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Dheensa S, Carrieri D, Kelly S, Clarke A, Doheny S, Turnpenny P, Lucassen A. A 'joint venture' model of recontacting in clinical genomics: challenges for responsible implementation. Eur J Med Genet 2017; 60:403-409. [PMID: 28501562 DOI: 10.1016/j.ejmg.2017.05.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Advances in genomics often lead healthcare professionals (HCPs) to learn new information, e.g., about reinterpreted variants that could have clinical significance for patients seen previously. A question arises of whether HCPs should recontact these former patients. We present some findings interrogating the views of patients (or parents of patients) with a rare or undiagnosed condition about how such recontacting might be organised ethically and practically. Forty-one interviews were analysed thematically. Participants suggested a 'joint venture' model in which efforts to recontact are shared with HCPs. Some proposed an ICT-approach involving an electronic health record that automatically alerts them to potentially relevant updates. The need for rigorous privacy controls and transparency about who could access their data was emphasised. Importantly, these findings highlight that the lack of clarity about recontacting is a symptom of a wider problem: the lack of necessary infrastructure to pool genomic data responsibly, to aggregate it with other health data, and to enable patients/parents to receive updates. We hope that our findings will instigate a debate about the way responsibilities for recontacting under any joint venture model could be allocated, as well as the limitations and normative implications of using ICT as a solution to this intractable problem. As a first step to delineating responsibilities in the clinical setting, we suggest HCPs should routinely discuss recontacting with patients/parents, including the new information that should trigger a HCP to initiate recontact, as part of the consent process for genetic testing.
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Affiliation(s)
- Sandi Dheensa
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, UK; ELSI Group, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | - Angus Clarke
- Division of Cancer & Genetics, School of Medicine, Cardiff University, UK
| | - Shane Doheny
- Division of Cancer & Genetics, School of Medicine, Cardiff University, UK
| | - Peter Turnpenny
- Egenis, University of Exeter, UK; Peninsular Genetics Service, Royal, Devon and Exeter Hospital, UK
| | - Anneke Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, UK; ELSI Group, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, UK
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2
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McGuire AL, Moore Q, Majumder M, Walkiewicz M, Eng CM, Belmont JW, Nassef S, Darilek S, Rutherford K, Pereira S, Scherer SE, Sutton VR, Wolf D, Gibbs RA, Kahn R, Sanchez LA. The ethics of conducting molecular autopsies in cases of sudden death in the young. Genome Res 2016; 26:1165-9. [PMID: 27412853 PMCID: PMC5052042 DOI: 10.1101/gr.192401.115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 02/05/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Quianta Moore
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA; Rice University Baker Institute for Public Policy, Houston, Texas 77005, USA
| | - Mary Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Magdalena Walkiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - John W Belmont
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Salma Nassef
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Sandra Darilek
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Katie Rutherford
- Harris County Institute of Forensic Sciences, Houston, Texas 77030, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Steven E Scherer
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Dwayne Wolf
- Harris County Institute of Forensic Sciences, Houston, Texas 77030, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Roger Kahn
- Harris County Institute of Forensic Sciences, Houston, Texas 77030, USA
| | - Luis A Sanchez
- Harris County Institute of Forensic Sciences, Houston, Texas 77030, USA
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3
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Moore QL, Majumder MA, Rutherford LK, McGuire AL. Ethical and Legal Challenges Associated with Public Molecular Autopsies. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:309-318. [PMID: 27338606 DOI: 10.1177/1073110516654124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is a national movement supporting the retention and use of bio-specimens from deceased individuals for the purpose of genetic testing. This manuscript discusses the significance of postmortem genetic testing in the context of death determination by medical examiners (i.e., public molecular autopsies). We highlight distinctive concerns that are raised in the areas of consent, confidentiality, and return of results when genetic testing is performed as part of a public molecular autopsy. We believe our manuscript will contribute to the development of a robust ethical and legal framework for genetic testing in this context.
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Affiliation(s)
- Quianta L Moore
- Quianta L. Moore, M.D., J.D., is a Research Associate in the Center for Medical Ethics and Health Policy at Baylor College of Medicine and a Scholar in Health Policy at the Baker Institute for Public Policy at Rice University. She has a M.D. from Baylor College of Medicine and a J.D. from the University of Houston Law Center. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She has a J.D. from Yale Law School and a Ph.D. from Rice University. Lindsey K. Rutherford, J.D., holds the title of Assistant County Attorney for Harris County, Texas and serves as the General Counsel to the Chief Medical Examiner and Harris County Institute of Forensic Sciences. She obtained her B.S. degree in Biology from Texas A&M University, her J.D. degree from the University of Houston Law Center and is licensed to practice law in the state of Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She received her J.D. from the University of Houston Law Center and Ph.D. from the University of Texas Medical School at Galveston
| | - Mary A Majumder
- Quianta L. Moore, M.D., J.D., is a Research Associate in the Center for Medical Ethics and Health Policy at Baylor College of Medicine and a Scholar in Health Policy at the Baker Institute for Public Policy at Rice University. She has a M.D. from Baylor College of Medicine and a J.D. from the University of Houston Law Center. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She has a J.D. from Yale Law School and a Ph.D. from Rice University. Lindsey K. Rutherford, J.D., holds the title of Assistant County Attorney for Harris County, Texas and serves as the General Counsel to the Chief Medical Examiner and Harris County Institute of Forensic Sciences. She obtained her B.S. degree in Biology from Texas A&M University, her J.D. degree from the University of Houston Law Center and is licensed to practice law in the state of Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She received her J.D. from the University of Houston Law Center and Ph.D. from the University of Texas Medical School at Galveston
| | - Lindsey K Rutherford
- Quianta L. Moore, M.D., J.D., is a Research Associate in the Center for Medical Ethics and Health Policy at Baylor College of Medicine and a Scholar in Health Policy at the Baker Institute for Public Policy at Rice University. She has a M.D. from Baylor College of Medicine and a J.D. from the University of Houston Law Center. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She has a J.D. from Yale Law School and a Ph.D. from Rice University. Lindsey K. Rutherford, J.D., holds the title of Assistant County Attorney for Harris County, Texas and serves as the General Counsel to the Chief Medical Examiner and Harris County Institute of Forensic Sciences. She obtained her B.S. degree in Biology from Texas A&M University, her J.D. degree from the University of Houston Law Center and is licensed to practice law in the state of Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She received her J.D. from the University of Houston Law Center and Ph.D. from the University of Texas Medical School at Galveston
| | - Amy L McGuire
- Quianta L. Moore, M.D., J.D., is a Research Associate in the Center for Medical Ethics and Health Policy at Baylor College of Medicine and a Scholar in Health Policy at the Baker Institute for Public Policy at Rice University. She has a M.D. from Baylor College of Medicine and a J.D. from the University of Houston Law Center. Mary A. Majumder, J.D., Ph.D., is an Associate Professor of Medicine in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She has a J.D. from Yale Law School and a Ph.D. from Rice University. Lindsey K. Rutherford, J.D., holds the title of Assistant County Attorney for Harris County, Texas and serves as the General Counsel to the Chief Medical Examiner and Harris County Institute of Forensic Sciences. She obtained her B.S. degree in Biology from Texas A&M University, her J.D. degree from the University of Houston Law Center and is licensed to practice law in the state of Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. She received her J.D. from the University of Houston Law Center and Ph.D. from the University of Texas Medical School at Galveston
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McBride KA, Hallowell N, Tattersall MHN, Kirk J, Ballinger ML, Thomas DM, Mitchell G, Young MA. Timing and context: important considerations in the return of genetic results to research participants. J Community Genet 2015; 7:11-20. [PMID: 26004130 DOI: 10.1007/s12687-015-0231-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022] Open
Abstract
General consensus exists that clinically significant germline genetic research results should be fed back to research participants. A body of literature is emerging about Australian research participants' experiences of feedback of genetic research results and factors that influence a participant's actions after receiving such information. This exploratory qualitative study conducted interviews with 11 participants from the International Sarcoma Kindred Study, four probands and seven of their relatives. They had been informed by letter of the availability of clinically significant germline TP53 mutations identified through research. We examined the participants' views about the feedback of these genetic test results. Thematic (inductive) analysis was used to analyse the data. A number of factors influenced participants' responses following notification. This included participants' understanding of the notification letter and their perception of the relevance of the information for them and/or their family. Most notably, timing of the letter in the context of an individual's current life experiences was important. Timing and context are novel factors identified that may impact on research participants' understanding or their ability to access clinically significant research results. We outline strategies for disseminating results to research participants and their next of kin that may reduce their uncertainty around the receipt of research results.
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Affiliation(s)
- Kate A McBride
- School of Public Health, Sydney Medical School, Camperdown, NSW, 2006, Australia. .,The Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, NSW, 2145, Australia.
| | - Nina Hallowell
- Centre for Health and Society, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Martin H N Tattersall
- Department of Cancer Medicine, Sydney Medical School, Royal Prince Alfred Hospital, Camperdown, NSW, 2006, Australia
| | - Judy Kirk
- The Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, NSW, 2145, Australia
| | - Mandy L Ballinger
- Research Division, Peter MacCallum Cancer Centre, East Melbourne, VIC, 3002, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - David M Thomas
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - Gillian Mitchell
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3052, Australia.,Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC, 3002, Australia
| | - Mary-Anne Young
- Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC, 3002, Australia
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Otten E, Plantinga M, Birnie E, Verkerk MA, Lucassen AM, Ranchor AV, Van Langen IM. Is there a duty to recontact in light of new genetic technologies? A systematic review of the literature. Genet Med 2014; 17:668-78. [PMID: 25503495 DOI: 10.1038/gim.2014.173] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/27/2014] [Indexed: 12/27/2022] Open
Abstract
PURPOSE With rapid advances in genetic technologies, new genetic information becomes available much faster today than just a few years ago. This has raised questions about whether clinicians have a duty to recontact eligible patients when new genetic information becomes available and, if such duties exist, how they might be implemented in practice. METHODS We report the results of a systematic literature search on the ethical, legal, social (including psychological), and practical issues involved in recontacting former patients who received genetic services. We identified 1,428 articles, of which 61 are covered in this review. RESULTS The empirical evidence available indicates that most but not all patients value being recontacted. A minority of (older) articles conclude that recontacting should be a legal duty. Most authors consider recontacting to be ethically desirable but practically unfeasible. Various solutions to overcome these practical barriers have been proposed, involving efforts of laboratories, clinicians, and patients. CONCLUSION To advance the discussion on implementing recontacting in clinical genetics, we suggest focusing on the question of in what situations recontacting might be regarded as good standard of care. To this end, reaching a professional consensus, obtaining more extensive empirical evidence, and developing professional guidelines are important.
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Affiliation(s)
- Ellen Otten
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mirjam Plantinga
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marian A Verkerk
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anneke M Lucassen
- 1] Faculty of Medicine, Clinical Ethics and Law, University of Southampton, Southampton, UK [2] Wessex Clinical Genetic Service, Southampton, UK
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene M Van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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6
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The responses of research participants and their next of kin to receiving feedback of genetic test results following participation in the Australian Ovarian Cancer Study. Genet Med 2013; 15:458-65. [DOI: 10.1038/gim.2012.154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Abstract
While the disclosure of research findings is relevant to all types of biomedical research, it has garnered particular attention with respect to genetics and genomics research due to some of the unique aspects of the data and the high public profile of the field. In this chapter, we review the attitudes of stakeholders (research participants, policymakers, and researchers) to define areas of consensus regarding the issue of returning research results across and within groups. In addition to stakeholder attitudes about obligations and interest in research results, other major related issues related to returning research results, such as informed consent, communication of research results, and cost, are discussed. Given the consensus between stakeholders to return summary reports of a study's outcomes and individual research results of clinical significance, we conclude that the time has come to encourage, if not require, researchers to consider these issues in the developmental planning stages of a project and to plan and budget accordingly.
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Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy, Duke University, Durham, North Carolina, USA.
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Bevan JL, Senn-Reeves JN, Inventor BR, Greiner SM, Mayer KM, Rivard MT, Hamilton RJ. Critical social theory approach to disclosure of genomic incidental findings. Nurs Ethics 2012; 19:819-28. [PMID: 22562957 DOI: 10.1177/0969733011433924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Technology has expanded genomic research and the complexity of extracted gene-related information. Health-related genomic incidental findings pose new dilemmas for nurse researchers regarding the ethical application of disclosure to participants. Consequently, informed consent specific to incidental findings is recommended. Critical Social Theory is used as a guide in recognition of the changing meaning of informed consent and to serve as a framework to inform nursing of the ethical application of disclosure consent in genomic nursing research practices.
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Affiliation(s)
- Jeffrey L Bevan
- Rush University, College of Nursing, Chicago, IL 60612, USA.
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Chan B, Facio FM, Eidem H, Hull SC, Biesecker LG, Berkman BE. Genomic inheritances: disclosing individual research results from whole-exome sequencing to deceased participants' relatives. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:1-8. [PMID: 22974017 PMCID: PMC4104597 DOI: 10.1080/15265161.2012.699138] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Whole-genome analysis and whole-exome analysis generate many more clinically actionable findings than traditional targeted genetic analysis. These findings may be relevant to research participants themselves as well as for members of their families. Though researchers performing genomic analyses are likely to find medically significant genetic variations for nearly every research participant, what they will find for any given participant is unpredictable. The ubiquity and diversity of these findings complicate questions about disclosing individual genetic test results. We outline an approach for disclosing a select range of genetic results to the relatives of research participants who have died, developed in response to relatives' requests during a pilot study of large-scale medical genetic sequencing. We also argue that studies that disclose individual research results to participants should, at a minimum, passively disclose individual results to deceased participants' relatives.
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Affiliation(s)
- Ben Chan
- Lawrence University, Appleton, WI 54911, USA.
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Disclosure of individual genetic data to research participants: the debate reconsidered. Trends Genet 2010; 27:41-7. [PMID: 21190750 DOI: 10.1016/j.tig.2010.11.004] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 11/21/2022]
Abstract
Despite extensive debate, there is no consensus on whether individual genetic data should be disclosed to research participants. The emergence of whole-genome sequencing methods is increasingly generating unequalled amounts of genetic data, making the need for a clear feedback policy even more urgent. In this debate two positions can be broadly discerned: a restrictive disclosure policy ('no feedback except life-saving data') and an intermediate policy of qualified disclosure ('feedback if the results meet certain conditions'). We explain both positions and present the principal underlying arguments. We suggest that the debate should no longer address whether genetic research results should be returned, but instead how best to make an appropriate selection and how to strike a balance between the possible benefits of disclosure and the harms of unduly hindering biomedical research.
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