Patient consent preferences on sharing personal health information during the COVID-19 pandemic: "the more informed we are, the more likely we are to help"

Background

Rapid ethical access to personal health information (PHI) to support research is extremely important during pandemics, yet little is known regarding patient preferences for consent during such crises. This follow-up study sought to ascertain whether there were differences in consent preferences between pre-pandemic times compared to during Wave 1 of the COVID-19 global pandemic, and to better understand the reasons behind these preferences.

Methods

A total of 183 patients in the pandemic cohort completed the survey via email, and responses were compared to the distinct pre-pandemic cohort (n = 222); all were patients of a large Canadian cancer center. The survey covered (a) broad versus study-specific consent; (b) opt-in versus opt-out contact approach; (c) levels of comfort sharing with different recipients; (d) perceptions of commercialization; and (e) options to track use of information and be notified of results. Four focus groups (n = 12) were subsequently conducted to elucidate reasons motivating dominant preferences.

Results

Patients in the pandemic cohort were significantly more comfortable with sharing all information and biological samples (90% vs. 79%, p = 0.009), sharing information with the health care institution (97% vs. 83%, p < 0.001), sharing information with researchers at other hospitals (85% vs. 70%, p < 0.001), sharing PHI provincially (69% vs. 53%, p < 0.002), nationally (65% vs. 53%, p = 0.022) and internationally (48% vs. 39%, p = 0.024) compared to the pre-pandemic cohort. Discomfort with sharing information with commercial companies remained unchanged between the two cohorts (50% vs. 51% uncomfortable, p = 0.58). Significantly more pandemic cohort patients expressed a wish to track use of PHI (75% vs. 61%, p = 0.007), and to be notified of results (83% vs. 70%, p = 0.012). Thematic analysis uncovered that transparency was strongly desired on outside PHI use, particularly when commercialization was involved.

Conclusions

In pandemic times, patients were more comfortable sharing information with all parties, except with commercial entities, where levels of discomfort (~ 50%) remained unchanged. Focus groups identified that the ability to track and receive results of studies using one’s PHI is an important way to reduce discomfort and increase trust. These findings meaningfully inform wider discussions on the use of personal health information for research during global crises.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00790-z.

A blueprint for building an emergency department quality improvement and patient safety committee

The field of quality improvement and patient safety (QIPS) has matured significantly in emergency medicine over the past decade. From standalone, strategically misaligned, and incoherently designed QIPS projects years ago, emergency department (ED) leaders have now recognized that developing a more robust QIPS infrastructure helps prioritize and organize projects for a greater likelihood of success and impact for patients and the system. This process includes the development of a well-defined, accountable, and supported departmental QIPS committee. This can be achieved effectively using a deliberate and structured approach, such as the one described by Harvard Business School Professor John Kotter in his seminal work, “Leading Change.” Herein, we present a blueprint using this framework and include practical examples from our experience developing a robust and successful ED QIPS committee and infrastructure. The steps include how to develop a “burning platform,” select a guiding coalition of leaders, develop a strategic vision and initiatives, recruit a volunteer army of members, enable actions for the committee, generate short-term successes, sustain the pace of change, and, finally, enable the infrastructure to support ongoing improvements. This road map can be replicated by ED teams of variable sizes and settings to structure, prioritize, and operationalize their QIPS activities and ultimately improve the outcomes of their patients.

Physician Champions of Quality and Safety: Perspectives of MD Quality and Safety Leads to Drive Quality Innovation at an Academic Hospital

While the importance of physician involvement in organizational quality and safety (Q&S) activities has been well established, a paucity of information exists on tangible supports needed to effectively execute this role. Interviews with 13 MD Q&S leads uncovered common enablers, including valuing Q&S work academically, hiring skilled collaborators, ensuring appropriate power and authority to advance Q&S initiatives, facilitating connections, emphasizing culture change and strong action by leadership. To operationalize these enablers and drive quality innovation, organizations should prioritize the identification and appointment of MD Q&S leads for each department/division and facilitate their assembly as a formal physician Q&S committee.

Radiation Oncology Fellowship: a Value-Based Assessment Among Graduates of a Mature Program

The University of Toronto - Department of Radiation Oncology (UTDRO) has had a well-established Fellowship Program for over 20 years. An assessment of its graduates was conducted to evaluate training experience and perceived impact on professional development. Graduates of the UTDRO Fellowship Program between 1991 and 2015 were the focus of our review. Current employment status was collected using online tools. A study-specific web-based questionnaire was distributed to 263/293 graduates for whom active e-mails were identified; questions focused on training experience, and impact on career progression and academic productivity. As a surrogate measure for the impact of UTDRO Fellowship training, a comparison of current employment and scholarly activities of individuals who obtained their Fellow of the Royal College of Physicians of Canada (FRCPC) designation in Radiation Oncology between 2000 and 2012, with (n = 57) or without (n = 230) UTDRO Fellowship training, was conducted. Almost all UTDRO Fellowship graduates were employed as staff radiation oncologists (291/293), and most of those employed were associated with additional academic (130/293), research (53/293), or leadership (68/293) appointments. Thirty-eight percent (101/263) of alumni responded to the online survey. The top two reasons for completing the Fellowship were to gain specific clinical expertise and exposure to research opportunities. Respondents were very satisfied with their training experience, and the vast majority (99%) would recommend the program to others. Most (96%) felt that completing the Fellowship was beneficial to their career development. University of Toronto, Department of Radiation Oncology Fellowship alumni were more likely to hold university, research, and leadership appointments, and author significantly more publications than those with FRCPC designation without fellowship training from UTDRO. The UTDRO Fellowship Program has been successful since its inception, with the majority of graduates reporting positive training experiences, benefits to scholarly output, and professional development for their post-fellowship careers. Key features that would optimize the fellowship experience and its long-term impact on trainees were also identified.

Design and Implementation of a Distant-Learning Clinical Research Mentorship Program: The Accra-Toronto Collaboration

PURPOSE

For many oncology training programs in low- and middle-income countries, dedicated time for research education and mentorship of trainees is limited. Here, we report a 1-year-long collaboration between a cancer center in Canada and one in Ghana with the aim of imparting clinical research skills and mentoring the research of radiation oncology residents.

METHODS

On the basis of a needs assessment conducted in Ghana, we designed a curriculum consisting of 13 weekly seminars delivered via videoconference, followed by a 1-year-long mentorship program to support research projects. The primary outcome was the feasibility of the program from seminars to manuscript preparation. We used multiple secondary outcomes to capture the learning experience with study-specific questionnaires. We evaluated critical thinking ability using the Berlin questionnaire. Funding was made available for research and travel to international conferences.

RESULTS

Five Ghanaian trainees submitted research proposals. Nine Canadian faculty members delivered the seminars and two served as methodology mentors, and two Ghanaian faculty acted as local supervisors. Feedback questionnaires from all participants showed that they agreed strongly that they would recommend the sessions to another resident (75%), that the objectives were clear (71%), and that the topics were useful for their training (73%). At the end of the program, two Ghanaian trainees finalized their manuscripts and one was published.

CONCLUSION

Here, we report on the implementation of a mentorship program focused on research methods and evidence-based medicine in sub-Saharan Africa. The program was successful in the drafting and publication of abstracts and manuscripts by local trainees.

Accelerated Education Program in Radiation Medicine: International Learner Perceptions of Experiences, Outcomes, and Impact

PURPOSE

The Accelerated Education Program (AEP) at the Princess Margaret Cancer Centre (PM) has been offering continuing medical education courses since 2006. The purpose of this study was to assess learner experiences, perspectives, and outcomes using Kirkpatrick's Four Level Training Evaluation Model (ie, reaction, learning, behavior, results) to ascertain whether it was meeting stated goals.

METHODS AND MATERIALS

Past course participants (2010-2018) were invited to participate in a semistructured interview. Interviews were transcribed verbatim; thematic analysis was conducted by a 4-person research team.

RESULTS

Seventeen participants including 2 medical physicists, 6 radiation oncologists, and 9 radiation therapists from 6 countries on 4 continents participated in the study. Interviews lasted an average of 25 minutes. Consistently positive outcomes were reported at each level of Kirkpatrick's model. At the reaction level, participants liked the small, interactive case-based design, exposure to renowned faculty and practices from PM and other major centers, and the interprofessional practice (IPP) approach. Suggestions for improvements include enhancing practical content. At the learning level, participants reported gaining new knowledge or skills and new awareness or attitudes. Behavior changes described included sharing learnings with colleagues, implementing changes in practice or techniques, departmental structure, and IPP. Participants described the effects on clinical practice (results) in quality of care, access to care, and academic contribution. Identified barriers to change related to the restricted internal capacity for change and the need for wider staff training.

CONCLUSIONS

AEP courses were found to have a positive effect on local practices ranging from confirmation of current practice through to increased access to and quality of advanced radiotherapeutic techniques and care. Our findings confirm that AEP is achieving its goal of "putting innovation to work" and suggest curricular improvements that can enhance these effects.

"It's good for the soul:" Perceptions of a formal junior faculty mentorship program at a large academic cancer centre

BACKGROUND

Mentorship fosters professional and personal growth; however, the components essential to program success remain unclear. Our objective was to evaluate and explore the impact of a junior faculty mentorship program within an academic radiation oncology department.

MATERIALS AND METHODS

In 2016, our institution implemented a junior faculty mentorship program consisting of: (1) an orientation handbook; (2) faculty development sessions; and (3) direct, one-to-one selection of a mentor. Confidentiality agreements are signed, a goals template is provided, and meeting dates are tracked. Mentors/mentees were invited to participate in a program evaluation using mixed-methodology: a questionnaire followed by a one-on-one semi-structured interview to explore perceptions of the program. Interviews were audiotaped and transcribed verbatim. Descriptive statistics summarized questionnaire results and thematic analysis summarized interview results.

RESULTS

Eleven junior faculty have selected 10 mentors. Of these, 17 completed the evaluation questionnaire (81%) (7 mentors, 10 mentees; 5 women, 12 men) and 13 were interviewed (62%) (5 mentors, 8 mentees; 3 women, 10 men). The majority (80%) have participated in the program for >2 years. Although most mentees report additional mentors, 30% report this as their sole mentorship relationship. Four themes emerged: (i) Components of an Ideal Mentoring Relationship, (ii) The Value of Mentorship, (iii) Sponsorship, in addition to Mentorship and (iv) Cultivating Departmental Bonds and Boundaries.

CONCLUSION

Implementation of a junior faculty mentorship program within an academic radiation oncology department is feasible. Participants expressed satisfaction with most formal program components. Many junior faculty have additional mentors; however, some do not, highlighting the importance of formal programs for professional development.

The use of personal health information outside the circle of care: consent preferences of patients from an academic health care institution

BACKGROUND

Immense volumes of personal health information (PHI) are required to realize the anticipated benefits of artificial intelligence in clinical medicine. To maintain public trust in medical research, consent policies must evolve to reflect contemporary patient preferences.

METHODS

Patients were invited to complete a 27-item survey focusing on: (a) broad versus specific consent; (b) opt-in versus opt-out approaches; (c) comfort level sharing with different recipients; (d) attitudes towards commercialization; and (e) options to track PHI use and study results.

RESULTS

222 participants were included in the analysis; 83% were comfortable sharing PHI with researchers at their own hospital, although younger patients (≤ 49 years) were more uncomfortable than older patients (50 + years; 13% versus 2% uncomfortable, p < 0.05). While 56% of patients preferred broad consent, 38% preferred specific consent; 6% preferred not sharing at all. The majority of patients (63%) preferred to be asked for permission before entry into a contact pool. Again, this trend was more pronounced for younger patients (≤ 49 years: 76%). Approximately half of patients were uncomfortable sharing PHI with commercial enterprises (51% uncomfortable, 27% comfortable, 22% neutral). Most patients preferred to track PHI usage (61%), with the highest proportion once again reported by the youngest patients (≤ 49 years: 71%). A majority of patients also wished to be notified regarding study results (70%).

CONCLUSIONS

While most patients were willing to share their PHI with researchers within their own institution, many preferred a transparent and reciprocal consent process. These data also suggest a generational shift, wherein younger patients preferred more specific consent options. Modernizing consent policies to reflect increased autonomy is crucial in fostering sustained public engagement with medical research.

The use of patient health information outside the circle of care: Consent preferences of patients from a large academic cancer centre

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Background: Massive volumes of patient health information (PHI) are required to realize the anticipated benefits of artificial intelligence in future clinical medicine. To maintain public trust in medical research however, consent policies must evolve to reflect contemporary patient preferences. Methods: From January-December 2019, patients attending clinics at a large academic cancer centre were invited to complete a 27-item iPad survey on consent preferences. Survey items focused on: (a) broad vs. specific consent; (b) opt-in vs. opt-out approaches for research contact; (c) comfort sharing with different recipients; (d) perceptions on commercialization; and (e) options to track information use and study results. Demographic questions addressed cancer type, treatment stage, age, gender, ethnicity, education level, and household income. Results: A total of 222 participants were included in the analysis (112 males, 108 females; 2 rather not say); 83% were comfortable sharing PHI with researchers at their own hospital. While 56% of patients preferred broad consent, 38% preferred to be contacted with study details and asked to consent every time (specific consent); 6% prefer not to share at all. Younger patients ( < 49 years) most often chose specific consent (50%); significantly more than those 75+ years (24%; p < .05). Younger patients ( < 49 years) were also significantly more uncomfortable than older patients (50+ years) sharing even within their own hospital (13% uncomfortable vs. 1% uncomfortable; p < .05). A significant majority of patients (63%, p = .0001) preferred to be asked for permission before being entered into a contact pool vs. automatic entry with opportunity to opt-out. The majority of patients were uncomfortable sharing PHI with commercial enterprises (51% uncomfortable, 27% comfortable, 22% neutral). A significant majority expressed the desire to track who is using their PHI (61%, p < .0001), and be notified regarding study results (70%, p < .0001). Conclusions: While most patients were willing to share their PHI with researchers at their own hospital, many preferred a transparent and reciprocal consent process. These data also suggest a generational shift, wherein younger patients preferred more informed consent options. Modernizing consent policies to reflect increased patient interest in the exercise of their autonomy is crucial in fostering sustained public engagement in medical research.

Interrelationships between Blood Pressure, Blood Gases and Plasma Acetate Concentrations during Conventional Hemodialysis

To determine to what extent the intradialysis changes in blood pressure (BP) are related to the variations in blood gases and plasma acetate concentrations (plAc), 11 dialysed uremics were studied with measurement of plAc, pH, pCO2 and pO2 every 60’ during a hemodialysis lasting 4 hrs. Dialysis resulted in significant decreases in the BP, pO2 and pCO2 and in significant increases in pH and plAc. Multiple regression analysis demonstrated that the Δ% for the mean BP was closely related to plAc, pCO2 and Δ− % of body weight (BW). Partial regression coefficient indicated the following rank order of correlation: plAc > pCO2 ≥ Δ−% BW > pO2 = O, thus demonstrating that the fall in blood pressure is related both to the increase in plAc and the decrease in pCO2.

The physiological relevance of these relationships is discussed. The hypothesis is advanced that the pCO2 decrease during dialysis might contribute to the acetate-induced vascular instability.

Spontaneous Oxidation of Ni Nanoclusters on MgO Monolayers Induced by Segregation of Interfacial Oxygen

We report the study of Ni nanoclusters deposited on MgO/Ag(100) ultrathin films (one monolayer) at T = 200 K. We show by STM analysis and DFT calculations that in the limit of low Ni coverage the formation of nanoclusters of four to six atoms occurs and that these aggregates are flat rather than 3D, as expected for Ni tetramers, pentamers, or hexamers. Both the shape of the clusters and the interatomic distance between neighboring Ni atoms are indicative that the nanoparticles do not consist of pure metal atoms but that a NiyOx structure has formed thanks to the availability of atomic oxygen accumulated at the MgO/Ag interface, with Ni clusters acting as oxygen pumps. Besides being of relevance in view of the use of metal nanoclusters in catalysis and other applications, this finding gives a further proof of the peculiar behavior of ultrathin oxide films.

Positive inotropic effects of an ACTH analogue (ACTH 1-17) on myocardial performance

The aim of the present investigation was to study the effects of a single 100-micrograms i.v. administration of the synthetic heptadecapeptide [beta-Ala1-Lys17]ACTH1-17-4-amino-N-butylamide (ACTH 1-17) on the left ventricular performance. The systolic time intervals (STI) were recorded in 20 healthy adult young subjects (10 treated with ACTH 1-17 and 10 receiving placebo) before as well as 20, 40, 60 and 80 min after the i.v. ACTH 1-17 or placebo infusion. The STI were recorded immediately after blood withdrawal for measuring cortisol, aldosterone, adrenaline and noradrenaline plasma levels. A highly significant statistical difference was demonstrated for preejection period (PEP) and preejection period/left ventricular ejection time (PEP/LVET) ratio between subjects treated with ACTH 1-17 and subjects receiving placebo. As expected, a significant increase of cortisol and aldosterone plasma levels was observed in subjects treated with ACTH 1-17. The difference of adrenaline and noradrenaline plasma levels was statistically highly significant between subjects treated with ACTH 1-17 and those receiving placebo. The lack of increase in PEP and PEP/LVET ratio recorded in subjects treated with ACTH 1-17 is consistent with an increased left ventricular contractile performance. An increased plasma catecholamine release is postulated as the mechanism of this improvement.

Evaluation of valproic acid fluoroimmunoassay and comparison with a gas liquid chromatographic method

A method for monitoring valproic acid in serum with a fluoroimmunoassay is described. The evaluation was performed with run-to-run and within-run reproducibility, dilution, and recovery tests. The interferences of hemoglobin, bilirubin, and triglycerides were checked, and a comparison with a gas liquid chromatographic method was also performed. The between-run and within-run coefficients of variation were less than 5.2 and 2.6%, respectively. The method gave satisfactory results in dilution tests and a high correlation with a gas liquid chromatographic method (r = 0.98). The percentage of recovery was greater than 97%. No interference from hemolysis, bilirubin, or triglycerides was observed. The accuracy and simplicity of this method make it suitable for routine laboratory use.

Plasma catecholamines assay: comparison between fluorimetric and radioenzymatic methods

Plasma catecholamines were simultaneously measured in duplicate plasma samples by the fluorimetric method of Renzini et al. (1970) Clin. Chim. Acta 39, 587-594) and by the radioenzymatic method of Da Prada & Zurcher ((1976) Life Sci. 19, 1161-1174). The correlation of noradrenaline and adrenaline plasma concentrations determined by the two methods were, respectively, r = 0.95 (p less than 0.001) and r = 0.75 (p less than 0.01). The fluorimetric method was less sensitive, but more economical and less time-consuming than the radioenzymatic method. The fluorimetric method is still of value for measuring plasma catecholamines in man.

Interrelationships between blood pressure, blood gases and plasma acetate concentrations during conventional hemodialysis

To determine to what extent the intradialysis changes in blood pressure (BP) are related to the variations in blood gases and plasma acetate concentrations (plAc), 11 dialysed uremics were studied with measurement of plAc,pH, pCO2 and pO2 every 60' during a hemodialysis lasting 4 hrs. Dialysis resulted in significant decreases in the BP, pO2 and pCO2 and in significant increases in pH and plAc. Multiple regression analysis demonstrated that the delta % for the mean BP was closely related to plAc, pCO2 and delta-% of body weight (BW). Partial regression coefficient indicated the following rank order of correlation: plAc greater than pCO2 greater than or equal to delta-% BW greater than pO2 = O, thus demonstrating that the fall in blood pressure is related both to the increase in plAc and the decrease in pCO2. The physiological relevance of these relationships is discussed. The hypothesis is advanced that the pCO2 decrease during dialysis might contribute to the acetate-induced vascular instability.