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Jamal L, May M, Setzer MR, Yu M, Berkman B, Similuk M. Research participants' perspectives about the return of uninformative genomic test results in a clinical research setting. J Genet Couns 2023:10.1002/jgc4.1772. [PMID: 37641538 PMCID: PMC10899523 DOI: 10.1002/jgc4.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
The majority of genomic sequencing and microarray results are clinically uninformative, meaning that they do not suggest a need for any behavioral action or medical intervention. Prior studies have shown that recipients of uninformative genomic testing results ("uninformative results" hereafter) may incorrectly interpret them to imply a lowered risk of disease or false reassurance about future health risks. Few studies have examined how patients understand uninformative results when they are returned in a research setting, where there is wide variation in analytical specifications of testing, interpretation and reporting practices, and resources to support the return of results. We conducted cross-sectional interviews (N = 17) to explore how a subset of research participants in one genomics study at the National Institutes of Health reacted to and understood their uninformative test results, which were returned to them via a patient portal without genetic counseling. We found that most participants did not remember the details of the informed consent process, including the distinction between "primary" and "secondary" findings. Participants had questions about what genes were tested for and, in most cases, requested a list of the genes covered. Several participants incorrectly assumed that autosomal recessive carrier results would have been reported to them if detected. Some participants interpreted their uninformative results to mean that they could forgo prenatal testing, and participants had mixed expectations about whether their results might be reinterpreted in the future. These themes suggest that there are specific challenges to returning uninformative results in research settings. Educational supplements to uninformative test reports may be most useful if they contextualize results in relation to other types of clinical genetic or genomic testing that may be made available to research participants in their lifetimes.
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Affiliation(s)
- Leila Jamal
- Center for Cancer Research, Genetics Branch, National Cancer Institute, Bethesda, Maryland
- NIH Clinical Center Department of Bioethics, Bethesda, Maryland
| | - Makenna May
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Medical Genetics and Genomics Branch, National Human Genome Research Institute, Bethesda, Maryland
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Michael R. Setzer
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Mary Yu
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Benjamin Berkman
- NIH Clinical Center Department of Bioethics, Bethesda, Maryland
- Bioethics Core, National Human Genome Research Institute, Bethesda, Maryland
| | - Morgan Similuk
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
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2
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Vears DF, Hallowell N, Bentzen HB, Ellul B, Nøst TH, Kerasidou A, Kerr SM, Th Mayrhofer M, Mežinska S, Ormondroyd E, Solberg B, Sand BW, Budin-Ljøsne I. A practical checklist for return of results from genomic research in the European context. Eur J Hum Genet 2023; 31:687-695. [PMID: 36949262 PMCID: PMC10250331 DOI: 10.1038/s41431-023-01328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/24/2023] Open
Abstract
An increasing number of European research projects return, or plan to return, individual genomic research results (IRR) to participants. While data access is a data subject's right under the General Data Protection Regulation (GDPR), and many legal and ethical guidelines allow or require participants to receive personal data generated in research, the practice of returning results is not straightforward and raises several practical and ethical issues. Existing guidelines focusing on return of IRR are mostly project-specific, only discuss which results to return, or were developed outside Europe. To address this gap, we analysed existing normative documents identified online using inductive content analysis. We used this analysis to develop a checklist of steps to assist European researchers considering whether to return IRR to participants. We then sought feedback on the checklist from an interdisciplinary panel of European experts (clinicians, clinical researchers, population-based researchers, biobank managers, ethicists, lawyers and policy makers) to refine the checklist. The checklist outlines seven major components researchers should consider when determining whether, and how, to return results to adult research participants: 1) Decide which results to return; 2) Develop a plan for return of results; 3) Obtain participant informed consent; 4) Collect and analyse data; 5) Confirm results; 6) Disclose research results; 7) Follow-up and monitor. Our checklist provides a clear outline of the steps European researchers can follow to develop ethical and sustainable result return pathways within their own research projects. Further legal analysis is required to ensure this checklist complies with relevant domestic laws.
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Affiliation(s)
- Danya F Vears
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
- University of Melbourne, Parkville, VIC, 3052, Australia.
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, 3000, Belgium.
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, OX3 7RF, UK.
| | - Nina Hallowell
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield department of Population Health, University of Oxford, Oxford, OX3 7RF, UK
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bridget Ellul
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Therese Haugdahl Nøst
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health, NTNU, Norwegian University of Science and Technology, N- 7491, Trondheim, Norway
| | - Angeliki Kerasidou
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield department of Population Health, University of Oxford, Oxford, OX3 7RF, UK
| | - Shona M Kerr
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | | | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Elizabeth Ormondroyd
- Radcliffe Department of Medicine, NIHR Oxford Biomedical Research Centre United Kingdom, University of Oxford, Oxford, UK
| | - Berge Solberg
- Department of Public Health and Nursing, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Isabelle Budin-Ljøsne
- Division of Climate and Environmental Health, Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway
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3
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de Hemptinne MC, Posthuma D. Addressing the ethical and societal challenges posed by genome-wide association studies of behavioral and brain-related traits. Nat Neurosci 2023:10.1038/s41593-023-01333-4. [PMID: 37217727 DOI: 10.1038/s41593-023-01333-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/14/2023] [Indexed: 05/24/2023]
Abstract
Genome-wide association studies have led to the identification of robust statistical associations of genetic variants with numerous brain-related traits, including neurological and psychiatric conditions, and psychological and behavioral measures. These results may provide insight into the biology underlying these traits and may facilitate clinically useful predictions. However, these results also carry the risk of harm, including possible negative effects of inaccurate predictions, violations of privacy, stigma and genomic discrimination, raising serious ethical and legal implications. Here, we discuss ethical concerns surrounding the results of genome-wide association studies for individuals, society and researchers. Given the success of genome-wide association studies and the increasing availability of nonclinical genomic prediction technologies, better laws and guidelines are urgently needed to regulate the storage, processing and responsible use of genetic data. Also, researchers should be aware of possible misuse of their results, and we provide guidance to help avoid such negative impacts on individuals and society.
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Affiliation(s)
- Matthieu C de Hemptinne
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Danielle Posthuma
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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4
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Return of individual research results from genomic research: A systematic review of stakeholder perspectives. PLoS One 2021; 16:e0258646. [PMID: 34748551 PMCID: PMC8575249 DOI: 10.1371/journal.pone.0258646] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.
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5
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Vanaken GJ, Noens I, Roeyers H, van Esch L, Warreyn P, Steyaert J, Hens K. Ethics of returning children's individual research findings: from principles to practice. Eur Child Adolesc Psychiatry 2021; 30:1163-1171. [PMID: 32715320 DOI: 10.1007/s00787-020-01606-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Little ethical recommendations on returning children's individual research findings are available for researchers in behavioral sciences, especially when compared to genetic research. Anecdotic evidence suggests that since parents are often interested in their child's individual research findings, researchers tend to offer this information as a form of compensation for research participation. Despite good intentions, these practices are not without potential harmful consequences for children. We were confronted with these difficulties and with the paucity of available guidance on this topic, being involved in a longitudinal, infant development study, i.e. tracking infants at risk for autism (TIARA). First, we review current ethical recommendations and discuss their limitations in the light of the TIARA study. Second, we will suggest to revise these recommendations, by identifying and applying the relevant bioethical principles and concepts at hand. Third, as an example of practical implementation, the adopted 'return of research findings'-policy for the TIARA-study is presented. The principles and concepts we engage with are the ancillary care responsibilities of the researcher, non-maleficence and beneficence, the right to an open future of the child, and the avoidance of therapeutic misconception. Ultimately, we present the concrete return of research findings policy implemented in the TIARA-study. Here, we suggest restricting the systematic return of children's individual research findings to cases where findings are considered clinically significant and actionable for the child. We discuss the broader implications for designing and conducting research in behavioral sciences with children.
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Affiliation(s)
- Gert-Jan Vanaken
- Parenting and Special Education Research Unit, Faculty of Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32, 3000, Leuven, Belgium. .,Leuven Autism Research (LAuRes), Leuven, Belgium. .,Department of Philosophy, Centre for Ethics, University of Antwerp, Antwerp, Belgium.
| | - Ilse Noens
- Parenting and Special Education Research Unit, Faculty of Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32, 3000, Leuven, Belgium.,Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Herbert Roeyers
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Lotte van Esch
- Parenting and Special Education Research Unit, Faculty of Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32, 3000, Leuven, Belgium.,Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Petra Warreyn
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), Leuven, Belgium.,Department of Neurosciences, Centre for Developmental Psychiatry, KU Leuven, Leuven, Belgium
| | - Kristien Hens
- Leuven Autism Research (LAuRes), Leuven, Belgium.,Department of Philosophy, Centre for Ethics, University of Antwerp, Antwerp, Belgium.,Institute of Philosophy, KU Leuven, Leuven, Belgium
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6
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Vears DF, Minion JT, Roberts SJ, Cummings J, Machirori M, Murtagh MJ. Views on genomic research result delivery methods and informed consent: a review. Per Med 2021; 18:295-310. [PMID: 33822658 DOI: 10.2217/pme-2020-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There has been little discussion of the way genomic research results should be returned and how to obtain informed consent for this. We systematically searched the empirical literature, identifying 63 articles exploring stakeholder perspectives on processes for obtaining informed consent about return of results and/or result delivery. Participants, patients and members of the public generally felt they should choose which results are returned to them and how, ranging from direct (face-to-face, telephone) to indirect (letters, emails, web-based delivery) communication. Professionals identified inadequacies in result delivery processes in the research context. Our findings have important implications for ensuring participants are supported in deciding which results they wish to receive or, if no choice is offered, preparing them for potential research outcomes.
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Affiliation(s)
- Danya F Vears
- Melbourne Law School, University of Melbourne, Carlton 3052, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville 3052, Australia.,Center for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, Leuven 3000, Belgium.,Leuven Institute for Human Genetics & Society, Leuven 3000, Belgium
| | - Joel T Minion
- Policy, Ethics & Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle NE1 7RU, UK
| | - Stephanie J Roberts
- Policy, Ethics & Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle NE1 7RU, UK
| | - James Cummings
- School of Art, Media & American Studies, University of East Anglia, NR4 7TJ, UK
| | - Mavis Machirori
- School of Social & Political Sciences, University of Glasgow, G12 8QQ, UK
| | - Madeleine J Murtagh
- Policy, Ethics & Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle NE1 7RU, UK.,School of Social & Political Sciences, University of Glasgow, G12 8QQ, UK
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7
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Kostick KM, Blumenthal-Barby JS. Avoiding "toxic knowledge": the importance of framing personalized risk information in clinical decision-making. Per Med 2021; 18:91-95. [PMID: 33616460 DOI: 10.2217/pme-2020-0174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
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8
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Corsico P. "It's all about delivery": researchers and health professionals' views on the moral challenges of accessing neurobiological information in the context of psychosis. BMC Med Ethics 2021; 22:11. [PMID: 33557813 PMCID: PMC7869514 DOI: 10.1186/s12910-020-00551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health Service (NHS) or a university in England (n = 14), and mental health professionals employed in NHS mental health services (n = 14). This article compares results in the two groups (total n = 28). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255.
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Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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9
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Lázaro-Muñoz G, Torgerson L, Pereira S. Return of results in a global survey of psychiatric genetics researchers: practices, attitudes, and knowledge. Genet Med 2021; 23:298-305. [PMID: 33033403 PMCID: PMC8374879 DOI: 10.1038/s41436-020-00986-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Patient-participants in psychiatric genetics research may be at an increased risk for negative psychosocial impacts related to the return of genetic research results. Examining psychiatric genetics researchers' return of results practices and perspectives can aid the development of empirically informed and ethically sound guidelines. METHODS A survey of 407 psychiatric genetics researchers from 39 countries was conducted to examine current return of results practices, attitudes, and knowledge. RESULTS Most respondents (61%) reported that their studies generated medically relevant genomic findings. Although 24% have returned results to individual participants, 52% of those involved in decisions about return of results plan to return or continue to return results. Respondents supported offering "medically actionable" results related to psychiatric disorders (82%), and the majority agreed non-medically actionable risks for Huntington (71%) and Alzheimer disease (64%) should be offered. About half (49%) of respondents supported offering reliable polygenic risk scores for psychiatric conditions. Despite plans to return, only 14% of researchers agreed there are adequate guidelines for returning results, and 59% rated their knowledge about how to manage the process for returning results as poor. CONCLUSION Psychiatric genetics researchers support returning a wide range of results to patient-participants, but they lack adequate knowledge and guidelines.
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Affiliation(s)
- Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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10
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Streeten EA, See VY, Jeng LBJ, Maloney KA, Lynch M, Glazer AM, Yang T, Roden D, Pollin TI, Daue M, Ryan KA, Van Hout C, Gosalia N, Gonzaga-Jauregui C, Economides A, Perry JA, O'Connell J, Beitelshees A, Palmer K, Mitchell BD, Shuldiner AR. KCNQ1 and Long QT Syndrome in 1/45 Amish: The Road From Identification to Implementation of Culturally Appropriate Precision Medicine. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e003133. [PMID: 33141630 PMCID: PMC7748050 DOI: 10.1161/circgen.120.003133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. In population-based research exome sequencing, the path from variant discovery to return of results is not well established. Variants discovered by research exome sequencing have the potential to improve population health.
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Affiliation(s)
- Elizabeth A Streeten
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Vincent Y See
- Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine.,Division of Cardiolovascular Medicine (V.Y.S., T.I.P., K.P.), University of Maryland School of Medicine
| | - Linda B J Jeng
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Kristin A Maloney
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Megan Lynch
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Andrew M Glazer
- Division of Clinical Pharmacology, Department of Medicine (A.M.G., T.Y., D.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Tao Yang
- Division of Clinical Pharmacology, Department of Medicine (A.M.G., T.Y., D.R.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology (T.Y., D.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Dan Roden
- Division of Clinical Pharmacology, Department of Medicine (A.M.G., T.Y., D.R.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology (T.Y., D.R.), Vanderbilt University Medical Center, Nashville, TN.,Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Toni I Pollin
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine.,Division of Cardiolovascular Medicine (V.Y.S., T.I.P., K.P.), University of Maryland School of Medicine
| | - Melanie Daue
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Kathleen A Ryan
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Cristopher Van Hout
- Regeneron Genetics Center LLC, Tarrytown, NY (C.V.H., N.G., C.G.-J., A.E., A.R.S.)
| | - Nehal Gosalia
- Regeneron Genetics Center LLC, Tarrytown, NY (C.V.H., N.G., C.G.-J., A.E., A.R.S.)
| | | | - Aris Economides
- Regeneron Genetics Center LLC, Tarrytown, NY (C.V.H., N.G., C.G.-J., A.E., A.R.S.)
| | - James A Perry
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Jeffrey O'Connell
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Amber Beitelshees
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine
| | - Kathleen Palmer
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Division of Cardiolovascular Medicine (V.Y.S., T.I.P., K.P.), University of Maryland School of Medicine
| | - Braxton D Mitchell
- Program for Personalized and Genomic Medicine (E.A.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., K.P., B.D.M.), University of Maryland School of Medicine.,Department of Medicine (E.A.S., V.Y.S., L.B.J.J., K.A.M., M.L., T.I.P., M.D., K.A.R., J.A.P., J.O., A.B., B.D.M.), University of Maryland School of Medicine.,Baltimore Veterans Administration Medical Center Geriatrics Research and Education Clinical Center, Baltimore, MD (B.D.M.)
| | - Alan R Shuldiner
- Regeneron Genetics Center LLC, Tarrytown, NY (C.V.H., N.G., C.G.-J., A.E., A.R.S.)
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11
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Perceptions of best practices for return of results in an international survey of psychiatric genetics researchers. Eur J Hum Genet 2020; 29:231-240. [PMID: 33011736 PMCID: PMC7532738 DOI: 10.1038/s41431-020-00738-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Many research sponsors and genetic researchers agree that some medically relevant genetic findings should be offered to participants. The scarcity of research specific to returning genetic results related to psychiatric disorders hinders the ability to develop ethically justified and empirically informed guidelines for responsible return of results for these conditions. We surveyed 407 psychiatric genetics researchers from 39 countries to examine their perceptions of challenges to returning individual results and views about best practices for the process of offering and returning results. Most researchers believed that disclosure of results should be delayed if a patient-participant is experiencing significant psychiatric symptoms. Respondents felt that there is little research on the impact of returning results to participants with psychiatric disorders and agreed that return of psychiatric genetics results to patient-participants may lead to discrimination by insurance companies or other third parties. Almost half of researchers believed results should be returned through a participant's treating psychiatrist, but many felt that clinicians lack knowledge about how to manage genetic research results. Most researchers thought results should be disclosed by genetic counselors or medical geneticists and in person; however, almost half also supported disclosure via telemedicine. This is the first global survey to examine the perspectives of researchers with experience working with this patient population and with these conditions. Their perspectives can help inform the development of much-needed guidelines to promote responsible return of results related to psychiatric conditions to patients with psychiatric disorders.
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12
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Driver MN, Kuo SIC, Dick DM. Genetic feedback for psychiatric conditions: Where are we now and where are we going. Am J Med Genet B Neuropsychiatr Genet 2020; 183:423-432. [PMID: 32812348 PMCID: PMC8108123 DOI: 10.1002/ajmg.b.32815] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/12/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022]
Abstract
Genome-wide association studies are rapidly advancing our understanding of the genetic architecture of complex disorders, including many psychiatric conditions such as major depression, schizophrenia, and substance use disorders. One common goal of genome-wide association studies is to use findings for enhanced clinical prediction in the future, which can aid in identifying at-risk individuals to enable more effective prevention screening and treatment strategies. In order to achieve this goal, we first need to gain a better understanding of the issues surrounding the return of complex genetic results. In this article, we summarize the current literature on: (a) genetic literacy in the general population, (b) the public's interest in receiving genetic test results for psychiatric conditions, (c) how individuals react to and interpret their genotypic information for specific psychiatric conditions, and (d) gaps in our knowledge that will be critical to address as we move toward returning genotypic information for psychiatric conditions in both research and clinical settings. By reviewing extant studies, we aim to increase awareness of the potential benefits and consequences of returning genotypic information for psychiatric conditions.
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Affiliation(s)
- Morgan N. Driver
- Department of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine, Richmond, Virginia
| | - Sally I-Chun Kuo
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle M. Dick
- Department of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine, Richmond, Virginia,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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13
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Lázaro-Muñoz G, Lenk C. The need for attention to the ethical, legal, and social implications of advances in psychiatric genomics. Am J Med Genet B Neuropsychiatr Genet 2019; 180:521-522. [PMID: 31693284 DOI: 10.1002/ajmg.b.32768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Gabriel Lázaro-Muñoz
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas
| | - Christian Lenk
- Institute for the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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14
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Lázaro-Muñoz G, Sabatello M, Huckins L, Peay H, Degenhardt F, Meiser B, Lencz T, Soda T, Docherty A, Crepaz-Keay D, Austin J, Peterson RE, Davis LK. International Society of Psychiatric Genetics Ethics Committee: Issues facing us. Am J Med Genet B Neuropsychiatr Genet 2019; 180:543-554. [PMID: 31124312 PMCID: PMC6861601 DOI: 10.1002/ajmg.b.32736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/21/2019] [Accepted: 05/10/2019] [Indexed: 12/19/2022]
Abstract
Psychiatric genetics research is improving our understanding of the biological underpinnings of neurodiversity and mental illness. Using psychiatric genetics in ways that maximize benefits and minimize harms to individuals and society depends largely on how the ethical, legal, and social implications (ELSI) of psychiatric genetics are managed. The International Society of Psychiatric Genetics (ISPG) is the largest international organization dedicated to psychiatric genetics. Given its history, membership, and international reach, we believe the ISPG is well-equipped to contribute to the resolution of these ELSI challenges. As such, we recently created the ISPG Ethics Committee, an interdisciplinary group comprised of psychiatric genetics researchers, clinical geneticists, genetic counselors, mental health professionals, patients, patient advocates, bioethicists, and lawyers. This article highlights key ELSI challenges identified by the ISPG Ethics Committee to be of paramount importance for the ethical translation of psychiatric research into society in three contexts: research settings, clinical settings, and legal proceedings. For each of these arenas, we identify and discuss pressing psychiatric genetics ELSI dilemmas that merit attention and require action. The goal is to increase awareness about psychiatric genetics ELSI issues and encourage dialogue and action among stakeholders.
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Affiliation(s)
| | | | - Laura Huckins
- Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Holly Peay
- RTI International, Research Triangle Park, NC, USA 27709
| | | | - Bettina Meiser
- University of New South Wales, UNSW Sydney 2052, Australia
| | - Todd Lencz
- Hofstra University, Hempstead, NY, USA 11549
| | - Takahiro Soda
- University of North Carolina at Chapel Hill, NC, USA 27599
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15
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Pereira S. "DNA Is Information, and Genetics Is Information Technology": Reconsidering the Genetic Code. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:75-76. [PMID: 31307366 DOI: 10.1080/15265161.2018.1544321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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