and family communication. By recruiting participants belonging to historically underserved populations, this study is uniquely positioned to evaluate the potential of a novel genetics care delivery program to reduce care disparities.
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Affiliation(s)
- Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | | | | | - Michael O Dorschner
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sandra Soo Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, 630 West 168(th) St, PH15E-1525, New York, NY 10032, USA
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Elizabeth G Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, 777 Bannock Denver, CO 80204, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Leslie S Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Bradley A Rolf
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Alan F Rope
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA; Genome Medical, 701 Gateway Blvd, Suite 380, San Francisco, CA 94080, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
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22
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Speight CD, Gregor C, Ko YA, Kraft SA, Mitchell AR, Niyibizi NK, Phillips BG, Porter KM, Shah SK, Sugarman J, Wilfond BS, Dickert NW. Reframing Recruitment: Evaluating Framing in Authorization for Research Contact Programs. AJOB Empir Bioeth 2021; 12:206-213. [PMID: 33719913 PMCID: PMC10788686 DOI: 10.1080/23294515.2021.1887962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/21/2022]
Abstract
BACKGROUND The changing clinical research recruitment landscape involves practical challenges but introduces opportunities. Researchers can now identify large numbers of eligible patients through electronic health record review and can directly contact those who have authorized contact. Applying behavioral science-driven strategies to design and frame communication could affect patients' willingness to authorize contact and their understanding of these programs. The ethical and practical implications of various strategies warrant empirical evaluation. METHODS We conducted an online survey (n = 1070) using a nationally-representative sample. Participants were asked to imagine being asked for authorization for research contact in clinic. They were randomly assigned to view one of three flyers: #1-neutral text flyer; #2-a positive text flyer; or #3-positive graphics-based flyer. Primary outcomes included likelihood of enrollment and comprehension of the program. Chi-Square tests and regression analyses were used to examine whether those who saw the positive flyers were more likely to enroll and had increased comprehension. RESULTS Compared to the neutral flyer, individuals who received the positive text flyer were numerically more likely to enroll, but this was not statistically significant (24.2% v. 19.0%, p = 0.11). Individuals who received the positive graphics flyer were more likely to enroll (28.7% v. 19.0%, p = 0.002). After adjustment, individuals assigned to both novel flyers had increased odds of being likely to enroll (OR = 1.55 95%CI [1.04, 2.31] and OR = 1.95 95%CI [1.31, 2.91]). Flyer type did not affect overall comprehension (p = 0.21), and greater likelihood of enrollment was observed only in individuals with better comprehension. CONCLUSIONS This study demonstrated that employing behavioral science-driven communication strategies for authorization for research contact had an effect on likelihood of hypothetical enrollment but did not significantly affect comprehension. Strategies using simple, positive language and visual tools may be effective and ethically appropriate. Further studies should explore how these and other approaches can help to optimize research recruitment.
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Affiliation(s)
- Candace D. Speight
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Charlie Gregor
- Institute of Translational Health Sciences at the University of Washington, Seattle, WA
| | - Yi-An Ko
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Stephanie A. Kraft
- University of Washington School of Medicine, Department of Pediatrics and the Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Andrea R. Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Nyiramugisha K. Niyibizi
- Georgia Clinical and Translational Science Alliance at Emory University School of Medicine, Atlanta, GA
| | - Bradley G. Phillips
- University of Georgia College of Pharmacy and the Director of the University of Georgia Office of Research Clinical and Translational Research Unit, Athens, GA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Seema K. Shah
- Northwestern Feinberg School of Medicine and Associate Director of Research Ethics at the Stanley Manne Research Institute, Lurie Children’s Hospital
| | | | - Benjamin S. Wilfond
- University of Washington School of Medicine, Department of Pediatrics and the Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Neal W. Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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23
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Porter KM, Weiss EM, Kraft SA. Promoting Disclosure and Understanding in Informed Consent: Optimizing the Impact of the Common Rule "Key Information" Requirement. Am J Bioeth 2021; 21:70-72. [PMID: 33945415 PMCID: PMC8600969 DOI: 10.1080/15265161.2021.1906996] [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: 05/04/2023]
Affiliation(s)
| | - Elliott M Weiss
- Seattle Children's Research Institute
- University of Washington School of Medicine
| | - Stephanie A Kraft
- Seattle Children's Research Institute
- University of Washington School of Medicine
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24
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Bridges C, Duenas DM, Lewis H, Anderson K, Opel DJ, Wilfond BS, Kraft SA. Patient perspectives on how to demonstrate respect: Implications for clinicians and healthcare organizations. PLoS One 2021; 16:e0250999. [PMID: 33914815 PMCID: PMC8084197 DOI: 10.1371/journal.pone.0250999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Clinicians and healthcare organizations are ethically obligated to treat patients with respect, yet it is not clear what actions best demonstrate respect to patients. This exploratory qualitative study aimed to understand what actions on both an individual and organizational level effectively demonstrate respect for primary care patients. METHODS We conducted semi-structured telephone interviews with primary care patients in an integrated healthcare delivery system in Oregon and an integrated safety net health system in Colorado who were participating in a genomics implementation research study of a hereditary cancer screening program. We systematically coded interview transcripts using a coding framework developed based on iterative review of the interview guide and transcripts. We further analyzed the data coded with sub-codes relating to patients' experiences with respect in healthcare using a descriptive content analysis approach. RESULTS We interviewed 40 English-speaking (n = 30, 75%) and Spanish-speaking (n = 10, 25%) patients. Most interviewees identified as female (n = 35, 88%) and either Hispanic/Latino(a) (n = 17, 43%) or White or European American (n = 15, 38%). Interviewees identified two categories of efforts by individual clinicians that demonstrate respect: engaging with patients and being transparent. They identified five efforts by healthcare organizations: promoting safety and inclusivity, protecting patient privacy, communicating about scheduling, navigating financial barriers to care, and ensuring continuity of care. CONCLUSIONS Our findings suggest that patients' experiences of respect depend on efforts by individual clinicians as well as healthcare organizations. Our findings offer insight into how clinicians can build stronger partnerships with patients and how organizations can seek to promote access to care and patient safety and comfort. They also illustrate areas for future research and quality improvement to more effectively respect patients.
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Affiliation(s)
- Celina Bridges
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Hannah Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Katherine Anderson
- Denver Health Ambulatory Care Services, Denver, Colorado, United States of America
| | - Douglas J. Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
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25
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Rothwell E, Brassil D, Barton-Baxter M, Brownley KA, Dickert NW, Ford DE, Kraft SA, McCormick JB, Wilfond BS. Informed consent: Old and new challenges in the context of the COVID-19 pandemic. J Clin Transl Sci 2021; 5:e105. [PMID: 34192059 PMCID: PMC8193198 DOI: 10.1017/cts.2021.401] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/07/2021] [Accepted: 03/18/2021] [Indexed: 01/23/2023] Open
Abstract
In this paper, we address how the COVID-19 pandemic has impacted informed consent for clinical research through examining experiences within Clinical and Translation Science Award (CTSA) institutions. We begin with a brief overview of informed consent and the challenges that existed prior to COVID-19. Then, we discuss how informed consent processes were modified or changed to address the pandemic, consider what lessons were learned, and present research and policy steps to prepare for future research and public health crises. The experiences and challenges for CTSA institutions offer an important perspective for examining what we have learned about informed consent and determining the next steps for improving the consent process.
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Affiliation(s)
- Erin Rothwell
- Department of Ob/Gyn, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Marietta Barton-Baxter
- University of Kentucky Center for Clinical and Translational Science, Lexington, KY, USA
| | - Kimberly A. Brownley
- Department of Psychiatry, School of Medicine, NC Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neal W. Dickert
- Emory University School of Medicine, Department of Medicine, and Georgia Clinical and Translational Science Alliancet, Atlanta, GA, USA
| | - Daniel E. Ford
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer B. McCormick
- Department of Humanities, College of Medicine, Pennsylvania State University, and Penn State Clinical and Translational Science Institute, Hershey, PA, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute; Department of Pediatrics, University of Washington School of Medicine; Institute of Translational Health Sciences, Seattle, WA, USA
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26
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Kraft SA. Respecting Donor-Recipient Relationships in Research Decision-Making Commentary on: When Living Donor and Kidney Transplant Recipient Are Both Research Subjects. Am J Bioeth 2021; 21:112-114. [PMID: 33825630 DOI: 10.1080/15265161.2021.1891326] [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: 06/12/2023]
Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute
- University of Washington School of Medicine
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27
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Lee BM, Kraft SA. Fostering Relationships in Pediatric Oncology Research: A Relational Ethics Approach to Clinically Integrated Research. Am J Bioeth 2021; 21:85-88. [PMID: 33825652 DOI: 10.1080/15265161.2021.1891350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Brittany M Lee
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and University of Washington School of Medicine
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and University of Washington School of Medicine
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28
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Niyibizi NK, Speight CD, Gregor C, Ko YA, Kraft SA, Mitchell AR, Phillips BG, Porter KM, Shah SK, Sugarman J, Wilfond BS, Dickert NW. Public attitudes toward an authorization for contact program for clinical research. J Am Med Inform Assoc 2021; 28:354-359. [PMID: 33150424 PMCID: PMC7883977 DOI: 10.1093/jamia/ocaa214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/15/2020] [Revised: 07/30/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
We conducted an online experimental survey to evaluate attitudes toward an authorization for contact (AFC) program allowing researchers to contact patients about studies based on electronic record review. A total of 1070 participants were randomly assigned to 1 of 3 flyers varying in design and framing. Participants were asked to select concerns about and reasons for signing up for AFC. Logistic regression and latent class analysis were conducted. The most commonly selected concerns included needing more information (43%), privacy (40%), and needing more time to think (28%). A minority were not interested in participating in research (16%) and did not want to be bothered (15%). Latent class analysis identified clusters with specific concerns about privacy, lack of interest in research, and not wanting to be bothered. A novel flyer with simple and positive framing was associated with lower odds of both not wanting to be bothered (P = .01) and not being interested in research (P = .01). Many concerns about AFC programs appear nonspecific. Addressing privacy, lack of interest in research, and not wanting to be bothered warrant further study as ways to enhance recruitment.
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Affiliation(s)
- Nyiramugisha K Niyibizi
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Candace D Speight
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlie Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Stephanie A Kraft
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Andrea R Mitchell
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley G Phillips
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, Georgia, USA
- Biomedical and Health Sciences Institute, University of Georgia Office of Research, Athens, Georgia, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Seema K Shah
- Research Ethics, Stanley Manne Research Institute, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Benjamin S Wilfond
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Neal W Dickert
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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29
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Kraft SA, Porter KM, Duenas DM, Guerra C, Joseph G, Lee SSJ, Shipman KJ, Allen J, Eubanks D, Kauffman TL, Lindberg NM, Anderson K, Zepp JM, Gilmore MJ, Mittendorf KF, Shuster E, Muessig KR, Arnold B, Goddard KAB, Wilfond BS. Participant Reactions to a Literacy-Focused, Web-Based Informed Consent Approach for a Genomic Implementation Study. AJOB Empir Bioeth 2021; 12:1-11. [PMID: 32981477 PMCID: PMC7785634 DOI: 10.1080/23294515.2020.1823907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/15/2022]
Abstract
BACKGROUND Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, California, USA
| | - Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, California, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jake Allen
- IT (Information Technology) Department, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Donna Eubanks
- IT (Information Technology) Department, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Nangel M Lindberg
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | | | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Elizabeth Shuster
- Research Data and Analysis Center, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Briana Arnold
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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30
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Riddle L, Amendola LM, Gilmore MJ, Rolf B, Zepp J, Guerra C, Biesecker B, Caruncho M, Anderson KP, Rope AF, Kauffman TL, Lewis H, Kraft SA, Duenas DM, Wilfond B, Goddard KA, Joseph G. Abstract PO-050: Reducing disparities in genomic medicine using a literacy-focused genetic counseling model for cancer risk assessment. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-050] [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: 11/16/2022] Open
Abstract
Abstract
Genetic and genomic testing is reaching more people than ever, yet disparities in access to and application of hereditary cancer screening remain. Further, with the advent of lower cost sequencing, the amount and complexity of information that is conveyed to patients, including secondary results, has increased. As part of the Clinical Sequencing Evidence-Generating Research (CSER) consortium, the Cancer Health Assessments Reaching Many (CHARM) study implemented a hereditary cancer risk assessment program for healthy adults aged 18-49. Participants were recruited in English and Spanish from two primary care settings (Kaiser Permanente Northwest and Denver Health). Participants underwent clinical exome sequencing and were randomized to receive their test results via usual care or a “literacy-focused” genetic counseling approach (n=845). Genetic counselors in the literacy- focused arm received in-depth training to adapt and apply evidence-based methods for effective communication with individuals of all literacy levels. We hypothesized that the literacy-focused approach would be non-inferior to usual care genetic counseling and generate higher satisfaction, engagement, and understanding of and adherence to recommended care. We also collected qualitative data to explore the experience of receiving exome sequencing results in this setting. Here, we present findings from qualitative interviews with participants conducted within a month (n=35) and again at 6 months (n=15) after receiving results, including: pathogenic cancer risk variants, medically actionable secondary findings and carrier results; variants of uncertain significant (VUS) in cancer genes; and negative results. The mean age of participants was 33. 72% spoke English and 75% were considered medically underserved by CHARM criteria. Participants in both trial arms expressed overall satisfaction; however, some participants in the literacy-focused arm indicated that specific elements of the approach, such as teach-back and plain language, helped facilitate their understanding, while some in the usual care arm said the information was overly technical. Younger participants in both arms, whose sequencing results will not be clinically actionable for many years, reported less worry and recalled fewer details about their results than older participants. While participants recognized the utility of positive results for family, at six months only some had spoken with them about testing, and few relatives had undergone cascade testing offered by CHARM. Genomic medicine requires clear communication of disease risk and prevention recommendations. Our qualitative findings suggest that the literacy-focused approach to genetic counseling can help facilitate patient understanding of cancer and other genomic risk. These results can guide effective disclosure of sequencing results and have implications for training clinical genetics professionals in the provision of equitable care for diverse patients.
Citation Format: Leslie Riddle, Laura M. Amendola, Marian J. Gilmore, Brad Rolf, Jamilyn Zepp, Claudia Guerra, Barbara Biesecker, Mikaella Caruncho, Katherine P. Anderson, Alan F. Rope, Tia L. Kauffman, Hannah Lewis, Stephanie A. Kraft, Devan M. Duenas, Benjamin Wilfond, Katrina A.B. Goddard, Galen Joseph. Reducing disparities in genomic medicine using a literacy-focused genetic counseling model for cancer risk assessment [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-050.
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Affiliation(s)
- Leslie Riddle
- 1University of California, San Francisco, San Francisco, CA,
| | | | | | - Brad Rolf
- 2University of Washington, Seattle, WA,
| | - Jamilyn Zepp
- 3Kaiser Permanente Center for Health Research, Portland, OR,
| | - Claudia Guerra
- 1University of California, San Francisco, San Francisco, CA,
| | | | | | | | | | - Tia L. Kauffman
- 3Kaiser Permanente Center for Health Research, Portland, OR,
| | - Hannah Lewis
- 7Seattle Children's Research Institute, Seattle, WA
| | | | | | | | | | - Galen Joseph
- 1University of California, San Francisco, San Francisco, CA,
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Kraft SA. Respect and Trustworthiness in the Patient-Provider-Machine Relationship: Applying a Relational Lens to Machine Learning Healthcare Applications. Am J Bioeth 2020; 20:51-53. [PMID: 33103984 PMCID: PMC7647419 DOI: 10.1080/15265161.2020.1820108] [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: 06/11/2023]
Affiliation(s)
- Stephanie A Kraft
- Seattle Children's Research Institute
- University of Washington School of Medicine
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Kraft SA, Rothwell E, Shah SK, Duenas DM, Lewis H, Muessig K, Opel DJ, Goddard KAB, Wilfond BS. Demonstrating 'respect for persons' in clinical research: findings from qualitative interviews with diverse genomics research participants. J Med Ethics 2020; 47:medethics-2020-106440. [PMID: 33023975 PMCID: PMC8021602 DOI: 10.1136/medethics-2020-106440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 05/11/2023]
Abstract
The ethical principle of 'respect for persons' in clinical research has traditionally focused on protecting individuals' autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals' rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English (n=30) or Spanish (n=10) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female (93%), identified as Hispanic/Latino(a) (43%) or non-Hispanic white (38%), reported annual household income under US$60 000 (70%) and did not have a Bachelor's degree (65%); 30% had limited health literacy. We identified four key domains for demonstrating respect: (1) personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; (2) study communication processes, including following up and sharing results with participants; (3) inclusion, particularly ensuring materials are understandable and procedures are accessible; and (4) consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin Rothwell
- Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Seema K Shah
- Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Hannah Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kristin Muessig
- Translational and Applied Genomics, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Katrina A B Goddard
- Translational and Applied Genomics, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Feigelson HS, Mittendorf KF, Kauffman TL, Anderson K, Okuyama S, Wilfond B, Jarvik GP, Amendola LM, McMullen C, Lynch F, Eubanks D, Shuster E, Allen J, Kraft SA, Joseph G, Lee SSJ, Goddard KA. Abstract PR02: Using web-based tools to assess familial cancer risk in diverse populations. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.modpop19-pr02] [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: 11/16/2022] Open
Abstract
Abstract
Introduction: The Cancer Health Risk Assessments Reaching Many (CHARM) study (NCT03426878) aims to increase access to genetic testing for hereditary cancer in low-income, low-literacy, and minority populations (hereafter referred to as “underserved”). To implement the study, we have capitalized on the availability of electronic medical record (EMR) systems, developed innovative web-based tools, and designed a novel telemedicine protocol for return of clinical genetic testing results.
Methods: Patients aged 18-49 years are recruited from two centers: Kaiser Permanente Northwest (KPNW; an integrated health care system in Portland, OR) and Denver Health (DH; a federally qualified health care center in Denver, CO). Specific protocols were developed to identify potentially eligible patients from the EMR and invite them to complete a web-based family history assessment. KPNW patients were recruited using email, text messaging, and in-clinic booths; DH patients were recruited via mail, phone, and provider referral. Validated risk assessment tools for Lynch syndrome (PREMM5) and heredity breast and ovarian cancer syndrome (B-RST) were adapted for our low-literacy and bilingual (English and Spanish) target population. Genetic testing is offered to patients with greater than average risk for hereditary cancer, or where risk cannot be assessed because of unknown family history or limited family structure. Eligible patients review a multipart, multimedia online consent. Those who consent to participate provide a saliva sample for clinical exome sequencing. Genetic counselors return results by telephone using traditional (usual care active comparator) or modified, communication-focused (experimental) counseling for pathogenic variants, likely pathogenic variants, and select variants of uncertain significance in 39 genes related to cancer risk, pathogenic variants in 79 genes related to medically actionable secondary findings, and 14 genes related to carrier status.
Results: In the first four months of recruitment, 258 patients have completed the risk assessment tool (48% are underserved). Of those, 180 (70%) had greater than average risk of hereditary cancer (or limited family history information) and were invited to participate (53% were underserved); 86% of underserved patients and 78% of patients who do not meet criteria for the underserved category have consented. The vast majority of participants complete enrollment without assistance from study staff, and in-person visits are not required for participation. Telephone genetic test result disclosure will begin in December 2018.
Conclusions: We have successfully developed online tools for cancer risk assessment that are accessible to underserved and low-literacy populations. These tools may be a cost-effective approach for improving the capture of family history data in the EMR. It does not require a provider to gather the information and the patient gets immediate feedback on results of the risk assessment and appropriate next steps.
This abstract is also being presented as Poster A37.
Citation Format: Heather Spencer Feigelson, Kathleen F. Mittendorf, Tia L. Kauffman, Katherine Anderson, Sonia Okuyama, Benjamin Wilfond, Gail P. Jarvik, Laura M. Amendola, Carmit McMullen, Fances Lynch, Donna Eubanks, Elizabeth Shuster, Jake Allen, Stephanie A. Kraft, Galen Joseph, Sandra Soo-Jin Lee, Katrina A.B. Goddard. Using web-based tools to assess familial cancer risk in diverse populations [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr PR02.
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Affiliation(s)
| | | | - Tia L. Kauffman
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | | | | | | | | | | | - Carmit McMullen
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | - Fances Lynch
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | - Donna Eubanks
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | | | - Jake Allen
- 2Kaiser Permanente Center for Health Research, Portland, OR,
| | | | - Galen Joseph
- 6University of California, San Francisco, San Francisco, CA,
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Kraft SA, Porter KM, Duenas DM, Sullivan E, Rowland M, Saelens BE, Wilfond BS, Shah SK. Assessing Parent Decisions About Child Participation in a Behavioral Health Intervention Study and Utility of Informed Consent Forms. JAMA Netw Open 2020; 3:e209296. [PMID: 32735337 PMCID: PMC7395235 DOI: 10.1001/jamanetworkopen.2020.9296] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Obtaining informed consent is an important ethical obligation for clinical research participation that is imperfectly implemented. Research on improving consent processes often focuses on consent forms, but little is known about consent forms' influence on decision-making compared with other types of engagement. OBJECTIVE To evaluate whether parents decide whether to enroll their children in research before or after they receive the consent form. DESIGN, SETTING, AND PARTICIPANTS An online survey of 88 parents who enrolled or declined to enroll their child in a weight management intervention study between January 2, 2018, and June 24, 2019, was conducted; surveys were completed between February 2, 2018, and July 9, 2019. A 31-item survey asked about impressions of the study throughout the enrollment process, timing of enrollment decisions, and decision-making factors. Responses were summarized descriptively and subgroups were compared using the Fisher exact test or χ2 test. MAIN OUTCOMES AND MEASURES Self-reported timing of enrollment decision. RESULTS A total of 106 parents were approached and gave permission for their contact information to be shared with the study team; 22 additional parents declined to allow their information to be shared, and 24 lost contact with the partner study before they could be asked for permission. A total of 88 parents (67 enrollees, 21 decliners) completed the survey (83% participation rate); 79 of 88 reporting gender (instead of sex, as biological sex was not relevant to survey) information were women (91%), 66 participants (75%) were non-Hispanic White, and 63 participants (72%) had annual household incomes greater than or equal to $70 000. No significant differences in respondent characteristics between enrollees and decliners were identified. Fifty-nine parents (67%) responded that they decided whether to enroll in the weight management study before receiving the consent form. Only 17 of 69 parents (25%) who remembered receiving the consent form responded that it taught them new information. CONCLUSIONS AND RELEVANCE The findings of this study suggest that interventions to improve informed consent forms may have limited influence on decision-making because many research decisions occur before review of the consent form. It appears that regulatory review and interventions to improve decision-making should focus more on early engagement (eg, recruitment materials). Future studies should test timing of decisions in other types of research with different populations and clinical settings.
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Affiliation(s)
- Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
- University of Washington School of Medicine, Department of Pediatrics, Seattle
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
| | - Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
| | - Erin Sullivan
- Seattle Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington
| | - Maya Rowland
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Brian E. Saelens
- University of Washington School of Medicine, Department of Pediatrics, Seattle
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
- University of Washington School of Medicine, Department of Pediatrics, Seattle
| | - Seema K. Shah
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center; Stanley Manne Children’s Research Institute; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Kraft SA, Duenas DM, Lewis H, Shah SK. Bridging the Researcher-Participant Gap: A Research Agenda to Build Effective Research Relationships. Am J Bioeth 2020; 20:31-33. [PMID: 32364474 PMCID: PMC7241299 DOI: 10.1080/15265161.2020.1745936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Stephanie A Kraft
- Seattle Children's Hospital and Research Institute
- University of Washington School of Medicine
| | | | - Hannah Lewis
- Seattle Children's Hospital and Research Institute
| | - Seema K Shah
- Ann and Robert H. Lurie Children's Hospital of Chicago
- Northwestern University Feinberg School of Medicine
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Kraft SA, McMullen C, Lindberg NM, Bui D, Shipman K, Anderson K, Joseph G, Duenas DM, Porter KM, Kauffman TL, Koomas A, Ransom CL, Jackson P, Goddard KAB, Wilfond BS, Lee SSJ. Integrating stakeholder feedback in translational genomics research: an ethnographic analysis of a study protocol's evolution. Genet Med 2020; 22:1094-1101. [PMID: 32089547 PMCID: PMC7275883 DOI: 10.1038/s41436-020-0763-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study describes challenges faced while incorporating sometimes conflicting stakeholder feedback into study design and development of patient-facing materials for a translational genomics study aiming to reduce health disparities among diverse populations. METHODS We conducted an ethnographic analysis of study documents including summaries of patient advisory committee meetings and interviews, reflective field notes written by study team members, and correspondence with our institutional review board (IRB). Through this analysis, we identified cross-cutting challenges for incorporating stakeholder feedback into development of our recruitment, risk assessment, and informed consent processes and materials. RESULTS Our analysis revealed three key challenges: (1) balancing precision and simplicity in the design of study materials, (2) providing clinical care within the research context, and (3) emphasizing potential study benefits versus risks and limitations. CONCLUSIONS While involving patient stakeholders in study design and materials development can increase inclusivity and responsiveness to patient needs, patient feedback may conflict with that of content area experts on the research team and IRBs who are tasked with overseeing the research. Our analysis highlights the need for further empirical research about ethical challenges when incorporating patient feedback into study design, and for dialogue with genomic researchers and IRB representatives about these issues.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - David Bui
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kelly Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | | | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Alyssa Koomas
- Alliance for a Healthier Generation, Portland, OR, USA
| | - Chelese L Ransom
- CHARM English-Speaking Patient Advisory Committee, Denver, CO, USA
| | - Paige Jackson
- CHARM English-Speaking Patient Advisory Committee, Denver, CO, USA
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sandra Soo-Jin Lee
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Abstract
The American Academy of Neurology believes that doctors have the right to do tests to evaluate whether a patient is brain dead even if the family does not consent. They argue that physicians have "both the moral authority and professional responsibility" to do such evaluations, just as they have the authority and responsibility to declare someone dead by circulatory criteria. Not everyone agrees. Truog and Tasker argue that apnea testing to confirm brain death has risks and that, for some families, those risks may outweigh the benefits. So, what should doctors do when caring for a patient whom they believe to be brain dead but whose parents refuse to allow testing to confirm that the patient meets neurologic criteria for death? In this article, we analyze the issues that arise when parents refuse such testing.
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Affiliation(s)
- Brittany M Lee
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;
| | - Amy Trowbridge
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington; and.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | | | - Aaron Wightman
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington; and.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Stephanie A Kraft
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington; and.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Jonna D Clark
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington; and.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
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Kraft SA, Garrison NA, Wilfond BS. Understanding as an Ethical Aspiration in an Era of Digital Technology-Based Communication: An Analysis of Informed Consent Functions. Am J Bioeth 2019; 19:34-36. [PMID: 31090520 PMCID: PMC6885411 DOI: 10.1080/15265161.2019.1587035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephanie A Kraft
- a University of Washington School of Medicine and Seattle Children's Hospital and Research Institute
| | - Nanibaa' A Garrison
- a University of Washington School of Medicine and Seattle Children's Hospital and Research Institute
| | - Benjamin S Wilfond
- a University of Washington School of Medicine and Seattle Children's Hospital and Research Institute
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Kraft SA, Garrison NA. An Ethical Case for Dual-Role Consent: Increasing Research Diversity as a Matter of Respect and Justice. Am J Bioeth 2019; 19:44-46. [PMID: 31544678 DOI: 10.1080/15265161.2019.1572816] [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]
Affiliation(s)
- Stephanie A Kraft
- University of Washington School of Medicine and Seattle Children's Hospital and Research Institute
| | - Nanibaa' A Garrison
- University of Washington School of Medicine and Seattle Children's Hospital and Research Institute
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Kraft SA, Duenas DM, Kublin JG, Shipman KJ, Murphy SC, Shah SK. Exploring Ethical Concerns About Human Challenge Studies: A Qualitative Study of Controlled Human Malaria Infection Study Participants' Motivations and Attitudes. J Empir Res Hum Res Ethics 2018; 14:49-60. [PMID: 30585505 DOI: 10.1177/1556264618820219] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 01/25/2023]
Abstract
Controlled human malaria infection (CHMI) studies deliberately infect healthy participants with malaria to test interventions faster and more efficiently. Some argue the study design and high payments offered raise ethical concerns about participants' understanding of risks and undue inducement. We conducted baseline and exit interviews with 16 CHMI study participants to explore these concerns. Participants described themes including decision-making tension with friends and family, mixed motivations for participating, low study risks but high burdens, fair compensation, sacrificing values, deceiving researchers, and perceived benefits. Our findings do not support concerns that high payments limit understanding of study risks, but suggest participants may lack appreciation of study burdens, withhold information or engage in deception, and experience conflict with others regarding study participation.
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Affiliation(s)
- Stephanie A Kraft
- 1 Seattle Children's Research Institute, WA, USA.,2 University of Washington School of Medicine, Seattle, USA
| | | | - James G Kublin
- 3 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kelly J Shipman
- 1 Seattle Children's Research Institute, WA, USA.,3 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Seema K Shah
- 5 Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,6 Stanley Manne Children's Research Institute, Chicago, IL, USA.,7 Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
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Kraft SA, Duenas D, Wilfond BS, Goddard KAB. The evolving landscape of expanded carrier screening: challenges and opportunities. Genet Med 2018; 21:790-797. [PMID: 30245516 PMCID: PMC6752283 DOI: 10.1038/s41436-018-0273-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
Carrier screening allows individuals to learn their chance of passing on an autosomal or X-linked condition to their offspring. Initially introduced as single-disease, ancestry-based screening, technological advances now allow for the possibility of multi-disease, pan-ethnic carrier screening, which we refer to as “expanded carrier screening.” There are numerous potential benefits to expanded carrier screening, including maximizing the opportunity for couples to make autonomous reproductive decisions, and efficiency and marginal additional costs of including more conditions if the test is already being offered. While numerous laboratories currently offer expanded carrier screening services, it is not yet commonly used in clinical practice, and there is a lack of consensus among experts about the service, including whether this should be offered to individuals and couples, whether this should be offered preconception or prenatally, and what conditions to include in screening programs. Challenges for expanded carrier screening programs include a lack of demand from the public, low prioritization by health systems, the potential for pressure to undergo screening, the possibility of disability-based discrimination, needed adaptations to pre- and post-test counseling, technical limitations, and the evolving technological and socio-political landscape.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Devan Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Lee SSJ, Cho MK, Kraft SA, Varsava N, Gillespie K, Ormond KE, Wilfond BS, Magnus D. "I don't want to be Henrietta Lacks": diverse patient perspectives on donating biospecimens for precision medicine research. Genet Med 2018; 21:107-113. [PMID: 29887604 PMCID: PMC6289900 DOI: 10.1038/s41436-018-0032-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/21/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine whether patients distinguish between biospecimens and electronic health records (EHRs) when considering research participation to inform research protections. Methods We conducted 20 focus groups with individuals who identified as African American, Hispanic, Chinese, South Asian and non-Hispanic White on the collection of biospecimens and EHR data for research. Results Our study found that many participants did not distinguish between biospecimens and EHR data. However, some participants identified specific concerns about biospecimens. These included the need for special care and respect for biospecimens due to enduring connections between the body and identity; the potential for unacceptable future research, specifically the prospect of human cloning; heightened privacy risks; and the potential for unjust corporate profiteering. Among those who distinguished biospecimens from EHR data, many supported separate consent processes and would limit their own participation to EHR data. Conclusion Considering that the potential misuse of EHR data is as great, if not greater than for biospecimens, more research is needed to understand how attitudes differ between biospecimens and EHR data across diverse populations. Such research should explore mechanisms beyond consent that can address diverse values, perspectives and misconceptions about sources of patient information to build trust in research relationships.
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Affiliation(s)
- Sandra S-J Lee
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Nina Varsava
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Katie Gillespie
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Kelly E Ormond
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
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43
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Kraft SA, Cho MK, Gillespie K, Varsava N, Ormond KE, Wilfond BS, Lee SSJ. Trustworthiness in Untrustworthy Times: Response to Open Peer Commentaries on Beyond Consent. Am J Bioeth 2018; 18:W6-W8. [PMID: 29697352 DOI: 10.1080/15265161.2018.1461953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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44
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Wilfond BS, Kauffman TL, Jarvik GP, Reiss JA, Richards CS, McMullen C, Gilmore M, Himes P, Kraft SA, Porter KM, Schneider JL, Punj S, Leo MC, Dickerson JF, Lynch FL, Clarke E, Rope AF, Lutz K, Goddard KAB. Lessons Learned From A Study Of Genomics-Based Carrier Screening For Reproductive Decision Making. Health Aff (Millwood) 2018; 37:809-816. [PMID: 29733724 DOI: 10.1377/hlthaff.2017.1578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/28/2022]
Abstract
Genomics-based carrier screening is one of many opportunities to use genomic information to inform medical decision making, but clinicians, health care delivery systems, and payers need to determine whether to offer screening and how to do so in an efficient, ethical way. To shed light on this issue, we conducted a study in the period 2014-17 to inform the design of clinical screening programs and guide further health services research. Many of our results have been published elsewhere; this article summarizes the lessons we learned from that study and offers policy insights. Our experience can inform understanding of the potential impact of expanded carrier screening services on health system workflows and workforces-impacts that depend on the details of the screening approach. We found limited patient or health system harms from expanded screening. We also found that some patients valued the information they learned from the process. Future policy discussions should consider the value of offering such expanded carrier screening in health delivery systems with limited resources.
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Affiliation(s)
- Benjamin S Wilfond
- Benjamin S. Wilfond ( ) is director of the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and of the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, all in Seattle, Washington
| | - Tia L Kauffman
- Tia L. Kauffman is a project director at the Center for Health Research, Kaiser Permanente Northwest, in Portland, Oregon
| | - Gail P Jarvik
- Gail P. Jarvik is a professor in the Division of Medical Genetics, Department of Medicine, and in the Department of Genome Sciences, both at the University of Washington
| | - Jacob A Reiss
- Jacob A. Reiss is a medical geneticist at the Center for Health Research, Kaiser Permanente Northwest
| | - C Sue Richards
- C. Sue Richards is a professor in the Knight Diagnostic Laboratories, Oregon Health & Science University, in Portland
| | - Carmit McMullen
- Carmit McMullen is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Marian Gilmore
- Marian Gilmore is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Patricia Himes
- Patricia Himes is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Stephanie A Kraft
- Stephanie A. Kraft is an acting assistant professor in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and in the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine
| | - Kathryn M Porter
- Kathryn M. Porter is a research scientist in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute
| | - Jennifer L Schneider
- Jennifer L. Schneider is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Sumit Punj
- Sumit Punj is a senior clinical scientist in the Clinical Genomics Program, GeneDx, in Gaithersburg, Maryland
| | - Michael C Leo
- Michael C. Leo is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - John F Dickerson
- John F. Dickerson is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Frances L Lynch
- Frances L. Lynch is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Elizabeth Clarke
- Elizabeth Clarke is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Alan F Rope
- Alan F. Rope is a staff physician at Northwest Permanente, Kaiser Permanente Northwest
| | - Kevin Lutz
- Kevin Lutz is publications manager at the Center for Health Research, Kaiser Permanente Northwest
| | - Katrina A B Goddard
- Katrina A. B. Goddard is associate director, research programs, at the Center for Health Research, Kaiser Permanente Northwest
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45
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Kraft SA, Cho MK, Gillespie K, Halley M, Varsava N, Ormond KE, Luft HS, Wilfond BS, Soo-Jin Lee S. Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research. Am J Bioeth 2018; 18:3-20. [PMID: 29621457 PMCID: PMC6173191 DOI: 10.1080/15265161.2018.1431322] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [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: 05/20/2023]
Abstract
With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: (1) Address the role of history and experience on trust, (2) engage concerns about potential group harm, (3) address cultural values and communication barriers, and (4) integrate patient values and expectations into oversight and governance structures.
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46
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Kraft SA, Schneider JL, Leo MC, Kauffman TL, Davis JV, Porter KM, McMullen CK, Wilfond BS, Goddard KAB. Patient actions and reactions after receiving negative results from expanded carrier screening. Clin Genet 2018; 93:962-971. [PMID: 29293279 DOI: 10.1111/cge.13206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/01/2017] [Revised: 12/05/2017] [Accepted: 12/27/2017] [Indexed: 02/04/2023]
Abstract
With the expansion of carrier screening to general preconception and prenatal patient populations, most patients will receive negative results, which we define as indicating <25% risk of having a child with a genetic condition. Because there is limited experience with expanded carrier screening, it is important to understand how receiving negative results affects patients, especially as providers, payers, and policymakers consider whether to offer it. In this mixed-methods study, we asked preconception patients enrolled in the NextGen study about their expectations and experiences receiving negative expanded carrier screening results. Participants completed surveys at study enrollment (n = 110 women, 51 male partners), after receiving carrier results (n = 100 women, 38 male partners), after receiving secondary findings (n = 98 women, 36 male partners), and 6 months after receiving results (n = 95 women, 28 male partners). We also interviewed a subset of participants 12 to 24 months after receiving results (n = 24 women, 12 male partners). We found minimal negative emotional impact and privacy concerns, increased confidence in reproductive plans, and few changes to health behaviors, although some patients made health decisions based on misunderstandings of their results. These findings suggest that expanded carrier screening causes minimal psychosocial harms, but systems are needed to reduce the risk of misinterpreting results.
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Affiliation(s)
- S A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - J L Schneider
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - M C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - T L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - J V Davis
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - K M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington
| | - C K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - B S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - K A B Goddard
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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47
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Abstract
The lack of diversity of populations included in genomics databases is an important inhibitor of genomic discovery from bench to bedside. One way to increase the diversity of participants is to ensure that informed consent processes are designed for cultural and linguistic concordance for non-majority populations. This article describes two case studies of genomics research studies that are using novel approaches to informed consent to increase recruitment and retention of participants from traditionally underrepresented populations: The Cancer Health Assessments Reaching Many (CHARM) study, part of the Clinical Sequencing Evidence-Generating Research (CSER) consortium, and the All of Us Research Program, part of the Precision Medicine Initiative. We conclude by proposing a community of practice among researchers seeking to improve informed consent to increase diversity in genomics research.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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48
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Cho MK, Varsava N, Kraft SA, Ashwal G, Gillespie K, Magnus D, Ormond KE, Thomas A, Wilfond BS, Lee SSJ. Metaphors matter: from biobank to a library of medical information. Genet Med 2017; 20:802-805. [PMID: 29267267 DOI: 10.1038/gim.2017.204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.
| | - Nina Varsava
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
| | - Gary Ashwal
- Booster Shot Media, Santa Monica, California, USA
| | - Katie Gillespie
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly E Ormond
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.,Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Alex Thomas
- Booster Shot Media, Santa Monica, California, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
| | - Sandra S-J Lee
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
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49
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Kraft SA, McMullen CK, Porter KM, Kauffman TL, Davis JV, Schneider JL, Goddard KAB, Wilfond BS. Patient perspectives on the use of categories of conditions for decision making about genomic carrier screening results. Am J Med Genet A 2017; 176:376-385. [DOI: 10.1002/ajmg.a.38583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/05/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie A. Kraft
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
- Division of BioethicsDepartment of PediatricsUniversity of Washington School of MedicineSeattleWashington
| | | | - Kathryn M. Porter
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
| | - Tia L. Kauffman
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregon
| | - James V. Davis
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregon
| | | | | | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
- Division of BioethicsDepartment of PediatricsUniversity of Washington School of MedicineSeattleWashington
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50
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Wilfond BS, Kraft SA. Attending to the Interrelatedness of the Functions of Consent. Am J Bioeth 2017; 17:12-13. [PMID: 29148942 PMCID: PMC6095135 DOI: 10.1080/15265161.2017.1388881] [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: 06/07/2023]
Affiliation(s)
- Benjamin S Wilfond
- a Seattle Children's Hospital and Research Institute and University of Washington School of Medicine
| | - Stephanie A Kraft
- a Seattle Children's Hospital and Research Institute and University of Washington School of Medicine
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