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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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Bak MAR, Ploem MC, Ateşyürek H, Blom MT, Tan HL, Willems DL. Stakeholders' perspectives on the post-mortem use of genetic and health-related data for research: a systematic review. Eur J Hum Genet 2020; 28:403-416. [PMID: 31527854 PMCID: PMC7080773 DOI: 10.1038/s41431-019-0503-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 01/20/2023] Open
Abstract
The majority of biobank policies and consent forms do not address post-mortem use of data for medical research, thus causing uncertainty after research participants' death. This systematic review identifies studies examining stakeholders' perspectives on this issue. We conducted a search in MEDLINE, CINAHL, EMBASE and Web of Science. Findings were categorised in two themes: (1) views on the use of data for medical research after participants' death, and (2) perspectives regarding the post-mortem return of individual genetic research results. An important subtheme was the appropriate authority and degree of control over posthumous use of data. The sixteen included studies all focused on genetic data and used quantitative and qualitative methods to survey perspectives of research participants, family members, researchers and Institutional Review Board members. Acceptability of post-mortem use of data for medical research was high among research participants and their relatives. Most stakeholders thought participants should be informed about post-mortem research uses during initial consent. Between lay persons and professionals, disagreement exists about whether relatives should receive actionable genetic findings, and whether the deceased's previous preferences can be overridden. We conclude that regulations and ethical guidance should leave room for post-mortem use of personal data for research, provided that informed consent procedures are transparent on this issue, including the return of individual research findings to relatives. Future research is needed to explore underlying causes for differences in views, as well as ethical and legal issues on the appropriate level of control by deceased research participants (while alive) and their relatives.
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Affiliation(s)
- Marieke A R Bak
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Corrette Ploem
- Section of Health Law, Department of Social Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hakan Ateşyürek
- Faculty of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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"I would like to discuss it further with an expert": a focus group study of Finnish adults' perspectives on genetic secondary findings. J Community Genet 2018; 9:305-314. [PMID: 29340884 DOI: 10.1007/s12687-018-0356-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022] Open
Abstract
Lowered costs of genomic sequencing facilitate analyzing large segments of genetic data. Ethical debate has focused on whether and what kind of incidental or secondary findings (SFs) to report, and how to obtain valid informed consent. However, people's support needs after receiving SFs have received less attention. We explored Finnish adults' perspectives on reporting genetic SFs. In this qualitative study which included four focus group discussions (N = 23) we used four vignette letters, each reporting a genetic SF predisposing to a different disease: familial hypercholesterolemia, long QT syndrome, Lynch syndrome, and Li-Fraumeni syndrome. Transcribed focus group discussions were analyzed using inductive thematic analysis. Major themes were immediate shock, dealing with worry and heightened risk, fear of being left alone to deal with SFs, disclosing to family, and identified support needs. Despite their willingness to receive SFs, participants were concerned about being left alone to deal with them. Empathetic expert support and timely access to preventive care were seen as essential to coping with shock and worry, and disclosing SFs to family. Discussion around SFs needs to concern not only which findings to report, but also how healthcare systems need to prepare for providing timely access to preventive care and support for individuals and families.
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Germline mutations in BRCA1 and BRCA2 incidentally revealed in a biobank research study: experiences from re-contacting mutation carriers and relatives. J Community Genet 2017; 9:201-208. [PMID: 29082482 PMCID: PMC6002297 DOI: 10.1007/s12687-017-0341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/09/2017] [Indexed: 01/30/2023] Open
Abstract
Once an incidental finding (IF) is discovered in the course of genomic research, the researchers are faced with the question of whether or not that finding should be reported back to the study participant. A large number of hypothetical studies and policy documents on this issue have been published, but there are very few empirical studies to inform the bioethics debate. Within a biobank research study of somatic mutations in breast carcinomas, ten germline BRCA1/2 mutations were incidentally detected. After thorough discussions within a group of experts, the mutation carriers (n = 7) or relatives of deceased carriers (n = 3) were re-contacted and informed about the findings. Eight out of ten accepted to receive the information and underwent confirmatory testing. One year later, semi-structured interviews were undertaken with three of the study participants. All of them felt that BRCA mutations discovered in the course of research should be reported back to the individual study participants. In this paper, we report our step-by-step experiences of the re-contacting process. We hope that our detailed reporting will be helpful for other researchers and clinicians that are faced with similar situations. The results of our study lend empirical support to opinion that IFs that meet the three baseline criteria of analytic validity, clinical significance, and actionability should be reported back to the individual study participants.
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Manning M, Albrecht TL, Yilmaz-Saab Z, Shultz J, Purrington K. Influences of race and breast density on related cognitive and emotion outcomes before mandated breast density notification. Soc Sci Med 2016; 169:171-179. [PMID: 27733299 DOI: 10.1016/j.socscimed.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE Many states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws. OBJECTIVE We examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD. METHODS We received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD. RESULTS Whereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only. CONCLUSION We present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States.
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Zeynep Yilmaz-Saab
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Julie Shultz
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Kristen Purrington
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
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Unsolicited findings of next-generation sequencing for tumor analysis within a Dutch consortium: clinical daily practice reconsidered. Eur J Hum Genet 2016; 24:1496-500. [PMID: 27071717 DOI: 10.1038/ejhg.2016.27] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 12/24/2022] Open
Abstract
Cancer patients participating in studies involving experimental or diagnostic next-generation sequencing (NGS) procedures are confronted with the possibility of unsolicited findings. The Center for Personalized Cancer Treatment (CPCT), a Dutch consortium of cancer centers, is offering centralized large-scale NGS for the discovery of somatic tumor mutations with their germline DNA as reference. The CPCT aims to give all cancer patients with advanced disease stages access to tumor DNA analysis in order to improve selection for experimental therapy. In this article, our experiences at the CPCT will serve as an example to discuss the ethical and practical aspects regarding the management of unsolicited findings in personalized cancer research and treatment. Generic issues, relevant for all researchers in this field are discussed and illustrated by description of three patients faced with an unsolicited DNA finding, while they intended to be candidate for future anticancer treatment by participating in a trial that included NGS of both somatic and germline DNA. As options for DNA analysis expand and costs decrease rapidly, more and more patients are offered large-scale NGS testing. After reviewing current recommendations in literature, we conclude that classical informed consent procedures need to be adapted to become more explicit in asking patients if they want to be informed about unsolicited findings and if so, what level of detail of genetic risk information exactly they want to be returned after the analysis.
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Forrest LE, Young MA. Clinically Significant Germline Mutations in Cancer-Causing Genes Identified Through Research Studies Should Be Offered to Research Participants by Genetic Counselors. J Clin Oncol 2016; 34:898-901. [PMID: 26786918 DOI: 10.1200/jco.2015.60.9388] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Laura E Forrest
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia and The University of Melbourne, Melbourne, Victoria, Australia
| | - Mary-Anne Young
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Greenberg M, Smith RA. Support Seeking or Familial Obligation: An Investigation of Motives for Disclosing Genetic Test Results. HEALTH COMMUNICATION 2015; 31:668-78. [PMID: 26507777 PMCID: PMC5139682 DOI: 10.1080/10410236.2014.989384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Genetic test results reveal not only personal information about a person's likelihood of certain medical conditions but also information about the person's genetic relatives. Given the familial nature of genetic information, one's obligation to protect family members may be a motive for disclosing genetic test results, but this claim has not been methodically tested. Existing models of disclosure decision making presume self-interested motives, such as seeking social support, instead of other-interested motives, like familial obligation. This study investigated young adults' (N = 173) motives to share a genetic-based health condition, alpha-1 antitrypsin deficiency, after reading a hypothetical vignette. Results show that social support and familial obligation were both reported as motives for disclosure. In fact, some participants reported familial obligation as their primary motivator for disclosure. Finally, stronger familial obligation predicted increased likelihood of disclosing hypothetical genetic test results. Implications of these results were discussed in reference to theories of disclosure decision-making models and the practice of genetic disclosures.
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Affiliation(s)
- Marisa Greenberg
- a Department of Communication Arts and Sciences , Pennsylvania State University
| | - Rachel A Smith
- a Department of Communication Arts and Sciences , Pennsylvania State University
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Giacomazzi CR, Giacomazzi J, Netto CB, Santos-Silva P, Selistre SG, Maia AL, Oliveira VZD, Camey SA, Goldim JR, Ashton-Prolla P. Pediatric cancer and Li-Fraumeni/Li-Fraumeni-like syndromes: a review for the pediatrician. Rev Assoc Med Bras (1992) 2015; 61:282-9. [DOI: 10.1590/1806-9282.61.03.282] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 10/17/2014] [Indexed: 11/21/2022] Open
Abstract
Summary Introduction: cancer is the second leading cause of death in children between the ages of 0 and 14 years, corresponding to approximately 3% of all cases diagnosed in Brazil. A significant percentage (5-10%) of pediatric cancers are associated with hereditary cancer syndromes, including Li-Fraumeni/Li-Fraumeni-like syndromes (LFS/LFL), both of which are caused by TP53 germline mutations. Recent studies have shown that a specific TP53 mutation, known as p.R337H, is present in 1 in 300 newborns in Southern and Southeast Brazil. In addition, a significant percentage of children with LFS/LFL spectrum tumors in the region have a family history compatible with LFS/LFL. Objective: to review clinical relevant aspects of LFS/LFL by our multidisciplinary team with focus on pediatric cancer. Methods: the NCBI (PubMed) and SciELO databases were consulted using the keywords Li-Fraumeni syndrome, Li-Fraumeni-like syndrome and pediatric cancer; and all manuscripts published between 1990 and 2014 using these keywords were retrieved and reviewed. Conclusion: although LFS/LFL is considered a rare disease, it appears to be substantially more common in certain geographic regions. Recognition of population- specific risks for the syndrome is important for adequate management of hereditary cancer patients and families. In Southern and Southeastern Brazil, LFS/ LFL should be considered in the differential diagnosis of children with cancer, especially if within the spectrum of the syndrome. Due to the complexities of these syndromes, a multidisciplinary approach should be sought for the counseling, diagnosis and management of patients and families affected by these disorders. Pediatricians and pediatric oncologists in areas with high prevalence of hereditary cancer syndromes have a central role in the recognition and proper referral of patients and families to genetic cancer risk evaluation and management programs.
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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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Family decision maker perspectives on the return of genetic results in biobanking research. Genet Med 2015; 18:82-8. [PMID: 25856669 PMCID: PMC4600004 DOI: 10.1038/gim.2015.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/17/2015] [Indexed: 02/06/2023] Open
Abstract
PURPOSE There are many ethical considerations regarding the return of genetic results to biobanking participants, especially when biobanks collect samples from deceased organ and tissue donors that require the authorization of a family decision maker (FDM). This article explores FDM knowledge and opinions regarding return of genetic results in the context of the Genotype-Tissue Expression (GTEx) Project, which does not return results to participants. METHODS Data collection included a survey completed by Organ Procurement Organization requesters (n = 22) and semistructured telephone interviews with FDM (n = 55). RESULTS Nearly every FDM wanted some form of genetic results returned. Information regarding treatable diseases (94.3%) and diseases that could affect their children (84.9%) were more desirable than that regarding untreatable diseases (71.7%). Sixty percent of FDMs understood that GTEx would not return genetic results. FDMs were four times more likely to have correct knowledge of the GTEx policy when their GTEx requester reported discussing the topic with them. CONCLUSION FDMs from the GTEx project were interested in receiving genetic test results. Marked changes in the infrastructure of the GTEx would be required to alter the policy. Regardless, care must be taken to ensure that the return policy is clearly communicated with FDMs to dispel misconceptions.Genet Med 18 1, 82-88.
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Scollon S, Bergstrom K, McCullough LB, McGuire AL, Gutierrez S, Kerstein R, Parsons DW, Plon SE. Pediatric Cancer Genetics Research and an Evolving Preventive Ethics Approach for Return of Results after Death of the Subject. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:529-537. [PMID: 26479562 PMCID: PMC4617204 DOI: 10.1111/jlme.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The return of genetic research results after death in the pediatric setting comes with unique complexities. Researchers must determine which results and through which processes results are returned. This paper discusses the experience over 15 years in pediatric cancer genetics research of returning research results after the death of a child and proposes a preventive ethics approach to protocol development in order to improve the quality of return of results in pediatric genomic settings.
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Affiliation(s)
- Sarah Scollon
- Board-certified genetic counselor at Baylor College of Medicine. She received her M.S. in Genetic Counseling from University of Michigan, Ann Arbor, MI
| | - Katie Bergstrom
- Board certified genetic counselor at Baylor College of Medicine. She received her M.S. in Genetic Counseling from the University of Utah in Salt Lake City, UT
| | - Laurence B McCullough
- Professor of Medicine and Medical Ethics and the Associate Director for Education and holder of the Dalton Tomlin Chair in Medical Ethics and Health Policy in the Center for Medical Ethics and Health Policy, Baylor College of Medicine. He received his Ph.D. from University of Texas, Austin, TX
| | - Amy L McGuire
- Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy and a member of the Human Genome Sequencing Center at Baylor College of Medicine. She received her J.D. from the University of Houston, Houston, TX and her Ph.D. from the Institute for Medical Humanities at University of Texas Medical Branch
| | - Stephanie Gutierrez
- Project manager at Baylor College of Medicine. She received her B.S. from Texas State University in San Marcos, TX
| | - Robin Kerstein
- Project coordinator for the Baylor College of Medicine Advancing Sequencing in Childhood Cancer Care (BASIC3) study at Baylor College of Medicine. She received her M.T. from Baylor University, Waco, TX. She holds ASCP and CCRA certifications
| | - D Williams Parsons
- Board-certified pediatric hematologist-oncologist who studies the clinical application of genomic technologies in pediatric cancer care. He is the Director of the Center for Personal Cancer Genomics and Therapeutics and the Co-Director of the Cancer Genetics & Genomics Program at Texas Children's Cancer and Hematology Centers, Baylor College of Medicine. He received his M.D. and Ph.D. from Ohio State University College of Medicine, Columbus, OH
| | - Sharon E Plon
- Board-certified medical geneticist who focuses on laboratory and clinical research related to cancer susceptibility. She is a Professor in the departments of Pediatrics and Molecular and Human Genetics at Baylor College of Medicine. She is the Director of the Cancer Genetics and Genomics Program at Texas Children's Cancer and Hematology Centers. She received her M.D. and Ph.D. from Harvard University, Boston, MA
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Jarvik GP, Amendola LM, Berg JS, Brothers K, Clayton EW, Chung W, Evans BJ, Evans JP, Fullerton SM, Gallego CJ, Garrison NA, Gray SW, Holm IA, Kullo IJ, Lehmann LS, McCarty C, Prows CA, Rehm HL, Sharp RR, Salama J, Sanderson S, Van Driest SL, Williams MS, Wolf SM, Wolf WA, Burke W. Return of genomic results to research participants: the floor, the ceiling, and the choices in between. Am J Hum Genet 2014; 94:818-26. [PMID: 24814192 DOI: 10.1016/j.ajhg.2014.04.009] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/11/2014] [Indexed: 11/17/2022] Open
Abstract
As more research studies incorporate next-generation sequencing (including whole-genome or whole-exome sequencing), investigators and institutional review boards face difficult questions regarding which genomic results to return to research participants and how. An American College of Medical Genetics and Genomics 2013 policy paper suggesting that pathogenic mutations in 56 specified genes should be returned in the clinical setting has raised the question of whether comparable recommendations should be considered in research settings. The Clinical Sequencing Exploratory Research (CSER) Consortium and the Electronic Medical Records and Genomics (eMERGE) Network are multisite research programs that aim to develop practical strategies for addressing questions concerning the return of results in genomic research. CSER and eMERGE committees have identified areas of consensus regarding the return of genomic results to research participants. In most circumstances, if results meet an actionability threshold for return and the research participant has consented to return, genomic results, along with referral for appropriate clinical follow-up, should be offered to participants. However, participants have a right to decline the receipt of genomic results, even when doing so might be viewed as a threat to the participants' health. Research investigators should be prepared to return research results and incidental findings discovered in the course of their research and meeting an actionability threshold, but they have no ethical obligation to actively search for such results. These positions are consistent with the recognition that clinical research is distinct from medical care in both its aims and its guiding moral principles.
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Affiliation(s)
- Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jonathan S Berg
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kyle Brothers
- Hudson Alpha Institute for Biotechnology, Huntsville, AL 35806, USA; Department of Pediatrics, University of Louisville, Louisville, KY 40292, USA
| | - Ellen W Clayton
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37204, USA
| | - Wendy Chung
- Columbia University, New York, NY 10032, USA
| | | | - James P Evans
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Carlos J Gallego
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Nanibaa' A Garrison
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37204, USA
| | - Stacy W Gray
- Brigham and Women's Hospital and Harvard Medical School, Cambridge, MA 02138, USA; Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Cathy McCarty
- Essentia Institute of Rural Health, Duluth, MN 55805, USA
| | - Cynthia A Prows
- Divisions of Human Genetics and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Heidi L Rehm
- Brigham and Women's Hospital and Harvard Medical School, Cambridge, MA 02138, USA
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph Salama
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Saskia Sanderson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sara L Van Driest
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37204, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, PA 17822, USA
| | - Susan M Wolf
- Law School, Medical School, and Consortium on Law and Values in Health, Environment, & the Life Sciences, Minneapolis, University of Minnesota, Minneapolis, MN 55455, USA
| | - Wendy A Wolf
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
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Campuzano O, Allegue C, Partemi S, Iglesias A, Oliva A, Brugada R. Negative autopsy and sudden cardiac death. Int J Legal Med 2014; 128:599-606. [PMID: 24532175 DOI: 10.1007/s00414-014-0966-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/15/2014] [Indexed: 12/20/2022]
Abstract
Forensic medicine defines the unexplained sudden death as a death with a non-conclusive diagnosis after autopsy. Molecular diagnosis is being progressively incorporated in forensics, mainly due to improvement in genetics. New genetic technologies may help to identify the genetic cause of death, despite clinical interpretation of genetic data remains the current challenge. The identification of an inheritable defect responsible for arrhythmogenic syndromes could help to adopt preventive measures in family members, many of them asymptomatic but at risk of sudden death. This multidisciplinary translational research requires a specialized team.
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Affiliation(s)
- Oscar Campuzano
- Cardiovascular Genetic Center, University of Girona-IDIBGI, Girona, Spain
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15
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Haukkala A, Kujala E, Alha P, Salomaa V, Koskinen S, Swan H, Kääriäinen H. The return of unexpected research results in a biobank study and referral to health care for heritable long QT syndrome. Public Health Genomics 2013; 16:241-50. [PMID: 24029681 DOI: 10.1159/000354105] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In this study, we examined how biobank study participants, who were found to have long QT syndrome (LQTS), a potentially life-threatening but treatable cardiac arrhythmia condition, experienced the process of disclosure of unexpected results and referral to health care. METHODS All 27 subjects with a LQTS mutation finding were asked to complete a questionnaire. Four participants did not uptake the re-testing and 5 others did not respond to the questionnaire. We received 17 questionnaires from 6 males and 11 females, aged 46-82; 5 of them were also willing to participate in qualitative interviews. RESULTS Of the respondents, 16/17 had experienced the process of receiving the results as positive and useful, especially if they had had symptoms. One respondent experienced the process negatively due to concerns related to informing her children. All respondents felt that genetic results should be reported back to the participants, while 2 indicated that this should occur only in the case of treatable conditions. Respondents had informed all of their children about the genetic condition, except 2 minors. CONCLUSIONS The respondents from a population biobank study who were informed about an unexpected genetic finding evaluated this process as mainly positive. They considered that delivering genetic information about a life-threatening but actionable condition has more beneficial than adverse consequences. The feedback policy for biobanks should include how and who is informed, advise treatment or care pathways for actionable findings, and it should also include suitable options for those who do not want to know about such findings.
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Affiliation(s)
- A Haukkala
- Department of Social Research, University of Helsinki, Helsinki, Finland
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16
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Wolf SM. Return of individual research results and incidental findings: facing the challenges of translational science. Annu Rev Genomics Hum Genet 2013; 14:557-77. [PMID: 23875796 PMCID: PMC4452115 DOI: 10.1146/annurev-genom-091212-153506] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The debate over return of individual research results and incidental findings to study participants is a key frontier in research ethics and practice. This is fundamentally a problem of translational science-a question of when information about an individual that is generated in research should be communicated for clinical attention, particularly as technologies such as whole-genome sequencing and whole-exome sequencing are increasingly used in clinical care. There is growing consensus that investigators should offer participants at least those individual findings of high clinical importance and actionability. Increasing attention to what information biobanks and secondary researchers owe people who provide data and specimens offers an opportunity to treat these source individuals as research partners. Cutting-edge issues include return of results in pediatric populations and return to kin and family, both before and after the death of the proband, as well as how to manage incidental findings in clinical sequencing. Progress will require an understanding of the continuum linking research and clinical care and developing standards and models for return.
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Affiliation(s)
- Susan M Wolf
- Law School, Medical School, and Center for Bioethics, University of Minnesota, Minneapolis, Minnesota 55455;
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17
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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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18
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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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19
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Perspectives of surrogate decision makers for critically ill patients regarding gene variation research. Genet Med 2012; 15:368-73. [PMID: 23154525 DOI: 10.1038/gim.2012.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We undertook this investigation to explore the manner in which surrogate decision makers for critically ill patients perceived genetic data collected in the context of clinical investigation. METHODS Surrogate decision makers for critically ill patients cared for in intensive care units of two urban hospitals participated in focus groups designed to explore perceptions regarding gene variation research. RESULTS Surrogate decision makers were generally familiar with genetic concepts and reported that they could provide an informed opinion regarding permitting (or declining) the participation of their loved ones in gene variation research. Respondents perceived the risk associated with this type of research largely as the risk associated with acquiring the sample (i.e., whether it involved an invasive procedure or not) but appreciated that genetic samples could provide information not readily obtained from nongenetic sources. Concerns about potential misuse of genetic data largely centered on misconduct, paternity, forensic applications, and insurance and employment discrimination. Although surrogate decision makers expressed that their loved ones would have interest in return of results and being recontacted for future use, these interests were secondary to confidentiality concerns. CONCLUSION Respondents perceived genetic and nongenetic data as comparable. Informed consent processes that provide clear information regarding confidentiality protections, specimen handling, and parameters for future use may enhance enrollment.Genet Med 2013:15(5):368-373.
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20
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Hawkins NA, McCarty F, Peipins LA, Rodriguez JL. Measuring the degree of closeness to the cancer experience: development and initial validation of the CONNection to the Experience of Cancer Scale (CONNECS). PATIENT EDUCATION AND COUNSELING 2012; 89:292-9. [PMID: 22940373 PMCID: PMC6334758 DOI: 10.1016/j.pec.2012.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/19/2012] [Accepted: 08/09/2012] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To describe the development and psychometric testing of items measuring connection to the cancer experience through a close friend or relative. METHODS Ten items assess four aspects of connection to cancer: emotional and cognitive involvement, kind and amount of shared experience, perceived similarity to the affected person, and negative change witnessed. Interviews were conducted with 2200 women close to someone with cancer. The sample was split into two samples for exploratory and confirmatory factor analysis. Sample 1 (n=1342) was used to examine the underlying structure of the items. Sample 2 (n=858) was used for CFA. Internal consistency and reliability analysis were also conducted. RESULTS Three factors with moderate correlation were extracted: general closeness, resemblance, and cognitive processing. Results from the CFA analysis confirmed a good fit of the three-factor model (Bentler-Bonett NIF=0.973, Bentler-Bonett NNFI=0.975, RMSEA=0.040 and CFI=0.984) and all path coefficients were statistically significant. CONCLUSION Findings provide preliminary evidence for the reliability and construct validity of the CONNECS scale in measuring individuals' connection to the cancer experience through a close friend or relative. PRACTICE IMPLICATIONS CONNECS may be a useful tool for examining the impact of the cancer experience on risk perceptions, cancer worry, and medical decision making.
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Affiliation(s)
- Nikki A Hawkins
- Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control, Atlanta, GA 30341, USA.
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21
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Fernandez CV, Ruccione K, Wells RJ, Long JB, Pelletier W, Hooke MC, Pentz RD, Noll RB, Baker JN, O'Leary M, Reaman G, Adamson PC, Joffe S. Recommendations for the return of research results to study participants and guardians: a report from the Children's Oncology Group. J Clin Oncol 2012; 30:4573-9. [PMID: 23109703 DOI: 10.1200/jco.2012.45.2086] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Children's Oncology Group (COG) strongly supports the widely recognized principle that research participants should be offered a summary of study results. The mechanism by which to do so in a cooperative research group setting has not been previously described. METHODS On the basis of a review of the available empirical and theoretic literature and on iterative, multidisciplinary discussion, a COG Return of Results Task Force (RRTF) offered detailed recommendations for the return of results to research study participants. RESULTS The RRTF established guidelines for the notification of research participants and/or their parents/guardians about the availability of research results, a mechanism for and timing of sharing results via registration on the COG public Web site, the scope of the research to be shared, the target audience, and a process for creating and vetting lay summaries of study results. The RRTF recognized the challenges in adequately conveying complex scientific results to audiences with varying levels of health literacy and recommended that particularly sensitive or complex results be returned using direct personal contact. The RRTF also recommended evaluation of the cost, effectiveness, and impact of sharing results. CONCLUSION These recommendations provide a framework for the offering and returning of results to participants. They can be used by individual investigators, multi-investigator research collaboratives, and large cooperative groups.
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Affiliation(s)
- Conrad V Fernandez
- Izaak Walton Killam and Steven Joffe Health Centre, Dalhousie University, Halifax, Nova Scotia
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22
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Freeman BD, Kennedy CR, Bolcic-Jankovic D, Eastman A, Iverson E, Shehane E, Celious A, Barillas J, Clarridge B. Considerations in the construction of an instrument to assess attitudes regarding critical illness gene variation research. J Empir Res Hum Res Ethics 2012; 7:58-70. [PMID: 22378135 DOI: 10.1525/jer.2012.7.1.58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical studies conducted in intensive care units are associated with logistical and ethical challenges. Diseases investigated are precipitous and life-threatening, care is highly technological, and patients are often incapacitated and decision-making is provided by surrogates. These investigations increasingly involve collection of genetic data. The manner in which the exigencies of critical illness impact attitudes regarding genetic data collection is unstudied. Given interest in understanding stakeholder preferences as a foundation for the ethical conduct of research, filling this knowledge gap is timely. The conduct of opinion research in the critical care arena is novel. This brief report describes the development of parallel patient/surrogate decision-maker quantitative survey instruments for use in this environment. Future research employing this instrument or a variant of it with diverse populations promises to inform research practices in critical illness gene variation research.
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Affiliation(s)
- Bradley D Freeman
- Washington University School of Medicine, Department of Surgery, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
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23
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Cox K, Fernandez CV, Chambers CT, Bandstra NF, Parker JA. Impact on parents of receiving individualized feedback of psychological testing conducted with children as part of a research study. Account Res 2012; 18:342-56. [PMID: 21916741 DOI: 10.1080/08989621.2011.606737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
While many researchers accept the principle that participants have a right to receive information learned from their participation in research, there are few studies examining the impact of receiving results on participants. This study was developed to examine the impact on parents of the receipt of individual results of research-based psychological testing of their children. A summary of the child's individual results of standardized measures of language and development was sent by mail with the questionnaire designed to assess the impact of receiving results. Response rate from the mailed questionnaire was 55.6% (n=74/133). Most parents reported the results as helpful and positive. The majority would receive results again. Overall, the sharing of individualized feedback from psychological testing conducted as part of a research study was well accepted by parents. This practice appears ethically permissible with appropriate support options for addressing participant concerns upon receiving the results as well options for clinical follow-up for the child.
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Affiliation(s)
- Kelly Cox
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
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24
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Abstract
This review of family communication of genetic risk information addresses questions of what the functions and influences on communication are; what, who and how family members are told about genetic risk information; what the impact for counsellee, relative and relationships are; whether there are differences by gender and condition; and what theories and methodologies are used. A systematic search strategy identified peer-reviewed journal articles published 1985-2009 using a mixture of methodologies. A Narrative Synthesis was used to extract and summarise data relevant to the research questions. This review identified 33 articles which found a consistent pattern of findings that communication about genetic risk within families is influenced by individual beliefs about the desirability of communicating genetic risk and by closeness of relationships within the family. None of the studies directly investigated the impact of communication on counsellees or their families, differences according to gender of counsellee or by condition nor alternative methods of communication with relatives. The findings mainly apply to late onset conditions such as Hereditary Breast and Ovarian Cancer. The most frequently used theory was Family Systems Theory and methods were generally qualitative. This review points to multifactorial influences on who is communicated with in families and what they are told about genetic risk information. Further research is required to investigate the impact of genetic risk information on family systems and differences between genders and conditions.
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25
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Brealey S, Andronis L, Dennis L, Atwell C, Bryan S, Coulton S, Cox H, Cross B, Fylan F, Garratt A, Gilbert F, Gillan M, Hendry M, Hood K, Houston H, King D, Morton V, Robling M, Russell I, Wilkinson C. Participants' preference for type of leaflet used to feed back the results of a randomised trial: a survey. Trials 2010; 11:116. [PMID: 21122094 PMCID: PMC3002349 DOI: 10.1186/1745-6215-11-116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 12/01/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hundreds of thousands of volunteers take part in medical research, but many will never hear from researchers about what the study revealed. There is a growing demand for the results of randomised trials to be fed back to research participants both for ethical research practice and for ensuring their co-operation in a trial. This study aims to determine participants' preferences for type of leaflet (short versus long) used to summarise the findings of a randomised trial; and to test whether certain characteristics explained participants' preferences. METHODS 553 participants in a randomised trial about General Practitioners' access to Magnetic Resonance Imaging for patients presenting with suspected internal derangement of the knee were asked in the final follow-up questionnaire whether they would like to be fed back the results of the trial. Participants who agreed to this were included in a postal questionnaire survey asking about their preference, if any, between a short and a long leaflet and what it was about the leaflet that they preferred. Multinomial logistic regression was used to test whether certain demographics of responding participants along with treatment group explained whether a participant had a preference for type of leaflet or no preference. RESULTS Of the participants who returned the final follow-up questionnaire, 416 (88%) agreed to receive the results of the trial. Subsequently 132 (32%) participants responded to the survey. Most participants preferred the longer leaflet (55%) and the main reasons for this were the use of technical information (94%) and diagrams (89%). There was weak evidence to suggest that gender might explain whether participants have a preference for type of leaflet or not (P = 0.084). CONCLUSIONS Trial participants want to receive feed back about the results and appear to prefer a longer leaflet. Males and females might require information to be communicated to them differently and should be the focus of further research. TRIAL REGISTRATION The trial is registered with http://www.isrctn.org/ and ID is ISRCTN76616358.
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Affiliation(s)
- Stephen Brealey
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Lazaros Andronis
- Department of Health Economics, Occupational Health Building, University of Birmingham, Birmingham, West Midlands, B15 2TT, UK
| | - Laura Dennis
- School of Health & Social Care, University of Teesside, Parkside West Offices, Middlesbrough, TS1 3BA, UK
| | - Christine Atwell
- Department of Primary Care & Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Stirling Bryan
- Department of Medicine, University of British Columbia, Centre for Clinical Epidemiology & Evaluation, 702 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC V5Z 1M9, Canada
| | - Simon Coulton
- Centre for Health Service Studies, Cornwallis George Allen Wing, University of Kent, Canterbury, Kent CT2 7NF, UK
| | - Helen Cox
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Ben Cross
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Fiona Fylan
- Department of Psychology, Leeds Metropolitan University, Leeds LS1 3HE, UK
| | - Andrew Garratt
- Norwegian Knowledge Centre for Health Services, PO Box 7004, St Olavs plass, N-0130 Oslo, Norway
| | - Fiona Gilbert
- Department of Radiology, Lillian Sutton Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Maureen Gillan
- Department of Radiology, Lillian Sutton Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Maggie Hendry
- Cardiff University School of Medicine, North Wales Clinical School, Gwenfro Building, Unit 5, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Kerenza Hood
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Helen Houston
- Department of Primary Care & Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK
| | - David King
- X-ray Department, York Hospital, Wigginton Road, York, YO31 8HE, UK
| | - Veronica Morton
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK
| | - Michael Robling
- Department of Primary Care & Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Ian Russell
- School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Clare Wilkinson
- Cardiff University School of Medicine, North Wales Clinical School, Gwenfro Building, Unit 5, Wrexham Technology Park, Wrexham, LL13 7YP, UK
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Elger BS, Michaud K, Fellmann F, Mangin P. Sudden death: ethical and legal problems of post-mortem forensic genetic testing for hereditary cardiac diseases. Clin Genet 2009; 77:287-92. [PMID: 19863545 DOI: 10.1111/j.1399-0004.2009.01293.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hereditary non-structural diseases such as catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT, and the Brugada syndrome as well as structural disease such as hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) cause a significant percentage of sudden cardiac deaths in the young. In these cases, genetic testing can be useful and does not require proxy consent if it is carried out at the request of judicial authorities as part of a forensic death investigation. Mutations in several genes are implicated in arrhythmic syndromes, including SCN5A, KCNQ1, KCNH2, RyR2, and genes causing HCM. If the victim's test is positive, this information is important for relatives who might be themselves at risk of carrying the disease-causing mutation. There is no consensus about how professionals should proceed in this context. This article discusses the ethical and legal arguments in favour of and against three options: genetic testing of the deceased victim only; counselling of relatives before testing the victim; counselling restricted to relatives of victims who tested positive for mutations of serious and preventable diseases. Legal cases are mentioned that pertain to the duty of geneticists and other physicians to warn relatives. Although the claim for a legal duty is tenuous, recent publications and guidelines suggest that geneticists and others involved in the multidisciplinary approach of sudden death (SD) cases may, nevertheless, have an ethical duty to inform relatives of SD victims. Several practical problems remain pertaining to the costs of testing, the counselling and to the need to obtain permission of judicial authorities.
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Affiliation(s)
- B S Elger
- Unité de droit médical et d'éthique clinique, University of Geneva, Geneva 1211, Switzerland.
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27
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Ormondroyd E, Moynihan C, Ardern-Jones A, Eeles R, Foster C, Davolls S, Watson M. Communicating genetics research results to families: problems arising when the patient participant is deceased. Psychooncology 2009; 17:804-11. [PMID: 18688787 DOI: 10.1002/pon.1356] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study explores communication within families of clinically significant genetics research results, after the death of the patient participant. BRCA2 mutations were found in several men after their death from prostate cancer. Spouses were given the results in a genetic counselling session and asked to inform relatives. METHODS Cross-sectional, qualitative exploratory study. Interviews with 13 relatives, including informers and recipients of the information, were analysed using interpretative phenomenological analysis. RESULTS Dissemination was hampered when communication channels between relatives were limited, because of family rifts or socially distant or problematic relationships. When informing other branches of the family, relatives approached individuals in the generation of the deceased man, regardless of their risk status, who were then responsible for informing younger relatives. Most people informed by a relative did not seek genetic counselling. The informing relative may not have sufficient authority for the information either to be taken seriously or to challenge individual constructions about the aetiology of cancer. This impeded information transmission to further at-risk relatives. Most participants knew of relatives who had not been told about their cancer risk. CONCLUSIONS The implications of this limited efficiency of information transfer among relatives are discussed in the context of a potential role for genetics services in contacting at-risk relatives directly.
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Affiliation(s)
- E Ormondroyd
- Psychology Research Group, Institute of Cancer Research, Sutton, UK
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28
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Strømsvik N, Råheim M, Oyen N, Gjengedal E. Men in the women's world of hereditary breast and ovarian cancer--a systematic review. Fam Cancer 2009; 8:221-9. [PMID: 19165626 DOI: 10.1007/s10689-009-9232-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 01/02/2009] [Indexed: 12/31/2022]
Abstract
Little is known about men seeking genetic counseling for hereditary breast and ovarian cancer (HBOC). We review the sparse literature on men attending such genetic consultations. Two main themes are identified: the women's influence on the genetic counseling process, and the psychological impact on men. The women in the HBOC families have an influence on the men's decision to request genetic testing, and they take the leading role in communicating genetic information. With respect to psychological impact, the men suffer from grief and fear of developing cancer, and they seem to use avoidance as a coping strategy. Carrier males experience feelings of guilt because they might have passed on a mutation to their children. Non-carriers experience test-related stress if their siblings tested positive. Mutation status may have an impact on reproductive issues. These findings are discussed in light of gender issues and literature concerning men's health behavior. Further studies are needed to provide optimal care for men seeking genetic counseling for hereditary breast and ovarian cancer.
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Affiliation(s)
- Nina Strømsvik
- Center of Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
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29
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Fernandez CV, Gao J, Strahlendorf C, Moghrabi A, Pentz RD, Barfield RC, Baker JN, Santor D, Weijer C, Kodish E. Providing research results to participants: attitudes and needs of adolescents and parents of children with cancer. J Clin Oncol 2009; 27:878-83. [PMID: 19164211 DOI: 10.1200/jco.2008.18.5223] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is an increasing demand for researchers to provide research results to participants. Our aim was to define an appropriate process for this, based on needs and attitudes of participants. METHODS A multicenter survey in five sites in the United States and Canada was offered to parents of children with cancer and adolescents with cancer. Respondents indicated their preferred mode of communication of research results with respect to implications; timing, provider, and content of the results; reasons for and against providing results; and barriers to providing results. RESULTS Four hundred nine parents (including 19 of deceased children) and 86 adolescents responded. Most parents (n = 385; 94.2%) felt that they had a strong right to research results. For positive results, most wanted a letter or e-mail summary (n = 238; 58.2%) or a phone call followed by a letter (n = 100; 24.4%). If the results were negative, phone call (n = 136; 33.3%) or personal visits (n = 150; 36.7%) were preferred. Parents wanted the summary to include long-term sequelae and suggestions for participants (n = 341; 83.4%), effect on future treatments (n = 341; 83.4%), and subsequent research steps (n = 284; 69.5%). Understanding the researcher was a main concern about receiving results (n = 145; 35.5%). Parents felt that results provide information to support quality of life (n = 315; 77%) and raise public awareness of research (n = 282; 68.9%). Adolescents identified similar preferences. CONCLUSION Parents of children with cancer and adolescents with cancer feel strongly that they have a right to be offered research results and have specific preferences of how and what information should be communicated.
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Affiliation(s)
- Conrad Vincent Fernandez
- Department of Pediatrics, IWK Health Centre, Dalhousie University, 5850 University Ave, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada.
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30
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Abstract
The authors discuss the available data on the effects of communicating aggregate and individual research results on participants, investigators, and the research enterprise.
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Affiliation(s)
- David I Shalowitz
- Bioethics Program, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
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31
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Sexton AC, Sahhar M, Thorburn DR, Metcalfe SA. Impact of a Genetic Diagnosis of a Mitochondrial Disorder 5–17 Years After the Death of an Affected Child. J Genet Couns 2008; 17:261-73. [DOI: 10.1007/s10897-007-9145-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 12/05/2007] [Indexed: 11/25/2022]
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