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Weiss EM, Guttmann KF, Olszewski AE, Magnus BE, Li S, Kim SYH, Shah AR, Juul SE, Wu YW, Ahmad KA, Bendel-Stenzel E, Isaza NA, Lampland AL, Mathur AM, Rao R, Riley D, Russell DG, Salih ZNI, Torr CB, Weitkamp JH, Anani UE, Chang T, Dudley J, Flibotte J, Havrilla EM, O’Kane AC, Perez K, Stanley BJ, Shah SK, Wilfond BS. Parental Enrollment Decision-Making for a Neonatal Clinical Trial. J Pediatr 2021; 239:143-149.e3. [PMID: 34400207 PMCID: PMC8610170 DOI: 10.1016/j.jpeds.2021.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the parental experience of recruitment and assess differences between parents who participated and those who declined to enroll in a neonatal clinical trial. STUDY DESIGN This was a survey conducted at 12 US neonatal intensive care units of parents of infants who enrolled in the High-dose Erythropoietin for Asphyxia and encephaLopathy (HEAL) trial or who were eligible but declined enrollment. Questions assessed 6 factors of the parental experience of recruitment: (1) interactions with research staff; (2) the consent experience; (3) perceptions of the study; (4) decisional conflict; (5) reasons for/against participation; and (6) timing of making the enrollment decision. RESULTS In total, 269 of 387 eligible parents, including 183 of 242 (75.6%) of those who enrolled their children in HEAL and 86 of 145 (59.3%) parents who declined to enroll their children in HEAL, were included in analysis. Parents who declined to enroll more preferred to be approached by clinical team members rather than by research team members (72.9% vs 49.2%, P = .005). Enrolled parents more frequently reported positive initial impressions (54.9% vs 10.5%, P < .001). Many parents in both groups made their decision early in the recruitment process. Considerations of reasons for/against participation differed by enrollment status. CONCLUSIONS Understanding how parents experience recruitment, and how this differs by enrollment status, may help researchers improve recruitment processes for families and increase enrollment. The parental experience of recruitment varied by enrollment status. These findings can guide future work aiming to inform optimal recruitment strategies for neonatal clinical trials.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Katherine F Guttmann
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aleksandra E Olszewski
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Brooke E Magnus
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts
| | - Sijia Li
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Scott YH Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda Maryland
| | - Anita R Shah
- Division of Neonatology, Children’s Hospital of Orange County, Orange, California
| | - Sandra E Juul
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yvonne W Wu
- Departments of Neurology and Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - Kaashif A Ahmad
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas
| | | | - Natalia A Isaza
- Division of Neonatology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Andrea L Lampland
- Department of Neonatology, Children’s Minnesota Hospital, Minneapolis, Minnesota
| | - Amit M Mathur
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Rakesh Rao
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - David Riley
- Department of Pediatrics, Cook Children’s Medical Center, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, Texas
| | - David G Russell
- Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Zeynep N I Salih
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carrie B Torr
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Uchenna E Anani
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Taeun Chang
- Department of Neurology, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Juanita Dudley
- Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John Flibotte
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Erin M Havrilla
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra C O’Kane
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Krystle Perez
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Seema K Shah
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Turley P, Meyer MN, Wang N, Cesarini D, Hammonds E, Martin AR, Neale BM, Rehm HL, Wilkins-Haug L, Benjamin DJ, Hyman S, Laibson D, Visscher PM. Problems with Using Polygenic Scores to Select Embryos. N Engl J Med 2021; 385:78-86. [PMID: 34192436 PMCID: PMC8387884 DOI: 10.1056/nejmsr2105065] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Companies have recently begun to sell a new service to patients considering in vitro fertilization: embryo selection based on polygenic scores (ESPS). These scores represent individualized predictions of health and other outcomes derived from genomewide association studies in adults to partially predict these outcomes. This article includes a discussion of many factors that lower the predictive power of polygenic scores in the context of embryo selection and quantifies these effects for a variety of clinical and nonclinical traits. Also discussed are potential unintended consequences of ESPS (including selecting for adverse traits, altering population demographics, exacerbating inequalities in society, and devaluing certain traits). Recommendations for the responsible communication about ESPS by practitioners are provided, and a call for a society-wide conversation about this technology is made. (Funded by the National Institute on Aging and others.).
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Affiliation(s)
- Patrick Turley
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Michelle N Meyer
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Nancy Wang
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - David Cesarini
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Evelynn Hammonds
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Alicia R Martin
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Benjamin M Neale
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Heidi L Rehm
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Louise Wilkins-Haug
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Daniel J Benjamin
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Steven Hyman
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - David Laibson
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
| | - Peter M Visscher
- From the University of Southern California (P.T.) and the University of California, Los Angeles (D.J.B.) - both in Los Angeles; Geisinger Health System, Danville, PA (M.N.M.); the National Bureau of Economic Research (N.W., D.C., D.J.B., D.L.), Harvard University (E.H., S.H., D.L.), and the Broad Institute of Harvard and MIT (A.R.M., B.M.N., H.L.R., S.H.) - all in Cambridge, MA; Massachusetts General Hospital (A.R.M., B.M.N., H.L.R.), Harvard Medical School (A.R.M., B.M.N., H.L.R., L.W.-H.), and Brigham and Women's Hospital (L.W.-H.) - all in Boston; New York University, New York (D.C.); and the University of Queensland, Brisbane, Australia (P.M.V.)
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