Support for decision-making on sharing health data for research: are data counsellors relevant?

Background

The implications of sharing one's health data are far-reaching. Potential applications of health data range from the delivery of treatments tailored to individuals' characteristics to improvements in public health, while also posing concerns about privacy, social justice and equity. Making informed decisions about health data sharing thus requires thorough consideration of the scientific, ethical and personal implications of donations. This study assessed participants' preferences regarding decision-making about health data sharing for research, including the need for support by data counsellors.

Methods

This observational cross-sectional study includes 159 patients and 479 carers followed at two reference centres for rare diseases in a Portuguese academic hospital, between June 2019 and March 2020. Participants were asked about preferred modes of decision-making: deciding on their own, deciding with support from another person, or delegating the decision to someone else. Those who responded the last two options also reported who they would choose for support or delegation: family or friends; a data counsellor; a professional with no specific training on data counselling; other. Data were analysed using descriptive and inferential statistics.

Results

The majority of respondents would prefer to decide with support (62%), 37% would prefer to decide on their own and 1% would opt to delegate the decision of sharing health data. Among those who expressed a preference for support, 60% would like to rely on a data counsellor. Carers, older and higher educated participants, and those with upper white-collar occupations and who were satisfied with their own health were significantly more likely to select data counsellors as their preferred source of support when engaging in decision-making about health data sharing for research (p < 0.05).

Conclusions

This study supports recommendations for the creation of a new professional specialty of health data counsellors.

Key messages

Most participants express the need for support in making decisions about health data sharing for research, with 60% preferring support from a data counsellor. As a new professional specialism, health data counselling can help to advance informed public participation in health research.

Public preferences for involvement in the governance of health data

Background

Public involvement in the governance of epidemiological and public health studies can foster needs-driven research, enhance participants' recruitment, reduce attrition and improve the quality of and ethics in research and surveillance. However, it can also reinforce health inequalities if it fails to ensure public representation across socioeconomic gradients. This study aimed to assess patients' and carers' preferences for involvement in collective health data governance, and its associated factors, to strengthen the evidence base for policy development.

Methods

Between June 2019 and January 2020, 644 people (157 patients and 487 carers; participation rate=89.3%) followed at two reference centres for rare diseases in a university hospital from Northern Portugal were enrolled in an observational cross-sectional study. Data about willingness to participate in data governance was collected through four intersecting options: periodic or sporadic meetings, by either giving opinions (consultation) or participating in decision-making (deliberation). Data were analysed using descriptive and inferential statistics.

Results

From a total of 629 respondents, 39% are willing to get involved through at least one of the four participatory options and 16% do not want to participate. Patients and carers do not differ in their preferences for involvement. Sex and education are associated with willingness to participate, after adjustment for participant type (patient/carer), occupation and trust in national and international institutions (OR:1.60; 95%CI 1.05-2.45 for men vs. women and OR:1.65; 95%CI 1.07-2.56 for >12 vs. ≤12 educational years). Participants' preferred option for participation is consultative sporadic meetings (29.5%).

Conclusions

Anticipating which social groups are likely to become under-represented in participatory exercises is crucial to inform policy aimed at promoting inclusive involvement in health data governance.

Key messages

Men and higher educated participants are more willing to participate. Forecasting potential for subgroup under-representation is crucial to develop policy for inclusive participatory data governance.

Participation in data generation and information sharing: are patients and carers willing to engage?

Background

Health systems are moving towards a personalisation of care. Personalised care relies on data-intensive research, which depends on active participation by citizens in data generation and information sharing. Collecting and sharing one's data for research can deliver several benefits. However, it also comes at a cost in time and effort that may burden different population subsets to varying degrees. This study aimed to assess patients' and carers' willingness to generate and share health data, and its associated factors, to inform the design of inclusive engagement strategies.

Methods

A cross-sectional study was performed with 157 patients and 487 carers (participation rate=89.3%) followed at 2 rare diseases reference centres in Portugal (06/2019-01/2020). Participants were asked about willingness to collect their health data. Those who responded yes/maybe also reported, from 0 (not willing) to 4 (always willing), on willingness to share it for the following purposes: diagnosis/treatment, non-profit research and for-profit research related to their disease and to other diseases. Data were analysed using descriptive and inferential statistics.

Results

From 567 respondents, 42.7% are willing to collect their health data, 34.7% are unsure and 22.6% do not want to participate in data generation. More educated participants, with white-collar occupations, satisfied/very satisfied with their health and those with higher social trust levels are significantly more willing to engage in data collection (p < 0.05). Participants are less prone to share information for for-profit research on their disease (Median[P25-P75]: 3.0[2.0-4.0]) or others (Median[P25-P75]: 2.0[1.0-3.0]), in particular carers (p < 0.05).

Conclusions

Participants are more willing to share information for diagnosis/treatment and non-profit research. Efforts to engage people in data generation and sharing should be directed towards disadvantaged groups to reduce biases related to skewed populations.

Key messages

Willingness to participate in data generation and sharing is influenced by social indicators. Engagement by less advantaged groups should be promoted to avoid biases related to skewed populations.

Solidarity and reciprocity in data governance: information sharing among gamete donors and recipients

Background

Decreasing fertility rates have spiralled a growth in demand for assisted reproduction technologies, including reproduction through donated gametes. Gamete donation is grounded on solidaristic practices traditionally focused on the gift of gametes. However, solidarity and reciprocity between donors and recipients may also be enacted through the sharing of other types of information (e.g. donation outcomes, medical and identifying information). Little is known, however, about these stakeholders’ preferences regarding information sharing, which is crucial to promoting people-centred policy for data governance in gamete donation.

Methods

A self-report structured questionnaire was completed by 69 donors and 161 recipients (participation rate: 77.4%) between July 2017 and April 2018 at the Portuguese Public Bank of Gametes. Opinions about access to donation outcomes and medical, extended profile and identifying information about recipients, donors and children were analysed using descriptive statistics.

Results

Most participants considered that recipients should not have access to donors’ identifying (92%) and extended profile (79%) information, but that they should access donors’ medical information (58%). Donors stated more frequently that they should receive information about the outcomes of donation (e.g. pregnancies and births) than recipients (32% vs. 12%). Participants also disagreed with donors’ access to recipients’ medical (83%) and extended profile information (92%) and children’s identifying information (98%).

Conclusions

People-centred policy on data governance in gamete donation should be informed by donor and recipients’ preferences. Sharing donation outcomes with donors and medical information from donors with recipients can foster solidarity and reciprocity between them. This requires the development of a matching mechanism (via consent) to accommodate their preferences.

Key messages

Policy on data governance should be informed by gamete donors and recipients’ preferences. Sharing desired information with donors and recipients can foster solidarity and reciprocity between them.

Public participation in health data governance: a scoping review

Background

The sheer growth of the health data shared and traded globally holds great promise and menace to public health. Big health data can foster scientific advancements with potential to heal millions across the globe. However, inerasable digital footprints left by the use of apps and digital services challenge people’s privacy and autonomy in (un)foreseeable ways that may cause them to stop sharing data. While many argue that public participation in data governance is a right, others view it as a means to increase data subjects’ recruitment and amass large quantities of data. Little systematic knowledge exists, however, about the arguments for and impact of public participation on health data policy and management.

Methods

A descriptive systematic scoping review was performed. Studies indexed in PubMed, WoS and PsycINFO published until March 2019 were searched. Only empirical, original, peer-reviewed studies reporting on public participation on health data governance were included. Eligibility and data extraction were performed by 3 researchers.

Results

The 21 studies analyzed point to public participation in several governance dimensions including data access, linkage, dissemination and policy. Involvement of (potential) data subjects in health data governance was substantiated by democratic arguments of legitimacy, transparency and accountability. However, the need to earn public support for data generation and use can override these arguments and foster utilitarian approaches that may transform participatory exercises into a technology of legitimation for a priori made decisions. Furthermore, although public participation in data governance can deliver instrumental benefits (e.g. participant-centred data policy), systematic assessment of participatory exercises’ impact is lacking.

Conclusions

Public participation in health data governance can promote public trust in and thrust for science. Further research is needed to fully assess its impact.

Key messages

Democratic-led participatory exercises in health data governance can foster public trust in science. Further research is needed to fully assess the impact of public participation in data governance.