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Nabukenya S, Waitt C, Senyonga R, Castelnuovo B, Munabi IG, Kyaddondo D, Mwaka ES. Research Participants' Preferences for Individual Results of Pharmacogenomics Research: A Case of a Ugandan HIV Research Institute. J Empir Res Hum Res Ethics 2023; 18:218-232. [PMID: 37448227 PMCID: PMC10648306 DOI: 10.1177/15562646231187434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Little is known about whether people living with HIV would like to receive their results from pharmacogenomics research. This study explored the factors influencing participants' preferences and the reasons for their desire to receive individual results from pharmacogenomics research. We employed a convergent parallel mixed methods study design comprising a survey of 225 research participants and 5 deliberative focus group discussions with 30 purposively selected research participants. Almost all (98%) participants wanted to receive individual pharmacogenomics research results. Reasons for the desire to receive results were reciprocity for valuable time and effort, preparing for future eventualities, and the right to information about their health. Overall, participants desire to receive feedback from pharmacogenomics research, particularly if results are well established and clinically actionable.
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Affiliation(s)
- Sylvia Nabukenya
- Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Kampala, Uganda
| | - Catriona Waitt
- Infectious Diseases Institute, Kampala, Uganda
- University of Liverpool, Liverpool, UK
| | - Ronald Senyonga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - David Kyaddondo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Erisa S. Mwaka
- Makerere University College of Health Sciences, Kampala, Uganda
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Meagher KM, Curtis SH, Borucki S, Beck A, Srinivasan T, Cheema A, Sharp RR. Communicating unexpected pharmacogenomic results to biobank contributors: A focus group study. PATIENT EDUCATION AND COUNSELING 2021; 104:242-249. [PMID: 32919825 DOI: 10.1016/j.pec.2020.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/08/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The goals of this study were to explore 1) the impact of returning unexpected pharmacogenomic (PGx) results to biobank contributors, and 2) participant views about improving communication. METHODS We conducted a qualitative focus group study with biobank participants (N = 54) who were notified by mail of an individual research result indicating increased risk for adverse events associated with the common cancer drug 5-fluorouracil (5-FU). We employed a framework approach for analysis. RESULTS Our results revealed three themes illustrating participants' questions and uncertainty, especially regarding how to share results with health providers and family members, and remember them over time. Participants valued results for themselves and others, and for the future of medicine. Risk perception was framed by health identity. "Toxicity narratives," or familiarity with another's adverse reaction to chemotherapy, increased the sense of importance participants reported. CONCLUSION These focus group results highlight research participant remaining questions and high valuation of PGx results, even when unexpected. PRACTICE IMPLICATIONS We identify PGx research participants' needs for clear clinical translation messaging that attends to health identity, pragmatics of sharing information with family members, and patient perceptions of barriers to transferring research results to a clinical context.
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Affiliation(s)
- Karen M Meagher
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA
| | - Susan H Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA
| | | | - Annika Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA
| | | | - Amal Cheema
- Geisel School of Medicine, Dartmouth College, Hanover, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA.
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Etchegary H, Winsor M, Power A, Simmonds C. Public engagement with genomic medicine: a summary of town hall discussions. J Community Genet 2021; 12:27-35. [PMID: 32865775 PMCID: PMC7846649 DOI: 10.1007/s12687-020-00485-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022] Open
Abstract
Engaging with the public for their input about genomic medicine is critical before it is implemented into routine healthcare practice. In order to inform discussion and planning for the introduction of genome sequencing into clinical care in an Eastern Canadian province, we implemented a program of public engagement activities. Here, we report a qualitative summary of two town hall discussions utilizing a hybrid information-consultation approach with 20 residents of the province of Newfoundland and Labrador, Canada. Discussion revealed largely positive attitudes towards genomic medicine; however, critical reflection around informed consent models, the return of sequencing findings, and access to qualified healthcare professionals revealed numerous public concerns. Public support will be important to realize the potential benefits of genomics and precision medicine to health outcomes. Our findings highlight public concerns that must be addressed in educational and informed consent documents related to sequencing. Town hall attendees endorsed ongoing public education and awareness-building initiatives which could help foster transparency and trust as genomics is integrated into healthcare systems.
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Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
| | - Mercy Winsor
- Health Research Unit, Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
| | - Angela Power
- Newfoundland and Labrador Centre for Health Information, St. John’s, NL A1B 2C7 Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
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Thorogood A, Dalpé G, Knoppers BM. Return of individual genomic research results: are laws and policies keeping step? Eur J Hum Genet 2019; 27:535-546. [PMID: 30622328 PMCID: PMC6460582 DOI: 10.1038/s41431-018-0311-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/30/2018] [Accepted: 11/01/2018] [Indexed: 01/23/2023] Open
Abstract
Efforts are underway to harmonise the return of individual results and incidental findings from whole genome sequencing (WGS) across research contexts and countries. We reviewed international, regional and national laws and policies applying to return across 20 countries to identify areas of convergence and divergence. Discrepancies between laws and policies are most problematic where they cannot be reconciled through harmonisation of project-level governance. Rules for the return of results apply at different levels in different jurisdictions (e.g., human subjects research, biobanks, clinical trials, genomic sequencing, and genetic/personal data), complicating comparison. A particular concern for harmonisation are the (often contradictory) rules about when results must, should, may, or must not be returned. Adding confusion are different thresholds for utility (medical, familial, reproductive, and/or personal). The importance of respecting individual choices to know or not know is widely recognised, though some norms emphasise respect for personal preferences. Another troubling observation is that requirements for data quality, variant assessment, and the effective communication of results are evolving in uneven ways. There is a growing gap between researchers with the expertise, infrastructure, and resources to meet these requirements and those without, threatening international collaboration. Best practices for the return of individual genomic results are sorely needed to inform not only the ethical return of results, but also future legislative and policy efforts.
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Affiliation(s)
- Adrian Thorogood
- Centre of Genomics and Policy, McGill University, 740 avenue Dr. Penfield, suite 5200, Montréal, QC, H3A 0G1, Canada.
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, 740 avenue Dr. Penfield, suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, McGill University, 740 avenue Dr. Penfield, suite 5200, Montréal, QC, H3A 0G1, Canada
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Jaitovich Groisman I, Hurlimann T, Shoham A, Godard B. Practices and views of neurologists regarding the use of whole-genome sequencing in clinical settings: a web-based survey. Eur J Hum Genet 2017; 25:801-808. [PMID: 28488681 DOI: 10.1038/ejhg.2017.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/28/2017] [Accepted: 03/28/2017] [Indexed: 12/23/2022] Open
Abstract
The use of Whole-Genome Sequencing (WGS) in clinical settings has brought up a number of controversial scientific and ethical issues. The application of WGS is of particular relevance in neurology, as many conditions are difficult to diagnose. We conducted a worldwide, web-based survey to explore neurologists' views on the benefits of, and concerns regarding, the clinical use of WGS, as well as the resources necessary to implement it. Almost half of the 204 neurologists in the study treated mostly adult patients (48%), while the rest mainly children (37.3%), or both (14.7%). Epilepsy (73%) and headaches (57.8%) were the predominant conditions treated. Factor analysis brought out two profiles: neurologists who would offer WGS to their patients, and those who would not, or were not sure in which circumstances it should be offered. Neurologists considering the use of WGS as bringing more benefits than drawbacks currently used targeted genetic testing (P<0.05) or treated mainly children (P<0.05). WGS' benefits were directed towards the patients, while its risks were of a financial and legal nature. Furthermore, there was a correlation between respondents' current use of genetic tests and an anticipation of increased use in the future (P<0.001). However, over half of respondents did not feel sufficiently informed to use WGS in their practice (53.5%). Our results highlight gaps in education, organization, and funding to support the use of WGS in neurology, and draw attention to the need for resources that could strongly contribute to more straightforward diagnoses and possibly better treatment of neurological conditions.
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Affiliation(s)
- Iris Jaitovich Groisman
- Groupe de recherche Omics-Ethics, Institut de recherche en santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Thierry Hurlimann
- Groupe de recherche Omics-Ethics, Institut de recherche en santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Amir Shoham
- Département de psychologie, Faculté des arts et des sciences, Université de Montréal, Montreal, Quebec, Canada
| | - Béatrice Godard
- Groupe de recherche Omics-Ethics, Institut de recherche en santé publique, Université de Montréal, Montreal, Quebec, Canada
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Adolescent perspectives on the return of individual results in genomic addiction research. Psychiatr Genet 2015; 25:127-30. [PMID: 25748091 DOI: 10.1097/ypg.0000000000000083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study surveyed all adolescents who were enrolled in behavioral genomic research and provided DNA to a biobank, including 320 patients undergoing treatment for substance and conduct problems (SCPs) and 109 non-SCP controls. Participants selected from three options on the return of individual genomic results (RIR) and rated eight methods of re-contact. Most individuals with SCPs (77.8%) and non-SCP controls (72.5%) wanted RIR involving health or behavioral implications. The majority of individuals with SCPs (67.2%) and non-SCP controls (69.7%) indicated that phone re-contact was 'best', with e-mail (22.5% SCPs, 33.9% non-SCPs) and social networking websites (21.3% SCPs, 20.2% non-SCPs) being viable options. These results suggest a layered approach for RIR: phone calls, followed by e-mails and a secure message to a social networking account. Data from this special and vulnerable population, which includes youth involved in the criminal justice system and substantial minority participation, bring an essential and missing perspective to the discussion of RIR.
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