Data sharing and community-engaged research

Towards trustworthiness of precision medicine research for people with disabilities

People with disabilities are underrepresented in general (i.e., non-disability specific) precision medicine research (PMR), limiting access to its benefits. This commentary examines key reasons for this limited participation, focusing on the role of (dis)trust. We identify areas for further inquiry to guide researchers and enhance the trustworthiness of PMR for people with disabilities.

Conceptualizing fairness in the secondary use of health data for research: A scoping review

With the introduction of the European Health Data Space (EHDS), the secondary use of health data for research purposes is attracting more attention. Secondary health data processing promises to address novel research questions, inform the design of future research and improve healthcare delivery generally. To comply with the existing data protection regulations, the secondary data use must be fair, among other things. However, there is no clear understanding of what fairness means in the context of secondary use of health data for scientific research purposes. In response, we conducted a scoping review of argument-based literature to explore how fairness in the secondary use of health data has been conceptualized. A total of 35 publications were included in the final synthesis after abstract and full-text screening. Using an inductive approach and a thematic analysis, our review has revealed that balancing individual and public interests, reducing power asymmetries, setting conditions for commercial involvement, and implementing benefit sharing are essential to guarantee fair secondary use research. The findings of this review can inform current and future research practices and policy development to adequately address concerns about fairness in the secondary use of health data.

Consideration and Disclosure of Group Risks in Genomics and Other Data-Centric Research: Does the Common Rule Need Revision?

Harms and risks to groups and third-parties can be significant in the context of research, particularly in data-centric studies involving genomic, artificial intelligence, and/or machine learning technologies. This article explores whether and how United States federal regulations should be adapted to better align with current ethical thinking and protect group interests. Three aspects of the Common Rule deserve attention and reconsideration with respect to group interests: institutional review board (IRB) assessment of the risks/benefits of research; disclosure requirements in the informed consent process; and criteria for waivers of informed consent. In accordance with respect for persons and communities, investigators and IRBs should systematically consider potential group harm when designing and reviewing protocols, respectively. Research participants should be informed about any potential group harm in the consent process. We call for additional public discussion, empirical research, and normative analysis on these issues to determine the right regulatory and policy path forward.

Patient perspectives on educational needs in scleroderma-interstitial lung disease

Background

Systemic sclerosis is a chronic and rare connective tissue disease with multiorgan effects, including interstitial lung disease (ILD). Navigating systemic sclerosis-interstitial lung disease presents a challenge for patients due to the gaps in patient education, which can impact patient health and quality of life. This study utilized the nominal group technique to identify priority knowledge gaps among patients with systemic sclerosis-interstitial lung disease and inform future educational interventions and research.

Methods

We conducted four structured group sessions using the nominal group technique. Patients with systemic sclerosis-interstitial lung disease were presented with two questions that aimed to identify knowledge gaps. Following participant ranking, investigators performed a thematic analysis of the patients' responses to categorize the generated knowledge gaps.

Results

Twenty-one patients were interviewed and ranked the top three themes for the first question (What questions about your scleroderma-lung disease that you have keep you awake at night?), based on total points, as: (1) Understanding progression, its impacts on the body, and managing health changes (39.7%); (2) anticipating future symptoms and implementing strategies for management and coping (19.8%); and (3) employing and understanding non-pharmacological interventions and self-management strategies (17.5%). The top three themes for the second question (What information do you want about your scleroderma-lung disease that you cannot find?) ranked by total points were: (1) understanding progression, its impacts on the body, and managing health changes (41.3%); (2) navigating health system barriers (16.7%); and (3) research efforts toward treating scleroderma (10.3%).

Conclusions

Our study underscores the importance of understanding the educational needs of patients with systemic sclerosis-interstitial lung disease. Patient responses emphasize the need to comprehensively address concerns about disease management, coping with impacts on social life, and navigating the healthcare system. By addressing these multifaceted concerns, we can design and implement patient-centered education to empower patients through increased support.

Caribbean data-sharing initiatives: activities of the Eastern Caribbean Health Outcomes Research Network

The dissemination of biomedical research data beyond academia remains limited. In response, funding agencies now regularly require that the projects they fund make research data openly available for reuse. This emerging open data movement aims to democratize data access, often guided by the FAIR data technical standards, requiring that data should be findable, accessible, interoperable and reusable. Recently, participant communities have advocated the idea that improving data democracy does not address the inequities underlying the power dynamics of research enterprises. In contrast, the CARE principles of Indigenous data governance focus on collective benefit, authority to control, responsibility and ethics. We describe the data-sharing infrastructure and initiatives of the Eastern Caribbean Health Outcomes Research Network (ECHORN) for the ECHORN Cohort Study, which longitudinally examines risks and protective factors for noncommunicable diseases among community-dwelling adults in the United States and Caribbean locations. This work has been grounded in a community-engaged process, with the goal of developing robust, sustainable solutions for the dissemination of information. We highlight efforts towards operationalizing greater access to these longitudinal data resources, including the implementation of a regional survey to understand data needs and data-sharing capacities and the development of Explore ECHORN (https://exploreechorn.org), a free public data dashboard. Through these efforts, ECHORN has identified opportunities to expand initiatives that have the potential to encourage data-sharing to inform policy and strengthen the impact of research, particularly in the Caribbean. ECHORN also seeks to reconcile a community-engaged approach with the dissemination of data for secondary use.

Can Open Science Advance Health Justice? Genomic Research Dissemination in the Evolving Data-Sharing Landscape

Scientific data-sharing and open science initiatives are increasingly important mechanisms for advancing the impact of genomic research. These mechanisms are being implemented as growing attention is paid to the need to improve the inclusion of research participants from marginalized and underrepresented groups. Together, these efforts aim to promote equitable advancements in genomic medicine. However, if not guided by community-informed protections, these efforts may harm the very participants and communities they aim to benefit. This essay examines potential benefits and harms of open science and explores how to advance a more just vision of open science in genomics. Drawing on relational ethics frameworks, we argue that researchers should consider their obligations to participants as well as the broader communities that are impacted by their research. We propose eight strategies to provide a foundation of practical steps for researchers to reduce the possibility of harms stemming from open science and to work toward genomic justice.

Expanding the Agenda for a More Just Genomics

The integration of genomics into public health and medicine is happening at a faster rate than the accrual of the capabilities necessary to ensure the equitable, global distribution of its clinical benefits. Uneven access to genetic testing and follow-up care, unequal distribution of the resources required to access and participate in research, and underrepresentation of some descent groups in genetic and clinical datasets (and thus uncertain genetic results for some patients) are just some of the reasons to center justice in genomics. A more just genomics is an imperative rooted in the ethical obligations incurred by a publicly funded science that is reliant on human data. These features of genomics indebt the genomics enterprise and compel the expanded scope of responsibility proposed by the authors of this special report. The report begins to define justice in genomics for different stakeholder groups and proposes substantial shifts in power, resource distribution, scientific practice, and governance that could enable genomics to meet its obligations to humanity.

Designing for data sharing: Considerations for advancing health equity in data management and dissemination

Data sharing, the act of making scientific research data available to others, can accelerate innovation and discoveries, and ultimately enhance public health. The National Cancer Institute Implementation Science Centers in Cancer Control convened a diverse group of research scientists, practitioners, and community partners in three interactive workshops (May-June 2022) to identify and discuss factors that must be considered when designing research for equitable data sharing with a specific emphasis on implementation science and social, behavioral, and population health research. This group identified and operationalized a set of seven key considerations for equitable data sharing-conceptualized as an inclusive process that fairly includes the perspectives and priorities of all partners involved in and impacted by data sharing, with consideration of ethics, history, and benefits-that were integrated into a framework. Key data-sharing components particularly important for health equity included: elevating data sharing into a core research activity, incorporating diverse perspectives, and meaningfully engaging partners in data-sharing decisions throughout the project lifecycle. As the process of data sharing grows in research, it is critical to continue considering the potential positive and adverse impact of data sharing on diverse beneficiaries of health data and research.

Real-World-Time Data and RCT Synergy: Advancing Personalized Medicine and Sarcoma Care through Digital Innovation

This manuscript examines the synergistic potential of prospective real-world/time data/evidence (RWTD/E) and randomized controlled trials (RCTs) to enrich healthcare research and operational insights, with a particular focus on its impact within the sarcoma field. Through exploring RWTD/E's capability to provide real-world/time, granular patient data, it offers an enriched perspective on healthcare outcomes and delivery, notably in the complex arena of sarcoma care. Highlighting the complementarity between RWTD/E's expansive real-world/time scope and the structured environment of RCTs, this paper showcases their combined strength, which can help to foster advancements in personalized medicine and population health management, exemplified through the lens of sarcoma treatment. The manuscript further outlines methodological innovations such as target trial emulation and their significance in enhancing the precision and applicability of RWTD/E, underscoring the transformative potential of these advancements in sarcoma care and beyond. By advocating for the strategic incorporation of prospective RWTD/E into healthcare frameworks, it aims to create an evidence-driven ecosystem that significantly improves patient outcomes and healthcare efficiency, with sarcoma care serving as a pivotal domain for these developments.

Breaking the silence of sharing data in medical research

Data sharing is highly advocated in the scientific community, with numerous organizations, funding agencies, and journals promoting transparency and collaboration. However, limited research exists on actual data sharing practices. We conducted a comprehensive analysis of the intent to share individual participant data (IPD) in a total of 313,990 studies encompassing clinical trials and observational studies obtained from ClinicalTrials.gov, spanning the period from 2000 to 2023. Our study found that only 10.3% of principal investigators (PIs) expressed intent to share IPD. Clinical trials were more likely to share data than observational studies (odds ratio, OR = 1.98, 95% CI: 1.92-2.04). Large sample size studies were 1.69 times more likely to share data than small ones (95% CI: 1.65-1.73). Studies registered after 2018 were 1.6 times more likely to share data (95% CI: 1.57-1.64) than before 2019. NIH and other US Federal agency-funded studies had 1.49 times higher odds of sharing data (95% CI: 1.43-1.55) than other funders. USA-based studies were 1.53 times more likely to share data (95% CI: 1.49-1.57) than out of USA. Biological trials were 1.58 times more likely to share data than drug and other trials (95% CI: 1.51-1.66). Phase III trials had the highest odds, 2.47 times, of sharing data (95% CI: 2.38-2.56) than non-Phase III trials.

A data-driven approach to choosing privacy parameters for clinical trial data sharing under differential privacy

OBJECTIVES

Clinical trial data sharing is crucial for promoting transparency and collaborative efforts in medical research. Differential privacy (DP) is a formal statistical technique for anonymizing shared data that balances privacy of individual records and accuracy of replicated results through a "privacy budget" parameter, ε. DP is considered the state of the art in privacy-protected data publication and is underutilized in clinical trial data sharing. This study is focused on identifying ε values for the sharing of clinical trial data.

MATERIALS AND METHODS

We analyzed 2 clinical trial datasets with privacy budget ε ranging from 0.01 to 10. Smaller values of ε entail adding greater amounts of random noise, with better privacy as a result. Comparison of rates, odds ratios, means, and mean differences between the original clinical trial datasets and the empirical distribution of the DP estimator was performed.

RESULTS

The DP rate closely approximated the original rate of 6.5% when ε > 1. The DP odds ratio closely aligned with the original odds ratio of 0.689 when ε ≥ 3. The DP mean closely approximated the original mean of 164.64 when ε ≥ 1. As ε increased to 5, both the minimum and maximum DP means converged toward the original mean.

DISCUSSION

There is no consensus on how to choose the privacy budget ε. The definition of DP does not specify the required level of privacy, and there is no established formula for determining ε.

CONCLUSION

Our findings suggest that the application of DP holds promise in the context of sharing clinical trial data.

A Call-In for Allyship and Anti-Ableism in Intellectual Disability Research

Provoked by decades of grassroots activism, anti-ableist work is underway to advance disability rights. Intellectual disability (ID) researchers can integrate these social changes into their work by interrogating and transforming the beliefs and practices that underpin ID research. We share actionable ideas to foster anti-ableism and allyship in ID research. These include: (1) Learn from and nurture long-term, mutual relationships with people with ID; (2) Amplify the voices of people with ID in institutional structures that influence research; (3) Infuse anti-ableist frameworks into our own research; and (4) Embody a career-long commitment to disability rights, reflexive practice, and growth.

Public attitudes towards genomic data sharing: results from a provincial online survey in Canada

BACKGROUND

While genomic data sharing can facilitate important health research and discovery benefits, these must be balanced against potential privacy risks and harms to individuals. Understanding public attitudes and perspectives on data sharing is important given these potential risks and to inform genomic research and policy that aligns with public preferences and needs.

METHODS

A cross sectional online survey measured attitudes towards genomic data sharing among members of the general public in an Eastern Canadian province.

RESULTS

Results showed a moderate comfort level with sharing genomic data, usually into restricted scientific databases with controlled access. Much lower comfort levels were observed for sharing data into open or publicly accessible databases. While respondents largely approved of sharing genomic data for health research permitted by a research ethics board, many general public members were concerned with who would have access to their data, with higher rates of approval for access from clinical or academic actors, but much more limited approval of access from commercial entities or governments. Prior knowledge about sequencing and about research ethics boards were both related to data sharing attitudes.

CONCLUSIONS

With evolving regulations and guidelines for genomics research and data sharing, it is important to consider the perspectives of participants most impacted by these changes. Participant information materials and informed consent documents must be explicit about the safeguards in place to protect genomic data and the policies governing the sharing of data. Increased public awareness of the role of research ethics boards and of the need for genomic data sharing more broadly is also needed.

Re-envisioning community genetics: community empowerment in preventive genomics

As genomic technologies rapidly develop, polygenic scores (PGS) are entering into a growing conversation on how to improve precision in public health and prevent chronic disease. While the integration of PGS into public health and clinical services raises potential benefits, it also introduces potential harms. In particular, there is a high level of uncertainty about how to incorporate PGS into clinical settings in a manner that is equitable, just, and aligned with the long-term goals of many healthcare systems to support person-centered and value-based care. This paper argues that any conversation about whether and how to design and implement PGS clinical services requires dynamic engagement with local communities, patients, and families. These parties often face the consequences, both positive and negative, of such uncertainties and should therefore drive clinical translation. As a collaborative effort between hospital stakeholders, community partners, and researchers, this paper describes a community-empowered co-design process for addressing uncertainty and making programmatic decisions about the implementation of PGS into clinical services. We provide a framework for others interested in designing clinical programs that are responsive to, and inclusive and respectful of, local communities.

Openness in Scientific Research: A Historical and Philosophical Perspective

Openness is widely regarded as a pillar of scientific ethics because it promotes reproducibility and progress in science and benefits society. However, the sharing of scientific information can sometimes adversely impact the interests of human research participants, human communities or populations, scientists, and private research sponsors; and may threaten national security. Because openness may conflict with other important social values, solutions to ethical and policy dilemmas should include meaningful input from those who are impacted by the sharing and use of scientific information, including research participants, communities, and the public. Data sharing and use policies should be reviewed and revised periodically to account for ongoing changes in science, technology, and society.

Linking coastal environmental and health observations for human wellbeing

Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries.

Precision medicine and the problem of structural injustice

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on-and simultaneously affects-access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects.

Including multiracial individuals is crucial for race, ethnicity and ancestry frameworks in genetics and genomics

Current ontologies of race, ethnicity and genetic ancestry rely on categorization, but have limitations — as exemplified by multiracial individuals. We argue that including these individuals will foster inclusion by better capturing complex identities, with equity benefits for the full human population.