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Ryan KA, De Vries RG, Uhlmann WR, Roberts JS, Gornick MC. Public's Views toward Return of Secondary Results in Genomic Sequencing: It's (Almost) All about the Choice. J Genet Couns 2017; 26:1197-212. [PMID: 28357777 DOI: 10.1007/s10897-017-0095-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/13/2017] [Indexed: 12/15/2022]
Abstract
The therapeutic use of genomic sequencing creates novel and unresolved questions about cost, clinical efficacy, access, and the disclosure of sequencing results. The disclosure of the secondary results of sequencing poses a particularly challenging ethical problem. Experts disagree about which results should be shared and public input - especially important for the creation of disclosure policies - is complicated by the complex nature of genetics. Recognizing the value of deliberative democratic methods for soliciting informed public opinion on matters like these, we recruited participants from a clinical research site for an all-day deliberative democracy (DD) session. Participants were introduced to the clinical and ethical issues associated with genomic sequencing, after which they discussed the tradeoffs and offered their opinions about policies for the return of secondary results. Participants (n = 66; mean age = 57 (SD = 15); 70% female; 76% white) were divided into 10 small groups (5 to 8 participants each) allowing interactive deliberation on policy options for the return of three categories of secondary results: 1) medically actionable results; 2) risks for adult-onset disorders identified in children; and 3) carrier status for autosomal recessive disorders. In our qualitative analysis of the session transcripts, we found that while participants favored choice and had a preference for making information available, they also acknowledged the risks (and benefits) of learning such information. Our research reveals the nuanced reasoning used by members of the public when weighing the pros and cons of receiving genomic information, enriching our understanding of the findings of surveys of attitudes regarding access to secondary results.
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Walter SD, Turner RM, Macaskill P, McCaffery KJ, Irwig L. Estimation of treatment preference effects in clinical trials when some participants are indifferent to treatment choice. BMC Med Res Methodol 2017; 17:29. [PMID: 28219326 PMCID: PMC5319089 DOI: 10.1186/s12874-017-0304-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/02/2017] [Indexed: 11/19/2022] Open
Abstract
Background In the two-stage randomised trial design, a randomly sampled subset of study participants are permitted to choose their own treatment, while the remaining participants are randomised to treatment in the usual way. Appropriate analysis of the data from both arms of the study allows investigators to estimate the impact on study outcomes of treatment preferences that patients may have, in addition to evaluating the usual direct effect of treatment. In earlier work, we showed how to optimise this design by making a suitable choice of the proportion of participants who should be assigned to the choice arm of the trial. However, we ignored the possibility of some participants being indifferent to the treatments under study. In this paper, we extend our earlier work to consider the analysis of two-stage randomised trials when some participants have no treatment preference, even if they are assigned to the choice arm and allowed to choose. Methods We compare alternative characterisations of the response profiles of the indifferent or undecided participants, and derive estimates of the treatment and preference effects on study outcomes. We also present corresponding test statistics for these parameters. The methods are illustrated with data from a clinical trial contrasting medical and surgical interventions. Results Expressions are obtained to estimate and test the impact of treatment choices on study outcomes, as well as the impact of the actual treatment received. Contrasts are defined between patients with stated treatment preferences and those with no preference. Alternative assumptions concerning the outcomes of undecided participants are described, and an approach leading to unbiased estimation and testing is identified. Conclusions Use of the two-stage design can provide important insights into determinants of study outcomes that are not identifiable with other designs. The design can remain attractive even in the presence of participants with no stated treatment preference. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0304-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL 233, Hamilton, ON, Canada, L8N 3Z5.
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney,, NSW 2052, Australia
| | - Petra Macaskill
- Screening and Test Evaluation Program, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Kirsten J McCaffery
- Screening and Test Evaluation Program, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Les Irwig
- Screening and Test Evaluation Program, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
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Gornick MC, Scherer AM, Sutton EJ, Ryan KA, Exe NL, Li M, Uhlmann WR, Kim SYH, Roberts JS, De Vries RG. Effect of Public Deliberation on Attitudes toward Return of Secondary Results in Genomic Sequencing. J Genet Couns 2016; 26:122-132. [PMID: 27307100 DOI: 10.1007/s10897-016-9987-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/02/2016] [Indexed: 01/16/2023]
Abstract
The increased use of genomic sequencing in clinical diagnostics and therapeutics makes imperative the development of guidelines and policies about how to handle secondary findings. For reasons both practical and ethical, the creation of these guidelines must take into consideration the informed opinions of the lay public. As part of a larger Clinical Sequencing Exploratory Research (CSER) consortium project, we organized a deliberative democracy (DD) session that engaged 66 participants in dialogue about the benefits and risks associated with the return of secondary findings from clinical genomic sequencing. Participants were educated about the scientific and ethical aspects of the disclosure of secondary findings by experts in medical genetics and bioethics, and then engaged in facilitated discussion of policy options for the disclosure of three types of secondary findings: 1) medically actionable results; 2) adult onset disorders found in children; and 3) carrier status. Participants' opinions were collected via surveys administered one month before, immediately following, and one month after the DD session. Post DD session, participants were significantly more willing to support policies that do not allow access to secondary findings related to adult onset conditions in children (Χ 2 (2, N = 62) = 13.300, p = 0.001) or carrier status (Χ 2 (2, N = 60) = 11.375, p = 0.003). After one month, the level of support for the policy denying access to secondary findings regarding adult-onset conditions remained significantly higher than the pre-DD level, although less than immediately post-DD (Χ 2 (1, N = 60) = 2.465, p = 0.041). Our findings suggest that education and deliberation enhance public appreciation of the scientific and ethical complexities of genome sequencing.
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Affiliation(s)
- Michele C Gornick
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA. .,Ann Arbor Veterans Affairs Health Services Research & Development, Ann Arbor, MI, USA.
| | - Aaron M Scherer
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA
| | - Erica J Sutton
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA
| | - Nicole L Exe
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA
| | - Ming Li
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Wendy R Uhlmann
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA.,Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA.,Molecular Medicine & Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott Y H Kim
- Department of Bioethics, National Institutes of Health, Bethesda, MA, USA
| | - J Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA.,Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Raymond G De Vries
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA.,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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Brown KM, Drake BF, Gehlert S, Wolf LE, DuBois J, Seo J, Woodward K, Perkins H, Goodman MS, Kaphingst KA. Differences in preferences for models of consent for biobanks between Black and White women. J Community Genet 2016; 7:41-9. [PMID: 26304495 PMCID: PMC4715814 DOI: 10.1007/s12687-015-0248-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/03/2015] [Accepted: 07/23/2015] [Indexed: 12/20/2022] Open
Abstract
Biobanks are essential resources, and participation by individuals from diverse groups is needed. Various models of consent have been proposed for secondary research use of biospecimens, differing in level of donor control and information received. Data are needed regarding participant preferences for models of consent, particularly among minorities. We conducted qualitative semi-structured interviews with 60 women to examine their attitudes about different models of consent. Recruitment was stratified by race (Black/White) and prior biobank participation (yes/no). Two coders independently coded interview transcripts. Qualitative thematic analysis was conducted using NVivo 10. The majority of Black and White participants preferred "broad" consent (i.e., blanket permission for secondary research use of biospecimens), and the second most preferred model for both groups was "study-specific" consent (i.e., consent for each future research study). The qualitative analysis showed that participants selected their most preferred model for 3 major reasons: having enough information, having control over their sample, and being asked for permission. Least preferred was notice model (i.e., participants notified that biospecimens may be used in future research). Attitudes toward models of consent differed somewhat by race and prior biobank participation. Participants preferred models of consent for secondary research use of biospecimens that provided them with both specific and general information, control over their biospecimens, and asked them to give permission for use. Our findings suggest that it will be important for researchers to provide information about future uses of biospecimens to the extent possible and have an explicit permission step for secondary research use.
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Affiliation(s)
- Katherine M Brown
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
| | - Bettina F Drake
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Sarah Gehlert
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Leslie E Wolf
- Georgia State University College of Law, Center for Law Health and Society, 85 Park Place NE, Atlanta, GA, 30303, USA
| | - James DuBois
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joann Seo
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Krista Woodward
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Hannah Perkins
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Department of Surgery, Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, 255 Central Campus Dr., Salt Lake, UT, 84112-0491, USA
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake, UT, 84112, USA
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