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Kasperbauer TJ, Waltz A, Hudson B, Hawryluk B, Moore C, Schmidt K, Schwartz PH. Collecting Biospecimens and Obtaining Biobank Consent From Patients in an Academic Health Care Setting: Practical and Ethical Considerations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:62-68. [PMID: 34524131 DOI: 10.1097/acm.0000000000004418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Academic health centers and health systems increasingly ask patients to enroll in research biobanks as part of standard care, raising important practical and ethical questions for integrating biobank consent processes into health care settings. This article aims to assist academic health centers and health systems considering implementing these integrated consent processes by outlining the 5 main issues-and the key practical and ethical considerations for each issue-that Indiana University Health and the Indiana Biobank faced when integrating biobank consent into their health system, as well as the key obstacles encountered. The 5 main issues to consider include the specimen to collect (leftover, new collection, or add-ons to clinical tests), whether to use opt-in or opt-out consent, where to approach patients, how to effectively use digital tools for consent, and how to appropriately simplify consent information.
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Affiliation(s)
- T J Kasperbauer
- T.J. Kasperbauer is a postdoctoral fellow, Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Amy Waltz
- A. Waltz is associate director, Office of Research Compliance, Indiana University, Indianapolis, Indiana
| | - Brenda Hudson
- B. Hudson is director of strategic operations, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Bridget Hawryluk
- B. Hawryluk is human-centered designer, Research Jam, Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Courtney Moore
- C. Moore is human-centered designer, Research Jam, Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Karen Schmidt
- K. Schmidt is project manager, Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter H Schwartz
- P.H. Schwartz is director, Indiana University Center for Bioethics, and associate professor of medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
The collection and use of human genetic data raise important ethical questions about how to balance individual autonomy and privacy with the potential for public good. The proliferation of local, national, and international efforts to collect genetic data and create linkages to support large-scale initiatives in precision medicine and the learning health system creates new demands for broad data sharing that involve managing competing interests and careful consideration of what constitutes appropriate ethical trade-offs. This review describes these emerging ethical issues with a focus on approaches to consent and issues related to justice in the shifting genomic research ecosystem.
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Affiliation(s)
- Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY 10032, USA;
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Kasperbauer TJ, Halverson C. Adolescent Assent and Reconsent for Biobanking: Recent Developments and Emerging Ethical Issues. Front Med (Lausanne) 2021; 8:686264. [PMID: 34307413 PMCID: PMC8301072 DOI: 10.3389/fmed.2021.686264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Research biobanks that enroll minors face important practical, ethical, and regulatory challenges in reconsenting participants when they reach the age of 18. Federal regulations governing research in the United States provide minimal guidance and allow for a range of practices, including waiving the requirement to obtain reconsent. Some commentators have argued that institutional review boards should indeed grant such waivers, given the low risks of biobank-based research and the impracticality of contacting all participants when they turn 18. There is also significant ethical debate about the age at which adolescents can make authentic, autonomous decisions regarding their research participation. This paper reviews these issues in detail, describes the current state of the ethical discussion, and outlines evidence-based policies for enrolling minors into research biobanks.
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Affiliation(s)
- T J Kasperbauer
- Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Colin Halverson
- Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, United States
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Page SA, Collisson BA, Godley J, Nguyen D, Metz L, Muruve D. How Semantics Connotations May Influence Concerns About Donation of Biospecimens. Biopreserv Biobank 2020; 19:156-162. [PMID: 33179960 PMCID: PMC8217592 DOI: 10.1089/bio.2020.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Human biological specimen (biospecimen) donation is routinely requested for clinical care and research purposes. Successfully engaging patients and research participants in biospecimen donation depends on what they understand these initiatives entail, including their perceptions of risk. Human biospecimens are stored in facilities routinely referenced as biobanks or biorepositories, both of which labels are known to embody a variety of connotations. The words chosen to describe biospecimen facilities may influence decisions about donation. Objective: To explore differences in likelihood of donation as a function of the words chosen to represent human biospecimen storage facilities and the commensurate concerns each label evokes. Materials and Methods: Two-group experimental design. Participants completed a survey about a fictitious undertaking requesting that they consider biospecimen donation. The term used to describe the facility housing the biospecimens differed; one half of the surveys referenced a biobank, and one half referenced a biorepository. Results: Two thousand five hundred ninety-six surveys were distributed; 586 completed surveys were received (response rate: 22.6%). Sixty-three percent of respondents, regardless of whether the label referenced a biobank or biorespository, reported being extremely likely to donate. There were no significant differences between the 2 groups on the 11 concerns sampled. Factor analyses revealed that concerns could be classified in two groups: use-related concerns and person-related concerns. The label biobank evoked significantly lower perception of importance of the person-related concerns sampled (e.g., personal or other benefit, discomfort or inconvenience). Conclusions: Our results suggest that researchers may consider using the word biobank to describe the facility housing the biospecimen, as this term appears less subject to concern biases. These outcomes confirm that misunderstandings or misattributions of words used to refer to biospecimen facilities could deter participation in clinical care or research. Participation may be enhanced through ensuring clear understanding of what biospecimen donation entails and by directly addressing common semantic misunderstandings and associations.
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Affiliation(s)
- Stacey A Page
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Beverly Anne Collisson
- Department of Pediatrics, Cumming School of Medicine, The Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Jenny Godley
- Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Canada
| | - Danny Nguyen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Luanne Metz
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Daniel Muruve
- Division of Nephrology, Department of Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Lee SSJ, Cho MK, Kraft SA, Varsava N, Gillespie K, Ormond KE, Wilfond BS, Magnus D. "I don't want to be Henrietta Lacks": diverse patient perspectives on donating biospecimens for precision medicine research. Genet Med 2018; 21:107-113. [PMID: 29887604 PMCID: PMC6289900 DOI: 10.1038/s41436-018-0032-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/21/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine whether patients distinguish between biospecimens and electronic health records (EHRs) when considering research participation to inform research protections. Methods We conducted 20 focus groups with individuals who identified as African American, Hispanic, Chinese, South Asian and non-Hispanic White on the collection of biospecimens and EHR data for research. Results Our study found that many participants did not distinguish between biospecimens and EHR data. However, some participants identified specific concerns about biospecimens. These included the need for special care and respect for biospecimens due to enduring connections between the body and identity; the potential for unacceptable future research, specifically the prospect of human cloning; heightened privacy risks; and the potential for unjust corporate profiteering. Among those who distinguished biospecimens from EHR data, many supported separate consent processes and would limit their own participation to EHR data. Conclusion Considering that the potential misuse of EHR data is as great, if not greater than for biospecimens, more research is needed to understand how attitudes differ between biospecimens and EHR data across diverse populations. Such research should explore mechanisms beyond consent that can address diverse values, perspectives and misconceptions about sources of patient information to build trust in research relationships.
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Affiliation(s)
- Sandra S-J Lee
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Nina Varsava
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Katie Gillespie
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Kelly E Ormond
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
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Kraft SA, Cho MK, Gillespie K, Halley M, Varsava N, Ormond KE, Luft HS, Wilfond BS, Soo-Jin Lee S. Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:3-20. [PMID: 29621457 PMCID: PMC6173191 DOI: 10.1080/15265161.2018.1431322] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: (1) Address the role of history and experience on trust, (2) engage concerns about potential group harm, (3) address cultural values and communication barriers, and (4) integrate patient values and expectations into oversight and governance structures.
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