Ethical and practical challenges to studying patients who opt out of large-scale biorepository research

Studying the impact of translational genomic research: Lessons from eMERGE

Two major goals of the Electronic Medical Record and Genomics (eMERGE) Network are to learn how best to return research results to patient/participants and the clinicians who care for them and also to assess the impact of placing these results in clinical care. Yet since its inception, the Network has confronted a host of challenges in achieving these goals, many of which had ethical, legal, or social implications (ELSIs) that required consideration. Here, we share impediments we encountered in recruiting participants, returning results, and assessing their impact, all of which affected our ability to achieve the goals of eMERGE, as well as the steps we took to attempt to address these obstacles. We divide the domains in which we experienced challenges into four broad categories: (1) study design, including recruitment of more diverse groups; (2) consent; (3) returning results to participants and their health care providers (HCPs); and (4) assessment of follow-up care of participants and measuring the impact of research on participants and their families. Since most phases of eMERGE have included children as well as adults, we also address the particular ELSI posed by including pediatric populations in this research. We make specific suggestions for improving translational genomic research to ensure that future projects can effectively return results and assess their impact on patient/participants and providers if the goals of genomic-informed medicine are to be achieved.

Collecting Biospecimens and Obtaining Biobank Consent From Patients in an Academic Health Care Setting: Practical and Ethical Considerations

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.

Resisting big data exploitations in public healthcare: free riding or distributive justice?

We draw on findings from qualitative interviews with health data researchers, GPs and citizens who opted out from NHS England's care.data programme to explore controversies and negotiations around data sharing in the NHS. Drawing on theoretical perspectives from science and technology studies, we show that the new socio-technical, ethical and economic arrangements were resisted not only on the basis of individual autonomy and protection from exploitation, but also as a collective effort to protect NHS services and patient data. We argue that the resulting opt-outs were a call for more personal control over data use. This was not because these citizens placed their personal interests above those of society. It was because they resisted proposed arrangements by networks of stakeholders, not seen as legitimate, to control flows and benefits of NHS patient data. Approaching informed consent this way helps us to explore resistance as a collective action for influencing the direction of such big data programmes towards the preservation of public access to healthcare as well as the distribution of ethical decision-making between independent, trustworthy institutions and individual citizens.

Patient and community attitudes toward perioperative biobanking and genomic research

We surveyed hospital patients and clinicians to ascertain their attitudes to the establishment of a perioperative biobank for future genomics research, and whether the requirements for an opt-out approach to consent can be met. We enrolled hospital patients (n=187), patient spouse/family members (n=64), ethics committee members (n=14), and clinical staff (doctors and nurses [n=67]), and unspecified community members (n=10). They were asked to rate and describe their views on medical research and biobanking, the need for individual consent, and the importance of confidentiality. Of 406 survey forms distributed, 342 (84%) were returned. Nearly all participants (98%) indicated that a perioperative biobank is important, 93% were comfortable with de-identified genetic research, and 90% indicated that the hospital should be able to use leftover blood for medical research, provided the research has been approved by an ethics committee and personally identifying information has been removed. Participants were more likely to support biobanking if it used de-identified samples, and if, for this reason, their consent was not sought. Participants with chronic medical and surgical conditions were significantly more supportive and comfortable with genetic research, as were most in the hospital community. Most hospital patients, community members and clinicians are supportive of the development of a perioperative biobank used for genomic research. This supports the adoption of an opt-out approach to consent model.