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Barton KS, Porter KM, Mai T, Claw KG, Hiratsuka VY, Carroll SR, Burke W, Garrison NA. Genetic Research within Indigenous Communities: Engagement Opportunities and Pathways Forward. Genet Med 2024:101158. [PMID: 38699966 DOI: 10.1016/j.gim.2024.101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Against a historical backdrop of researchers who violated trust through lack of benefit sharing, transparency, and engagement, efforts are underway to develop better approaches for genetic and genomic research with Indigenous communities. To increase engagement, there is a need to understand factors that impact researcher and community collaborations. This study aimed to understand the barriers, challenges, and facilitators of Indigenous Peoples in the US participating in genetic research. METHODS We conducted 42 semi-structured interviews with Tribal leaders, clinicians, researchers, policy makers, and Tribal research review board members across the US to explore perceived risks, benefits, barriers and facilitators of genetic research participation. RESULTS Participants, identifying as Indigenous (88%) or non-Indigenous allies (12%), described their concerns, hesitancy, and fears about genetic research as well as the roles of trust, transparency, and respect for culture in facilitating partnerships. Previous harms - such as sample and data misuse, stigmatization, or misrepresentation by researchers - revealed strategies for building trust to create more equitable and reciprocal research partnerships. CONCLUSION Participants in this study offered strategies for increasing genetic research engagement. The pathway forward should foster transparent research policies and practices to facilitate informed research that supports the needs and priorities of participants, communities, and researchers.
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Affiliation(s)
- Krysta S Barton
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children's Research Institute, Seattle, Washington
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Thyvu Mai
- Institute for Public Health Genetics, University of Washington School of Medicine, Seattle, Washington
| | - Katrina G Claw
- Department of Biomedical Informatics, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Vanessa Y Hiratsuka
- Center for Human Development, College of Health, University of Alaska Anchorage, Anchorage, AK 99508 USA; Southcentral Foundation, Anchorage, AK 99508 USA
| | - Stephanie Russo Carroll
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724 USA; Native Nations Institute, Udall Center for Studies in Public Policy, University of Arizona, Tucson, AZ 85719 USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington
| | - Nanibaa' A Garrison
- Institute for Society & Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Weiss EM, Donohue PK, Wootton SH, Stevens E, Merhar SL, Puia-Dumitrescu M, Mercer A, Oslin E, Porter KM, Wilfond BS. Motivations for and against Participation in Neonatal Research: Insights from Interviews of Diverse Parents Approached for Neonatal Research in the US. J Pediatr 2024:113923. [PMID: 38492913 DOI: 10.1016/j.jpeds.2024.113923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To describe parents' motivations for and against participation in neonatal research, including the views of those who declined participation. STUDY DESIGN We performed 44 semi-structured, qualitative interviews of parents approached for neonatal research. Here we describe their motivations for and against participation. RESULTS Altruism was an important reason parents chose to participate. Some hoped participation in research would benefit their infant. Burdens of participation to the family, such as transportation to follow up (distinct from risks/burdens to the infant), were often deciding factors among those who declined participation. Perceived risks to the infant were reasons against participation, but parents often did not differentiate between baseline risks and incremental risk of study participation. Concerns regarding their infant being treated like a "guinea pig" were common among those who declined. Finally, historical abuses and institutional racism were reported as important concerns by some research decliners from minoritized populations. CONCLUSIONS Within a diverse sample of parents approached to enroll their infant in neonatal research, motivations for and against participation emerged, which may be targets of future interventions. These motivations included reasons for participation which we may hope to encourage, such as altruism. They also included reasons against participation, which we may hope to, as feasible, eliminate, mitigate, or at least acknowledge. These findings can help clinical trialists, regulators, and funders attempting to improve neonatal research recruitment processes.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan H Wootton
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Emily Stevens
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati OH and Department of Pediatrics, University of Cincinnati College of Medicine
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, Oregon
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Weiss EM, Porter KM, Oslin E, Puia-Dumitrescu M, Donohue PK, Merhar SL, Stephens E, Mercer A, Wilfond BS. Experiences and preferences for learning about neonatal research: insights from parent interviews. J Perinatol 2024; 44:404-414. [PMID: 38001157 PMCID: PMC10939889 DOI: 10.1038/s41372-023-01790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Parents struggle with being asked to participate in neonatal research. Past work has largely failed to include views of minoritized parents, low-socioeconomic status parents, and those who declined research. We aimed to describe parents' preferences related to learning about eligibility for neonatal research. METHODS Qualitative interviews of parents who were asked to enroll their infant in neonatal research. Themes related to parental experiences and preferences for learning about neonatal research were identified using content analysis. RESULTS Many parents desired greater involvement of their clinical team. Emotions at the time of recruitment were critically important to parents' experience, where were deeply impacted by interpersonal relationships with research staff. DISCUSSION Increased involvement of the clinical team and greater sensitivity to the stressors around parent and infant conditions at the time of recruitment for neonatal research should be considered by those attempting to improve recruitment for neonatal research.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Emily Stephens
- McGovern Medical Center at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, OR, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Weiss EM, Porter KM, Sullivan TR, Sotelo Guerra LJ, Anderson EE, Garrison NA, Baker L, Smith JM, Kraft SA. Equity Concerns Across Pediatric Research Recruitment: An Analysis of Research Staff Interviews. Acad Pediatr 2024; 24:318-329. [PMID: 37442368 PMCID: PMC10782814 DOI: 10.1016/j.acap.2023.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Difficulty recruiting individuals from minoritized and underserved populations for clinical research is well documented and has health equity implications. Previously, we reported findings from interviews with research staff about pediatric research recruitment processes. Respondents raised equity concerns related to recruitment and enrollment of participants from minoritized, low resourced, and underserved populations. We therefore decided to perform a secondary coding of the transcripts to examine equity-related issues systematically. METHODS We conducted a process of secondary coding and analysis of interviews with research staff involved in recruitment for pediatric clinical research. Through consensus we identified codes relevant to equity and developed a conceptual framework including 5 stages of research. RESULTS We analyzed 28 interviews and coded equity-related items. We report 6 implications of our findings. First, inequitable access to clinical care is an upstream barrier to research participation. Second, there is a need to increase research opportunities where underserved and under-represented populations receive care. Third, increasing research team diversity can build trust with patients and families, but teams must ensure adequate support of all research team members. Fourth, issues related to consent processes raise institutional-level opportunities for improvement. Fifth, there are numerous study procedure-related barriers to participation. Sixth, our analysis illustrates that individuals who speak languages other than English face barriers across multiple stages. CONCLUSIONS Research staff members identified equity-related concerns and recommended potential solutions across 5 stages of the research process, which may guide those endeavoring to improve research recruitment for pediatric patients from minoritized and underserved populations.
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Affiliation(s)
- Elliott Mark Weiss
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash.
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash
| | | | - Laura J Sotelo Guerra
- Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Emily E Anderson
- Neiswanger Institute for Bioethics (EE Anderson), Loyola University Chicago Stritch School of Medicine, Maywood, Ill
| | - Nanibaa' A Garrison
- Institute for Society and Genetics (NA Garrison), University of California Los Angeles; Institute for Precision Health (NA Garrison), David Geffen School of Medicine, University of California Los Angeles; and Division of General Internal Medicine and Health Services Research (NA Garrison), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Laura Baker
- Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Jodi M Smith
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Stephanie A Kraft
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash
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Gilmore MJ, Knerr S, Kraft SA, Bulkley JE, Biesecker BB, Feigelson HS, Hunter JE, Jenkins CL, Kauffman TL, Lee SSJ, Liles EG, Mittendorf KF, Muessig KR, Porter KM, Rolf BA, Rope AF, Zepp JM, Anderson KP, Devine B, Joseph G, Leo MC, Goddard K, Wilfond BS. Improving Care for Marginalized Populations at Risk for Hereditary Cancer Syndromes: Innovations that Expanded Reach in the CHARM Study. Public Health Genomics 2023; 27:16-22. [PMID: 38142673 DOI: 10.1159/000535610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA,
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | | | - Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Charisma L Jenkins
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | | | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bradley A Rolf
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle, Washington, USA
| | - Alan F Rope
- Genome Medical, South San Francisco, California, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | - Beth Devine
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Katrina Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
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Duenas DM, Riddle L, Guerra C, Caruncho M, Lewis H, Porter KM, Kraft SA, Anderson KP, Biesecker B, Gilmore MJ, Zepp JM, Leo MC, Wilfond BS, Joseph G. Refining a Multifaceted Model of Perceived Utility of Genomic Sequencing Results. Public Health Genomics 2023; 26:135-144. [PMID: 37607497 PMCID: PMC10614499 DOI: 10.1159/000531782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/22/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Research on the perceived utility of genomic sequencing has focused primarily on pediatric populations and on individuals and families with rare genetic diseases. Here, we evaluate how well a multifaceted perceived utility model developed with these populations applies to a diverse, adult population aged 18-49 at risk for hereditary cancer and propose new considerations for the model. METHODS Participants received clinical genomic sequencing in the Cancer Health Assessments Reaching Many (CHARM) study. Semi-structured qualitative interviews were conducted with a subset of participants at 1 and 6 months after results disclosure. We used an approach influenced by grounded theory to examine perceptions of the utility of genomic sequencing and analyzed how utility in CHARM mapped to the published multifaceted perceived utility model, noting which domains were represented or absent and which were most salient to our population. RESULTS Participants' discussions of utility often involved multiple domains and revealed the variety of ways in which receiving sequencing results can impact one's life. Results demonstrated that an individual's perception of utility can change over the life course when sequenced at a relatively young age and may be influenced by the resources available to them to act on the results. CONCLUSION Our findings demonstrate the relevance of a multifaceted perceived utility model for a diverse adult population at risk for hereditary cancer. We identified refinements that could make the model more robust, including emphasizing the overlapping nature of the domains and the importance of life stage and personal resources to the perception of utility.
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Affiliation(s)
- Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Claudia Guerra
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Mikaella Caruncho
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hannah Lewis
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine P. Anderson
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO, USA
| | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Michael C. Leo
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - On behalf of the CHARM Study
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO, USA
- Analytics, RTI International, Washington, DC, USA
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Porter KM, Kraft SA, Speight CD, Duenas DM, Niyibizi NK, Mitchell A, O’Connor MR, Gregor C, Liljenquist K, Shah SK, Wilfond BS, Dickert NW. Research recruitment through the patient portal: perspectives of community focus groups in Seattle and Atlanta. JAMIA Open 2023; 6:ooad004. [PMID: 36751464 PMCID: PMC9897173 DOI: 10.1093/jamiaopen/ooad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/16/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Objective Research recruitment through patient portals (ie, patient-facing, web-based clinical interfaces) has the potential to be effective, efficient, and inclusive, but best practices remain undefined. We sought to better understand how patients view this recruitment approach. Materials and Methods We conducted 6 focus groups in Atlanta, GA and Seattle, WA with members of patient advisory committees and the general public. Discussions addressed acceptability of patient portal recruitment and communication preferences. Focus groups were audio-recorded, transcribed, and analyzed using deductive and inductive codes. Iterative team discussions identified major themes. Results Of 49 total participants, 20 were patient advisory committee members. Participants' mean age was 49 (range 18-74); 59% identified as non-Hispanic White and 31% as Black/African American. Participants were supportive of patient portal recruitment and confident that messages were private and legitimate. Participants identified transparency and patient control over whether and how to participate as essential features. Concerns included the frequency of research messages and the ability to distinguish between research and clinical messages. Participants also discussed how patient portal recruitment might affect diversity and inclusion. Discussion Focus group participants generally found patient portal recruitment acceptable and perceived it as secure and trustworthy. Transparency, control, and attention to inclusiveness were identified as key considerations for developing best practices. Conclusion For institutions implementing patient portal recruitment programs, continued engagement with patient populations can help facilitate translation of these findings into best practices and ensure that implemented strategies accomplish intended goals.
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Affiliation(s)
- Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Candace D Speight
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Nyiramugisha K Niyibizi
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
| | - Andrea Mitchell
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
| | - M Rebecca O’Connor
- Child, Family & Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Charles Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Seema K Shah
- Bioethics Program, Lurie Children’s Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Neal W Dickert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical and Translational Science Alliance, Emory University, Atlanta, Georgia, USA
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Thompson AD, Berkman ER, Simmons SW, Porter KM, Kroon L, Goldman R, Ramasamy RS. Ethical Considerations in Balancing Use of Seclusion and Restraint With Risk of COVID-19 Exposure: Recommendations for Youth Inpatient Psychiatry Units. J Am Acad Child Adolesc Psychiatry 2022; 61:1319-1321. [PMID: 35513190 PMCID: PMC9057649 DOI: 10.1016/j.jaac.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
The onset of the COVID-19 pandemic has presented unique challenges for inpatient psychiatry units (IPUs). IPUs, especially those caring for children and adolescents, rely heavily on milieu group programming to provide care and supervision for patients, and have had to adapt unit policies and procedures to maintain a therapeutic milieu while minimizing COVID-19 transmission.1 Simultaneously providing care while preventing transmission of COVID-19 within IPUs is a formidable task, and many IPUs face the additional challenge of treating youth who have been exposed to, or are actively infected with, COVID-19. In addition, given the need to prevent transmission of COVID-19, recommendations include "mandatory quarantine and isolation when patients refuse to adhere to guidelines,"2 potentially leading to the use of restraint when patients attempt to leave isolation; thus a conflict between the potential risks of enforcing infection prevention policies in order to reduce virus transmission and best practices of eliminating seclusion and restraint (S/R) creates an ethical dilemma for IPUs.
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Affiliation(s)
- Alysha D. Thompson
- Seattle Children’s Hospital, Washington,University of Washington, Seattle,Correspondence to Alysha D. Thompson, PhD, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Emily R. Berkman
- Seattle Children’s Hospital, Washington,University of Washington, Seattle
| | - Shannon W. Simmons
- Seattle Children’s Hospital, Washington,University of Washington, Seattle
| | | | | | | | - Ravi S. Ramasamy
- Seattle Children’s Hospital, Washington,University of Washington, Seattle
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Kraft SA, Porter KM, Sullivan TR, Anderson EE, Garrison NA, Baker L, Smith JM, Weiss EM. Relationship building in pediatric research recruitment: Insights from qualitative interviews with research staff. J Clin Transl Sci 2022; 6:e138. [PMID: 36590359 PMCID: PMC9794958 DOI: 10.1017/cts.2022.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Clinical research staff play a critical role in recruiting families for pediatric research, but their views are not well described. We aimed to describe how pediatric research staff build trusting research relationships with patients and their families. Methods We interviewed research staff at one pediatric research institution and its affiliated academic medical center between November 2020 and February 2021. Staff were eligible if they conducted participant recruitment, consent, and/or enrollment for clinical research. We developed our semi-structured interview guide based on a framework for trusting researcher-community partnerships. Results We interviewed 28 research staff, with a median age of 28 years (range 22-50) and a median of 5 years of experience (range 1-29). Interviewees identified factors relevant to relationship building across three levels: the individual staff member, the relational interaction with the family, and the institutional or other structural backdrop. Individual factors included how staff developed recruitment skills, their perceived roles, and their personal motivations. Relational factors spanned four stages of recruitment: before the approach, forming an initial connection with a family, building the connection, and following up. Structural factors were related to access and diversity, clinical interactions, and the COVID-19 pandemic. Conclusions Research staff discussed tensions and supports with various actors, challenges with the integration of research and clinical care, the importance of voluntariness for building trust, and multiple contributors to inequities in research. These findings reveal the importance of ensuring research staff have a voice in institutional policies and are supported to advocate for patients and families.
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Affiliation(s)
- Stephanie A. Kraft
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
| | | | - Emily E. Anderson
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Nanibaa’ A. Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Laura Baker
- Research Integration Hub, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Jodi M. Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Research Integration Hub, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Elliott M. Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
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10
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Liles EG, Leo MC, Freed AS, Porter KM, Zepp JM, Kauffman TL, Keast E, McMullen CK, Gruß I, Biesecker BB, Muessig KR, Eubanks DJ, Amendola LM, Dorschner MO, Rolf BA, Jarvik GP, Goddard KAB, Wilfond BS. ORCA, a values-based decision aid for selecting additional findings from genomic sequencing in adults: Efficacy results from a randomized trial. Genet Med 2022; 24:1664-1674. [PMID: 35522237 PMCID: PMC9586129 DOI: 10.1016/j.gim.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Individuals having genomic sequencing can choose to be notified about pathogenic variants in genes unrelated to the testing indication. A decision aid can facilitate weighing one's values before making a choice about these additional results. METHODS We conducted a randomized trial (N = 231) comparing informed values-choice congruence among adults at risk for a hereditary cancer syndrome who viewed either the Optional Results Choice Aid (ORCA) or web-based additional findings information alone. ORCA is values-focused with a low-literacy design. RESULTS Individuals in both arms had informed values-choice congruence (75% and 73% in the decision aid and web-based groups, respectively; odds ratio [OR] = 1.10, 95% CI = 0.58-2.08). Most participants had adequate knowledge (79% and 76% in the decision aid and web-based groups, respectively; OR = 1.20, 95% CI = 0.61-2.34), with no significant difference between groups. Most had information-seeking values (97% and 98% in the decision aid and web-based groups, respectively; OR = 0.59, 95% CI = 0.10-3.61) and chose to receive additional findings. CONCLUSION The ORCA decision aid did not significantly improve informed values-choice congruence over web-based information in this cohort of adults deciding about genomic results. Both web-based approaches may be effective for adults to decide about receiving medically actionable additional results.
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Affiliation(s)
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Amanda S Freed
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Inga Gruß
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Barbara B Biesecker
- Genetics, Bioinformatics and Translation, RTI International, Washington, D.C
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Michael O Dorschner
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Bradley A Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA; Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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11
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Mittendorf KF, Lewis HS, Duenas DM, Eubanks DJ, Gilmore MJ, Goddard KAB, Joseph G, Kauffman TL, Kraft SA, Lindberg NM, Reyes AA, Shuster E, Syngal S, Ukaegbu C, Zepp JM, Wilfond BS, Porter KM. Literacy-adapted, electronic family history assessment for genetics referral in primary care: patient user insights from qualitative interviews. Hered Cancer Clin Pract 2022; 20:22. [PMID: 35689290 PMCID: PMC9188215 DOI: 10.1186/s13053-022-00231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk assessment for hereditary cancer syndromes is recommended in primary care, but family history is rarely collected in enough detail to facilitate risk assessment and referral - a roadblock that disproportionately impacts individuals with healthcare access barriers. We sought to qualitatively assess a literacy-adapted, electronic patient-facing family history tool developed for use in diverse, underserved patient populations recruited in the Cancer Health Assessments Reaching Many (CHARM) Study. METHODS Interview participants were recruited from a subpopulation of CHARM participants who experienced barriers to tool use in terms of spending a longer time to complete the tool, having incomplete attempts, and/or providing inaccurate family history in comparison to a genetic counselor-collected standard. We conducted semi-structured interviews with participants about barriers and facilitators to tool use and overall tool acceptability; interviews were recorded and professionally transcribed. Transcripts were coded based on a codebook developed using inductive techniques, and coded excerpts were reviewed to identify overarching themes related to barriers and facilitators to family history self-assessment and acceptability of the study tool. RESULTS Interviewees endorsed the tool as easy to navigate and understand. However, they described barriers related to family history information, literacy and language, and certain tool functions. Participants offered concrete, easy-to-implement solutions to each barrier. Despite experience barriers to use of the tool, most participants indicated that electronic family history self-assessment was acceptable or preferable in comparison to clinician-collected family history. CONCLUSIONS Even for participants who experienced barriers to tool use, family history self-assessment was considered an acceptable alternative to clinician-collected family history. Barriers experienced could be overcome with minor adaptations to the current family history tool. TRIAL REGISTRATION This study is a sub-study of the Cancer Health Assessments Reaching Many (CHARM) trial, ClinicalTrials.gov, NCT03426878. Registered 8 February 2018.
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Affiliation(s)
- Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Hannah S Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE. Pacific St, Seattle, WA, 98195, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Ana A Reyes
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Sapna Syngal
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Chinedu Ukaegbu
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE. Pacific St, Seattle, WA, 98195, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, USA.
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12
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Duenas DM, Shipman KJ, Porter KM, Shuster E, Guerra C, Reyes A, Kauffman TL, Hunter JE, Goddard KAB, Wilfond BS, Kraft SA. Motivations and concerns of patients considering participation in an implementation study of a hereditary cancer risk assessment program in diverse primary care settings. Genet Med 2022; 24:610-621. [PMID: 34906471 PMCID: PMC8939763 DOI: 10.1016/j.gim.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Understanding the motivations and concerns of patients from diverse populations regarding participation in implementation research provides the needed evidence about how to design and conduct studies for facilitating access to genetics services. Within a hereditary cancer screening study assessing a multifaceted intervention, we examined primary care patients' motivations and concerns about participation. METHODS We surveyed and interviewed study participants after they enrolled, surveyed those who did not complete enrollment, and used descriptive qualitative and quantitative methods to identify motivations and concerns regarding participation. RESULTS Survey respondents' most common motivations included a desire to learn about their future risk (81%), receiving information that may help family (58%), and a desire to advance research (34%). Interviews revealed 3 additional important factors: affordability of testing, convenience of participation, and clinical relationships supporting research decision-making. Survey data of those who declined enrollment showed that the reasons for declining included concerns about privacy (38%), burdens of the research (19%), and their fear of not being able to cope with the genetic information (19%). CONCLUSION Understanding the facilitating factors and concerns that contribute to decisions about research may reveal ways to improve equity in access to care and research that could lead to greater uptake of genomic medicine across diverse primary care patient populations.
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Affiliation(s)
- Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA.
| | - Kelly J Shipman
- Palliative Care and Resilience Research Program, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, CA
| | - Ana Reyes
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
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13
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KA. Corrigendum to “Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations” [Contemporary Clinical Trials 106 (2021) 106432]. Contemp Clin Trials 2022; 114:106682. [DOI: 10.1016/j.cct.2022.106682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Taylor HA, Porter KM, Paquette ET, McCormick JB, Tumilty E, Arnold JF, Spector-Bagdady K, Danis M, Brandt D, Shah J, Wilfond BS, Lee LM. Creating a Research Ethics Consultation Service: Issues to Consider. Ethics Hum Res 2021; 43:18-25. [PMID: 34496156 DOI: 10.1002/eahr.500101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article provides pragmatic advice for organizations interested in creating a research ethics consultation service (RECS). A robust RECS has the potential to build capacity among investigators to identify and consider the ethical issues they encounter while conducting their research. Determining whether to establish an RECS should begin with an institutional-needs assessment that includes three key questions: What are the current resources available to research teams to navigate ethical concerns that arise from their research? Is there a demand or perceived need for more resources? Is there institutional support (financial and otherwise) to establish and maintain an RECS? If this results in the decision to establish the consultation service, relevant institutional stakeholders must be identified and consulted, and personnel with the requisite skills recruited. The next step is to establish an RECS and build the infrastructure to process and respond to requests. The RECS's long-term sustainability will depend on a stable source of funding and a mechanism to receive constructive feedback to ensure that the service is meeting the institutional needs it set out to address.
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Affiliation(s)
- Holly A Taylor
- Research bioethicist in the Department of Bioethics at the Clinical Center at the National Institutes of Health
| | - Kathryn M Porter
- Research scientist at the Seattle Children's Hospital and Research Institute
| | - Erin Talati Paquette
- Assistant professor of pediatrics (critical care) at the Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago and an assistant professor of law (by courtesy) at the Northwestern University Pritzker School of Law
| | - Jennifer B McCormick
- Associate professor in the Department of Humanities in the College of Medicine at the Pennsylvania State University
| | - Emma Tumilty
- Bioethicist and lecturer at the School of Medicine in the Faculty of Health at Deakin University Waurn Ponds, Geelong, Australia
| | - Jason F Arnold
- Senior fellow of bioethics and health policy and the assistant director of the CTR fellowship program at the Institute of Human Values in Health Care at the Medical University of South Carolina
| | - Kayte Spector-Bagdady
- Associate director of the Center for Bioethics & Social Sciences in Medicine and an assistant professor of obstetrics and gynecology at the University of Michigan Medical School
| | - Marion Danis
- Head of the section on ethics and health policy in the Department of Bioethics at the Clinical Center of the National Institutes of Health
| | - Debra Brandt
- Research assistant professor in the Department of Obstetrics and Gynecology at the University of Iowa
| | - Jina Shah
- Senior director of patient safety and pharmacovigilance at Kite, a Gilead Sciences company, in Santa Monica, CA
| | - Benjamin S Wilfond
- Professor in the divisions of bioethics and palliative care and pulmonary and sleep medicine in the Department of Pediatrics at the Seattle Children's Hospital and Research Institute at the University of Washington School of Medicine
| | - Lisa M Lee
- Associate vice president for research and innovation, the director of scholarly integrity and research compliance, and a professor of population health sciences at Virginia Tech
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15
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KAB. Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations. Contemp Clin Trials 2021; 106:106432. [PMID: 33984519 PMCID: PMC8336568 DOI: 10.1016/j.cct.2021.106432] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
Advances in the application of genomic technologies in clinical care have the potential to increase existing healthcare disparities. Studies have consistently shown that only a fraction of eligible patients with a family history of cancer receive recommended cancer genetic counseling and subsequent genetic testing. Care delivery models using pre-test and post-test counseling are not scalable, which contributes to barriers in accessing genetics services. These barriers are even more pronounced for patients in historically underserved populations. We have designed a multimodal intervention to improve subsequent cancer surveillance, by improving the identification of patients at risk for familial cancer syndromes, reducing barriers to genetic counseling/testing, and increasing patient understanding of complex genetic results. We are evaluating this intervention in two large, integrated healthcare systems that serve diverse patient populations (NCT03426878). The primary outcome is the number of diagnostic (hereditary cancer syndrome) findings. We are examining the clinical and personal utility of streamlined pathways to genetic testing using electronic medical record data, surveys, and qualitative interviews. We will assess downstream care utilization of individuals receiving usual clinical care vs. genetic testing through the study. We will evaluate the impacts of a literacy-focused genetic counseling approach versus usual care genetic counseling on care utilization and participant understanding, satisfaction, and family communication. By recruiting participants belonging to historically underserved populations, this study is uniquely positioned to evaluate the potential of a novel genetics care delivery program to reduce care disparities.
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Affiliation(s)
- Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | | | | | - Michael O Dorschner
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sandra Soo Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, 630 West 168(th) St, PH15E-1525, New York, NY 10032, USA
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Elizabeth G Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, 777 Bannock Denver, CO 80204, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Leslie S Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Bradley A Rolf
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Alan F Rope
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA; Genome Medical, 701 Gateway Blvd, Suite 380, San Francisco, CA 94080, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
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16
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Speight CD, Gregor C, Ko YA, Kraft SA, Mitchell AR, Niyibizi NK, Phillips BG, Porter KM, Shah SK, Sugarman J, Wilfond BS, Dickert NW. Reframing Recruitment: Evaluating Framing in Authorization for Research Contact Programs. AJOB Empir Bioeth 2021; 12:206-213. [PMID: 33719913 PMCID: PMC10788686 DOI: 10.1080/23294515.2021.1887962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The changing clinical research recruitment landscape involves practical challenges but introduces opportunities. Researchers can now identify large numbers of eligible patients through electronic health record review and can directly contact those who have authorized contact. Applying behavioral science-driven strategies to design and frame communication could affect patients' willingness to authorize contact and their understanding of these programs. The ethical and practical implications of various strategies warrant empirical evaluation. METHODS We conducted an online survey (n = 1070) using a nationally-representative sample. Participants were asked to imagine being asked for authorization for research contact in clinic. They were randomly assigned to view one of three flyers: #1-neutral text flyer; #2-a positive text flyer; or #3-positive graphics-based flyer. Primary outcomes included likelihood of enrollment and comprehension of the program. Chi-Square tests and regression analyses were used to examine whether those who saw the positive flyers were more likely to enroll and had increased comprehension. RESULTS Compared to the neutral flyer, individuals who received the positive text flyer were numerically more likely to enroll, but this was not statistically significant (24.2% v. 19.0%, p = 0.11). Individuals who received the positive graphics flyer were more likely to enroll (28.7% v. 19.0%, p = 0.002). After adjustment, individuals assigned to both novel flyers had increased odds of being likely to enroll (OR = 1.55 95%CI [1.04, 2.31] and OR = 1.95 95%CI [1.31, 2.91]). Flyer type did not affect overall comprehension (p = 0.21), and greater likelihood of enrollment was observed only in individuals with better comprehension. CONCLUSIONS This study demonstrated that employing behavioral science-driven communication strategies for authorization for research contact had an effect on likelihood of hypothetical enrollment but did not significantly affect comprehension. Strategies using simple, positive language and visual tools may be effective and ethically appropriate. Further studies should explore how these and other approaches can help to optimize research recruitment.
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Affiliation(s)
- Candace D. Speight
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Charlie Gregor
- Institute of Translational Health Sciences at the University of Washington, Seattle, WA
| | - Yi-An Ko
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Stephanie A. Kraft
- University of Washington School of Medicine, Department of Pediatrics and the Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Andrea R. Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Nyiramugisha K. Niyibizi
- Georgia Clinical and Translational Science Alliance at Emory University School of Medicine, Atlanta, GA
| | - Bradley G. Phillips
- University of Georgia College of Pharmacy and the Director of the University of Georgia Office of Research Clinical and Translational Research Unit, Athens, GA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Seema K. Shah
- Northwestern Feinberg School of Medicine and Associate Director of Research Ethics at the Stanley Manne Research Institute, Lurie Children’s Hospital
| | | | - Benjamin S. Wilfond
- University of Washington School of Medicine, Department of Pediatrics and the Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Neal W. Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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17
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Freed AS, Gruß I, McMullen CK, Leo MC, Kauffman TL, Porter KM, Muessig KR, Eubanks D, Goddard KAB, Wilfond BS, Liles EG. A decision aid for additional findings in genomic sequencing: Development and pilot testing. Patient Educ Couns 2021; 104:960-968. [PMID: 33191058 PMCID: PMC8099937 DOI: 10.1016/j.pec.2020.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/29/2020] [Accepted: 10/31/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To describe the development of a web-based, patient-facing decision aid to support patients and research participants to make an informed, values-based decision about whether to receive additional results from genomic sequencing. METHODS We developed the decision aid following the multi-step process described in the International Patient Decision Aids Standards. This utilized literature review, focus groups, and alpha testing with research participants undergoing clinical genomic sequencing. RESULTS The decision aid, the Optional Results Choice Aid (ORCA), includes a seven-question "values clarification exercise," illustrative patient quotes, and summative guidance for the user. The decision aid was found to be highly readable, acceptable and relevant in alpha testing. CONCLUSION We developed a decision aid to support informed, values-based decision making for patients and research participants considering whether to receive additional results from genomic sequencing. ORCA is being implemented in the NHGRI-funded Cancer Health Assessment Reaching Many (CHARM) study, where we are measuring informed values-choice congruence. PRACTICE IMPLICATIONS ORCA was designed to support patients and research participants to make an informed, values-based decision about whether to receive additional results from genomic sequencing.
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Affiliation(s)
- Amanda S Freed
- Department of Medicine, Division of Medical Genetics, University of Washington School of Medicine, Seattle, USA
| | - Inga Gruß
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Carmit K McMullen
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Michael C Leo
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Kathryn M Porter
- Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Donna Eubanks
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, USA
| | - Elizabeth G Liles
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA; Northwest Permanente, Kaiser Permanente Northwest, Portland, USA.
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Porter KM, Weiss EM, Kraft SA. Promoting Disclosure and Understanding in Informed Consent: Optimizing the Impact of the Common Rule "Key Information" Requirement. Am J Bioeth 2021; 21:70-72. [PMID: 33945415 PMCID: PMC8600969 DOI: 10.1080/15265161.2021.1906996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | - Elliott M Weiss
- Seattle Children's Research Institute
- University of Washington School of Medicine
| | - Stephanie A Kraft
- Seattle Children's Research Institute
- University of Washington School of Medicine
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Niyibizi NK, Speight CD, Gregor C, Ko YA, Kraft SA, Mitchell AR, Phillips BG, Porter KM, Shah SK, Sugarman J, Wilfond BS, Dickert NW. Public attitudes toward an authorization for contact program for clinical research. J Am Med Inform Assoc 2021; 28:354-359. [PMID: 33150424 PMCID: PMC7883977 DOI: 10.1093/jamia/ocaa214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/30/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
We conducted an online experimental survey to evaluate attitudes toward an authorization for contact (AFC) program allowing researchers to contact patients about studies based on electronic record review. A total of 1070 participants were randomly assigned to 1 of 3 flyers varying in design and framing. Participants were asked to select concerns about and reasons for signing up for AFC. Logistic regression and latent class analysis were conducted. The most commonly selected concerns included needing more information (43%), privacy (40%), and needing more time to think (28%). A minority were not interested in participating in research (16%) and did not want to be bothered (15%). Latent class analysis identified clusters with specific concerns about privacy, lack of interest in research, and not wanting to be bothered. A novel flyer with simple and positive framing was associated with lower odds of both not wanting to be bothered (P = .01) and not being interested in research (P = .01). Many concerns about AFC programs appear nonspecific. Addressing privacy, lack of interest in research, and not wanting to be bothered warrant further study as ways to enhance recruitment.
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Affiliation(s)
- Nyiramugisha K Niyibizi
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Candace D Speight
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlie Gregor
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Stephanie A Kraft
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Andrea R Mitchell
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley G Phillips
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, Georgia, USA
- Biomedical and Health Sciences Institute, University of Georgia Office of Research, Athens, Georgia, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Seema K Shah
- Research Ethics, Stanley Manne Research Institute, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Benjamin S Wilfond
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Neal W Dickert
- Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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20
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Kraft SA, Porter KM, Duenas DM, Guerra C, Joseph G, Lee SSJ, Shipman KJ, Allen J, Eubanks D, Kauffman TL, Lindberg NM, Anderson K, Zepp JM, Gilmore MJ, Mittendorf KF, Shuster E, Muessig KR, Arnold B, Goddard KAB, Wilfond BS. Participant Reactions to a Literacy-Focused, Web-Based Informed Consent Approach for a Genomic Implementation Study. AJOB Empir Bioeth 2021; 12:1-11. [PMID: 32981477 PMCID: PMC7785634 DOI: 10.1080/23294515.2020.1823907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, California, USA
| | - Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, California, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jake Allen
- IT (Information Technology) Department, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Donna Eubanks
- IT (Information Technology) Department, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Nangel M Lindberg
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | | | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Elizabeth Shuster
- Research Data and Analysis Center, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Briana Arnold
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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21
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Kraft SA, Porter KM, Duenas DM, Sullivan E, Rowland M, Saelens BE, Wilfond BS, Shah SK. Assessing Parent Decisions About Child Participation in a Behavioral Health Intervention Study and Utility of Informed Consent Forms. JAMA Netw Open 2020; 3:e209296. [PMID: 32735337 PMCID: PMC7395235 DOI: 10.1001/jamanetworkopen.2020.9296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Obtaining informed consent is an important ethical obligation for clinical research participation that is imperfectly implemented. Research on improving consent processes often focuses on consent forms, but little is known about consent forms' influence on decision-making compared with other types of engagement. OBJECTIVE To evaluate whether parents decide whether to enroll their children in research before or after they receive the consent form. DESIGN, SETTING, AND PARTICIPANTS An online survey of 88 parents who enrolled or declined to enroll their child in a weight management intervention study between January 2, 2018, and June 24, 2019, was conducted; surveys were completed between February 2, 2018, and July 9, 2019. A 31-item survey asked about impressions of the study throughout the enrollment process, timing of enrollment decisions, and decision-making factors. Responses were summarized descriptively and subgroups were compared using the Fisher exact test or χ2 test. MAIN OUTCOMES AND MEASURES Self-reported timing of enrollment decision. RESULTS A total of 106 parents were approached and gave permission for their contact information to be shared with the study team; 22 additional parents declined to allow their information to be shared, and 24 lost contact with the partner study before they could be asked for permission. A total of 88 parents (67 enrollees, 21 decliners) completed the survey (83% participation rate); 79 of 88 reporting gender (instead of sex, as biological sex was not relevant to survey) information were women (91%), 66 participants (75%) were non-Hispanic White, and 63 participants (72%) had annual household incomes greater than or equal to $70 000. No significant differences in respondent characteristics between enrollees and decliners were identified. Fifty-nine parents (67%) responded that they decided whether to enroll in the weight management study before receiving the consent form. Only 17 of 69 parents (25%) who remembered receiving the consent form responded that it taught them new information. CONCLUSIONS AND RELEVANCE The findings of this study suggest that interventions to improve informed consent forms may have limited influence on decision-making because many research decisions occur before review of the consent form. It appears that regulatory review and interventions to improve decision-making should focus more on early engagement (eg, recruitment materials). Future studies should test timing of decisions in other types of research with different populations and clinical settings.
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Affiliation(s)
- Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
- University of Washington School of Medicine, Department of Pediatrics, Seattle
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
| | - Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
| | - Erin Sullivan
- Seattle Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington
| | - Maya Rowland
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Brian E. Saelens
- University of Washington School of Medicine, Department of Pediatrics, Seattle
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
- University of Washington School of Medicine, Department of Pediatrics, Seattle
| | - Seema K. Shah
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center; Stanley Manne Children’s Research Institute; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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22
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Kraft SA, McMullen C, Lindberg NM, Bui D, Shipman K, Anderson K, Joseph G, Duenas DM, Porter KM, Kauffman TL, Koomas A, Ransom CL, Jackson P, Goddard KAB, Wilfond BS, Lee SSJ. Integrating stakeholder feedback in translational genomics research: an ethnographic analysis of a study protocol's evolution. Genet Med 2020; 22:1094-1101. [PMID: 32089547 PMCID: PMC7275883 DOI: 10.1038/s41436-020-0763-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study describes challenges faced while incorporating sometimes conflicting stakeholder feedback into study design and development of patient-facing materials for a translational genomics study aiming to reduce health disparities among diverse populations. METHODS We conducted an ethnographic analysis of study documents including summaries of patient advisory committee meetings and interviews, reflective field notes written by study team members, and correspondence with our institutional review board (IRB). Through this analysis, we identified cross-cutting challenges for incorporating stakeholder feedback into development of our recruitment, risk assessment, and informed consent processes and materials. RESULTS Our analysis revealed three key challenges: (1) balancing precision and simplicity in the design of study materials, (2) providing clinical care within the research context, and (3) emphasizing potential study benefits versus risks and limitations. CONCLUSIONS While involving patient stakeholders in study design and materials development can increase inclusivity and responsiveness to patient needs, patient feedback may conflict with that of content area experts on the research team and IRBs who are tasked with overseeing the research. Our analysis highlights the need for further empirical research about ethical challenges when incorporating patient feedback into study design, and for dialogue with genomic researchers and IRB representatives about these issues.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - David Bui
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kelly Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | | | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Alyssa Koomas
- Alliance for a Healthier Generation, Portland, OR, USA
| | - Chelese L Ransom
- CHARM English-Speaking Patient Advisory Committee, Denver, CO, USA
| | - Paige Jackson
- CHARM English-Speaking Patient Advisory Committee, Denver, CO, USA
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sandra Soo-Jin Lee
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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23
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Affiliation(s)
- Benjamin S Wilfond
- Seattle Children's Research Institute
- University of Washington School of Medicine
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24
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Porter KM, Stevens A, Wilfond BS. Flexibility Required: Balancing the Interests of Children and Risk in Drug Development for Rare Pediatric Conditions. Am J Bioeth 2020; 20:116-118. [PMID: 32208080 PMCID: PMC7175746 DOI: 10.1080/15265161.2020.1730494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Anne Stevens
- Seattle Children's Hospital and Research Institute
- University of Washington School of Medicine
- Janssen Research and Development
| | - Benjamin S Wilfond
- Seattle Children's Hospital and Research Institute
- University of Washington School of Medicine
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Abstract
As genomic researchers are encouraged to engage in broad genomic data sharing, American Indian/Alaska Native/Native Hawaiian (AI/AN/NH) leaders have raised questions about ownership of data and biospecimens and concerns over emerging challenges and potential threats to tribal sovereignty. Using a community-engaged research approach, we conducted 42 semi-structured interviews with tribal leaders, clinicians, researchers, policy makers, and tribal research review board members about their perspectives on ethical issues related to genetics in AI/AN/NH communities. We report findings related to perspectives on genetic research, data sharing, and envisioning stronger oversight and management of data. In particular, participants voiced concerns about different models of data sharing, infrastructure and logistics for housing data, and who should have authority to grant access to data. The results will ultimately guide policy-making and the creation of guidelines and new strategies for tribes to drive the research agenda and promote ethically and culturally appropriate research.
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Affiliation(s)
- Nanibaa' A Garrison
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Krysta S Barton
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Thyvu Mai
- Institute for Public Health Genetics, University of Washington School of Medicine, Seattle, WA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA
| | - Stephanie Russo Carroll
- Native Nations Institute, Udall Center for Studies in Public Policy, University of Arizona, Tucson, AZ.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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26
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DeCou CR, Shah SK, Porter KM. Improving Care for Suicidal Patients While Protecting Human Subjects: Addressing Ethical Challenges in Mental Health Research Involving Emergency Medical Services Providers. Am J Bioeth 2019; 19:99-101. [PMID: 31557112 PMCID: PMC6773257 DOI: 10.1080/15265161.2019.1654017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Seema K Shah
- Lurie Children's Hospital; Northwestern University Feinberg School of Medicine
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27
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Wilfond BS, Porter KM. Justifying Investigator/Clinician Consent When The Physician-Patient Relationship Can Support Better Research Decision-Making. Am J Bioeth 2019; 19:26-28. [PMID: 31544673 PMCID: PMC10027386 DOI: 10.1080/15265161.2019.1574496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute and
- University of Washington School of Medicine
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute and
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28
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Wilfond BS, Porter KM, Creevy KE, Kaeberlein M, Promislow D. Research to Promote Longevity and Health Span in Companion Dogs: A Pediatric Perspective. Am J Bioeth 2018; 18:64-65. [PMID: 30339074 PMCID: PMC6317354 DOI: 10.1080/15265161.2018.1513591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Benjamin S Wilfond
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA, 98101
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Center, Seattle, WA 98101;
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Center, Seattle, WA 98101;
| | - Kate E Creevy
- Small Animal Internal Medicine, College of Veterinary Medicine, Texas A&M University, College Station TX,
| | - Matt Kaeberlein
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195. ;
| | - Daniel Promislow
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195. ;
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Porter KM, Kauffman TL, Koenig BA, Lewis KL, Rehm HL, Richards CS, Strande NT, Tabor HK, Wolf SM, Yang Y, Amendola LM, Azzariti DR, Berg JS, Bergstrom K, Biesecker LG, Biswas S, Bowling KM, Chung WK, Clayton EW, Conlin LK, Cooper GM, Dulik MC, Garraway LA, Ghazani AA, Green RC, Hiatt SM, Jamal SM, Jarvik GP, Goddard KAB, Wilfond BS. Approaches to carrier testing and results disclosure in translational genomics research: The clinical sequencing exploratory research consortium experience. Mol Genet Genomic Med 2018; 6:898-909. [PMID: 30133189 PMCID: PMC6305639 DOI: 10.1002/mgg3.453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/23/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background Clinical genome and exome sequencing (CGES) is primarily used to address specific clinical concerns by detecting risk of future disease, clarifying diagnosis, or directing treatment. Additionally, CGES makes possible the disclosure of autosomal recessive and X‐linked carrier results as additional secondary findings, and research about the impact of carrier results disclosure in this context is needed. Methods Representatives from 11 projects in the clinical sequencing exploratory research (CSER) consortium collected data from their projects using a structured survey. The survey focused on project characteristics, which variants were offered and/or disclosed to participants as carrier results, methods for carrier results disclosure, and project‐specific outcomes. We recorded quantitative responses and report descriptive statistics with the aim of describing the variability in approaches to disclosing carrier results in translational genomics research projects. Results The proportion of participants with carrier results was related to the number of genes included, ranging from 3% (three genes) to 92% (4,600 genes). Between one and seven results were disclosed to those participants who received any positive result. Most projects offered participants choices about whether to receive some or all of the carrier results. There were a range of approaches to communicate results, and many projects used separate approaches for disclosing positive and negative results. Conclusion Future translational genomics research projects will need to make decisions regarding whether and how to disclose carrier results. The CSER consortium experience identifies approaches that balance potential participant interest while limiting impact on project resources.
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Affiliation(s)
- Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Barbara A Koenig
- Institute for Health and Aging, University of California, San Francisco, California
| | - Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch of the National Human Genome Research Institute, Bethesda, Maryland
| | - Heidi L Rehm
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Partners Personalized Medicine, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts
| | - Carolyn Sue Richards
- Knight Diagnostic Laboratories and Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon
| | - Natasha T Strande
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics, Palo Alto, California
| | - Susan M Wolf
- University of Minnesota Law School, Medical School and Consortium on Law and Values in Health, Environment & the Life Sciences, Minneapolis, Minnesota
| | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington
| | - Danielle R Azzariti
- Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts
| | - Jonathan S Berg
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katie Bergstrom
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch of the National Human Genome Research Institute, Bethesda, Maryland
| | - Sawona Biswas
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin M Bowling
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama
| | - Wendy K Chung
- Department of Pediatrics, Columbia University, New York, New York.,Department of Medicine, Columbia University Medical Center, New York, New York
| | - Ellen W Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura K Conlin
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Matthew C Dulik
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Arezou A Ghazani
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology and Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Partners Personalized Medicine, Boston, Massachusetts.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan M Hiatt
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama
| | - Seema M Jamal
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Wilfond BS, Kauffman TL, Jarvik GP, Reiss JA, Richards CS, McMullen C, Gilmore M, Himes P, Kraft SA, Porter KM, Schneider JL, Punj S, Leo MC, Dickerson JF, Lynch FL, Clarke E, Rope AF, Lutz K, Goddard KAB. Lessons Learned From A Study Of Genomics-Based Carrier Screening For Reproductive Decision Making. Health Aff (Millwood) 2018; 37:809-816. [PMID: 29733724 DOI: 10.1377/hlthaff.2017.1578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Genomics-based carrier screening is one of many opportunities to use genomic information to inform medical decision making, but clinicians, health care delivery systems, and payers need to determine whether to offer screening and how to do so in an efficient, ethical way. To shed light on this issue, we conducted a study in the period 2014-17 to inform the design of clinical screening programs and guide further health services research. Many of our results have been published elsewhere; this article summarizes the lessons we learned from that study and offers policy insights. Our experience can inform understanding of the potential impact of expanded carrier screening services on health system workflows and workforces-impacts that depend on the details of the screening approach. We found limited patient or health system harms from expanded screening. We also found that some patients valued the information they learned from the process. Future policy discussions should consider the value of offering such expanded carrier screening in health delivery systems with limited resources.
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Affiliation(s)
- Benjamin S Wilfond
- Benjamin S. Wilfond ( ) is director of the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and of the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, all in Seattle, Washington
| | - Tia L Kauffman
- Tia L. Kauffman is a project director at the Center for Health Research, Kaiser Permanente Northwest, in Portland, Oregon
| | - Gail P Jarvik
- Gail P. Jarvik is a professor in the Division of Medical Genetics, Department of Medicine, and in the Department of Genome Sciences, both at the University of Washington
| | - Jacob A Reiss
- Jacob A. Reiss is a medical geneticist at the Center for Health Research, Kaiser Permanente Northwest
| | - C Sue Richards
- C. Sue Richards is a professor in the Knight Diagnostic Laboratories, Oregon Health & Science University, in Portland
| | - Carmit McMullen
- Carmit McMullen is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Marian Gilmore
- Marian Gilmore is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Patricia Himes
- Patricia Himes is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Stephanie A Kraft
- Stephanie A. Kraft is an acting assistant professor in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and in the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine
| | - Kathryn M Porter
- Kathryn M. Porter is a research scientist in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute
| | - Jennifer L Schneider
- Jennifer L. Schneider is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Sumit Punj
- Sumit Punj is a senior clinical scientist in the Clinical Genomics Program, GeneDx, in Gaithersburg, Maryland
| | - Michael C Leo
- Michael C. Leo is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - John F Dickerson
- John F. Dickerson is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Frances L Lynch
- Frances L. Lynch is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Elizabeth Clarke
- Elizabeth Clarke is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Alan F Rope
- Alan F. Rope is a staff physician at Northwest Permanente, Kaiser Permanente Northwest
| | - Kevin Lutz
- Kevin Lutz is publications manager at the Center for Health Research, Kaiser Permanente Northwest
| | - Katrina A B Goddard
- Katrina A. B. Goddard is associate director, research programs, at the Center for Health Research, Kaiser Permanente Northwest
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Kraft SA, Schneider JL, Leo MC, Kauffman TL, Davis JV, Porter KM, McMullen CK, Wilfond BS, Goddard KAB. Patient actions and reactions after receiving negative results from expanded carrier screening. Clin Genet 2018; 93:962-971. [PMID: 29293279 DOI: 10.1111/cge.13206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/05/2017] [Accepted: 12/27/2017] [Indexed: 02/04/2023]
Abstract
With the expansion of carrier screening to general preconception and prenatal patient populations, most patients will receive negative results, which we define as indicating <25% risk of having a child with a genetic condition. Because there is limited experience with expanded carrier screening, it is important to understand how receiving negative results affects patients, especially as providers, payers, and policymakers consider whether to offer it. In this mixed-methods study, we asked preconception patients enrolled in the NextGen study about their expectations and experiences receiving negative expanded carrier screening results. Participants completed surveys at study enrollment (n = 110 women, 51 male partners), after receiving carrier results (n = 100 women, 38 male partners), after receiving secondary findings (n = 98 women, 36 male partners), and 6 months after receiving results (n = 95 women, 28 male partners). We also interviewed a subset of participants 12 to 24 months after receiving results (n = 24 women, 12 male partners). We found minimal negative emotional impact and privacy concerns, increased confidence in reproductive plans, and few changes to health behaviors, although some patients made health decisions based on misunderstandings of their results. These findings suggest that expanded carrier screening causes minimal psychosocial harms, but systems are needed to reduce the risk of misinterpreting results.
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Affiliation(s)
- S A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - J L Schneider
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - M C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - T L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - J V Davis
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - K M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington
| | - C K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - B S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - K A B Goddard
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Porter KM, Danis M, Taylor HA, Cho MK, Wilfond BS. Defining the Scope and Improving the Quality of Clinical Research Ethics Consultation: Response to Open Peer Commentaries About the National Collaborative. Am J Bioeth 2018; 18:W13-W15. [PMID: 29393779 PMCID: PMC6188676 DOI: 10.1080/15265161.2017.1413438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Open Peer Commentaries on “The Emergence of Clinical Research Ethics Consultation: Insights from a National Collaborative201D highlight the many ways in which the practice of ethics consultation for clinical research can be further advanced. We respond here to a number of key considerations highlighted by commentators, including the role and scope of research ethics consultation (REC), relationships with other institutional services and programs, efforts to ensure the quality of consultations provided, and the feasibility of widespread REC services.
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Abstract
The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards (IRBs), to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation (REC) services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research.
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Kraft SA, McMullen CK, Porter KM, Kauffman TL, Davis JV, Schneider JL, Goddard KAB, Wilfond BS. Patient perspectives on the use of categories of conditions for decision making about genomic carrier screening results. Am J Med Genet A 2017; 176:376-385. [DOI: 10.1002/ajmg.a.38583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/05/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie A. Kraft
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
- Division of BioethicsDepartment of PediatricsUniversity of Washington School of MedicineSeattleWashington
| | | | - Kathryn M. Porter
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
| | - Tia L. Kauffman
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregon
| | - James V. Davis
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregon
| | | | | | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
- Division of BioethicsDepartment of PediatricsUniversity of Washington School of MedicineSeattleWashington
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Kraft SA, Porter KM, Korngiebel DM, James C, Constantine M, Kelley M, Capron AM, Diekema D, Lee SSJ, Cho MK, Magnus D, Wilfond BS. Research on Medical Practices: Why Patients Consider Participating and the Investigational Misconception. IRB 2017; 39:10-16. [PMID: 30387977 PMCID: PMC7374557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Understanding how patients decide whether to enroll in research can help improve educational materials, protocols, and recruitment rates. However, little is known about patients' willingness to participate in research on medical practices (ROMP), or studies comparing interventions within usual care. We assessed willingness to consider participating in ROMP by surveying 1095 adults in the United States, of whom 834 answered at least one open-ended question about their reasons for being willing or unwilling to consider participating in two scenarios involving ROMP. Most respondents were willing to consider participating in the research scenarios. The most commonly cited reasons for being willing to consider participating included benefit to others and oneself; the top reasons for being unwilling to consider participating included belief that the research was unsafe and an unfavorable view of experimentation. Responses also revealed misconceptions about ROMP among both those who were willing and unwilling to consider participating. Because these misconceptions may present an obstacle to recruiting participants in ROMP, there may be a need for educational initiatives to clarify the nature of these types of studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Douglas Diekema
- University of Washington
- Seattle Children's Research Institute
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36
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Kraft SA, Porter KM, Shah SK, Wilfond BS. Comprehension and Choice Under the Revised Common Rule: Improving Informed Consent by Offering Reasons Why Some Enroll in Research and Others Do Not. Am J Bioeth 2017; 17:53-55. [PMID: 28661747 DOI: 10.1080/15265161.2017.1328535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
| | | | - Seema K Shah
- a Seattle Children's Hospital and Research Institute
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37
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Hartley FL, Howells A, Thurgood A, Hall FJ, Porter KM. Medical training for police officers in specialist role (D13): A retrospective review of patient report forms from 2010–2015. Trauma 2017. [DOI: 10.1177/1460408617707548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction D13 is a nationally agreed bespoke medical training package for specialist firearms police officers introduced in 2010. Patient report forms are completed after every episode of care provision. Methods A review of patient report forms submitted by police firearms officers in five regions of England over the five years since the introduction of D13. Results Officers attended a large range of incidents, both traumatic and medical, minor and life critical. The majority (69.5%) were responded to as part of a normal police response, while 30.5% of cases were due to primary firearm deployments. Catastrophic haemorrhage was dealt with in 8.1% of cases including the use of haemostatic dressings and tourniquet application. Airway interventions were required in 36.1% of patients and 50.4% required interventions for external bleeding. Discussion From a background of a minimum of 18 h for Standard and 24 h for Enhanced courses and with regular simulation refreshers, specialist police officers, who are part of a robust clinical governance process, play an important role in providing immediate medical care in non-permissive or dangerous environments where ambulance personnel will not be present and when the officers are frequently first on scene.
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Affiliation(s)
- FL Hartley
- FY1 Rotation, Aintree University Hospital, UK
| | - A Howells
- Firearms Unit, West Midlands Police, UK
| | - A Thurgood
- Independent Consultant Nurse in Pre Hospital Emergency Medicine
| | - FJ Hall
- Faculty of Pre Hospital Care, Royal College of Surgeons of Edinburgh, UK
| | - KM Porter
- Department of Clinical Traumatology, University Hospital Birmingham, Queen Elizabeth, UK
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Kraft SA, Constantine M, Magnus D, Porter KM, Lee SSJ, Green M, Kass NE, Wilfond BS, Cho MK. A randomized study of multimedia informational aids for research on medical practices: Implications for informed consent. Clin Trials 2017; 14:94-102. [PMID: 27625314 PMCID: PMC5300898 DOI: 10.1177/1740774516669352] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Participant understanding is a key element of informed consent for enrollment in research. However, participants often do not understand the nature, risks, benefits, or design of the studies in which they take part. Research on medical practices, which studies standard interventions rather than new treatments, has the potential to be especially confusing to participants because it is embedded within usual clinical care. Our objective in this randomized study was to compare the ability of a range of multimedia informational aids to improve participant understanding in the context of research on medical practices. METHODS We administered a web-based survey to members of a proprietary online panel sample selected to match national US demographics. Respondents were randomized to one of five arms: four content-equivalent informational aids (animated videos, slideshows with voice-over, comics, and text) and one no-intervention control. We measured knowledge of research on medical practices using a summary knowledge score from 10 questions based on the content of the informational aids. We used analysis of variance and paired t-tests to compare knowledge scores between arms. RESULTS There were 1500 completed surveys (300 in each arm). Mean knowledge scores were highest for the slideshows with voice-over (65.7%), followed by the animated videos (62.7%), comics (60.7%), text (57.2%), and control (50.3%). Differences between arms were statistically significant except between the slideshows with voice-over and animated videos and between the animated videos and comics. Informational aids that included an audio component (animated videos and slideshows with voice-over) had higher knowledge scores than those without an audio component (64.2% vs 59.0%, p < .0001). There was no difference between informational aids with a character-driven story component (animated videos and comics) and those without. CONCLUSION Our results show that simple multimedia aids that use a dual-channel approach, such as voice-over with visual reinforcement, can improve participant knowledge more effectively than text alone. However, the relatively low knowledge scores suggest that targeted informational aids may be needed to teach some particularly challenging concepts. Nonetheless, our results demonstrate the potential to improve informed consent for research on medical practices using multimedia aids that include simplified language and visual metaphors.
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Affiliation(s)
- Stephanie A Kraft
- Seattle Children’s Research Institute – Treuman Katz Center for Pediatric Bioethics, Seattle, WA USA
| | - Melissa Constantine
- University of Minnesota, Division of Health Policy and Management, Minneapolis, MN USA
| | - David Magnus
- Stanford University School of Medicine – Center for Biomedical Ethics, Stanford, CA USA
| | - Kathryn M. Porter
- Seattle Children’s Research Institute – Treuman Katz Center for Pediatric Bioethics, Seattle, WA USA
| | - Sandra Soo-Jin Lee
- Stanford University School of Medicine – Center for Biomedical Ethics, Stanford, CA USA
| | - Michael Green
- Penn State Milton S Hershey Medical Center – College of Medicine, Hershey, PA USA
| | - Nancy E Kass
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD USA
| | - Benjamin S. Wilfond
- Seattle Children’s Research Institute – Treuman Katz Center for Pediatric Bioethics, Seattle, WA USA
| | - Mildred K Cho
- Stanford University School of Medicine – Center for Biomedical Ethics, Stanford, CA USA
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39
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Porter KM, Cho MK, Kraft SA, Korngiebel DM, Constantine M, Lee SSJ, Kelley M, James C, Kuwana E, Meyer A, Diekema D, Capron AM, Magnus D, Wilfond BS. Research on Medical Practices (ROMP): Attitudes of IRB Personnel about Randomization and Informed Consent. IRB 2017; 39:10-16. [PMID: 30146866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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40
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Abstract
The patellofemoral joint relies on muscular, ligamentous and bony support for normal stability and function. Dislocations commonly occur due to simultaneous rotational force with contraction of the quadriceps. Bony, muscular and ligamentous factors predispose to dislocations although no single factor causes more dislocations than any other. The diagnosis is based on the history combined with physical examination and radiological investigations. A careful scrutiny of the radiographs is necessary to determine the presence of osteochondral fractures in acute patellar dislocations. Special views and further imagining is indicated especially in those with recurrent symptoms. The treatment of acute dislocations is most commonly non operative. Surgery in acute patellar dislocations is indicated for intra articular fragments or those with large osteochondral fractures. Various soft tissue and bony realignment procedures have been described for recurrent dislocations. No single procedure is superior to another. Factors such as the patient’s age, functional needs, extent of malalignment and the condition of the joint are important factors to be considered prior to operative intervention. In this paper we discuss an overview of the diagnosis and management of patella dislocations with a literature review on the current concepts in treatment.
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Affiliation(s)
- R Dath
- South Birmingham Trauma Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK,
| | - J Chakravarthy
- South Birmingham Trauma Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - KM Porter
- South Birmingham Trauma Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
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41
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Abstract
Monteggia fractures are part of a spectrum of forearm injuries and commonly result either from a fall on the outstretched arm with forced pronation or from a direct injury. An understanding of the mechanism of injury and an appropriate clinical examination followed by operative intervention is the basis of present day good practice. This paper reviews the literature and presents a contemporary overview of the Monteggia fracture in adults.
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Affiliation(s)
- NM Ramisetty
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK
| | - M Revell
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK
| | - KM Porter
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK,
| | - I Greaves
- A&E Department, James Cook University Hospital, Middlesborough, UK
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42
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Abstract
Modern trauma management has recognized the importance of using conservative fluid resuscitation regimes in order to prevent complications from fluid overload arising. Hypertonic/hyperoncotic fluids appear to provide an ideal means of facilitating this, requiring only small volumes to rapidly elevate blood pressure. Hypertonic saline dextran (HSD) was introduced in 1985 but its take up has been slow, a large part of this has been due to the lack of human trials and concerns about complications. The current evidence has been reviewed and it is clear that HSD is an efficient means of correcting hypotension, doing so mainly by the mobilizing endogenous water. It is becoming apparent that early administration has the potential to modulate the inflammatory cascade in patients at risk of developing adult respiratory distress syndrome (ARDS) and multiorgan failure. This is reflected in the handful of human trials that show a trend towards increased survival (particularly for head injuries) and a possible reduction in ARDS. The side effect profile appears to be good, even in the presence of dehydration or penetrating trauma. Published human trials have methodological problems and lack of power of study this has led to a reliance on animal studies. Clearly there is great potential, but before large-scale prehospital usage can be justified further well-conducted randomized human trials are needed.
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Affiliation(s)
- AM Perera
- University Hospital (Selly Oak) Birmingham, Birmingham, UK,
| | - KM Porter
- University Hospital (Selly Oak) Birmingham, Birmingham, UK
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43
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Abstract
The best time to operate on a fracture is governed in part by the nature of the fracture itself. It is also influenced by the premorbid condition of the patient and by the degree that associated injuries have disrupted normal processes. It is likely that some patients have a period of increased physiological risk for intervention, during which a second insult will result in further harm. The picture is not yet fully clear but relates to variations in the inflammatory response to trauma. One consistent lesson appears to resonate throughout the published literature. The most predictable risk factor for iatrogenic physiological disturbance is transfer to the operating theatre before adequate resuscitation of the patient has taken place.
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Affiliation(s)
- MP Revell
- SpR Trauma & Orthopaedics, West Midlands, UK
| | - KM Porter
- Consultant Trauma & Orthopaedic Surgeon, Selly Oak Hospital, Birmingham, UK
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44
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Abstract
The pattern of a limb fracture can be determined by the material property of the bone and the characteristics of the deforming force. In this review we outline the composition and material properties of cortical and cancellous bone, and articular cartilage. We defi ne the biomechanics of fractures and describe the various fracture patterns that are seen clinically.
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Affiliation(s)
- AM McGee
- University of Birmingham NHS Trust, South Birmingham Trauma Unit, Birmingham, UK
| | - AA Qureshi
- University of Birmingham NHS Trust, South Birmingham Trauma Unit, Birmingham, UK
| | - KM Porter
- University of Birmingham NHS Trust, South Birmingham Trauma Unit, Birmingham, UK,
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45
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Abstract
Cervical spine injuries are a persistant problem in trauma, from detection to initial management and then definitive treatment. This is compounded by the unique anatomy of the upper cervical spine which thus responds in a different way to trauma. This article examines the anatomy, initial management, including how to clear the spine, and then discusses each level of the spine with regards to mechanism of injury, classification and treatment.
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46
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Abstract
Patients undergoing hip fracture surgery are at increased risk of deep vein thrombosis. There are limited studies of good quality assessing thromboprophylactic therapies in this patient population. Mechanical pumping devices may have a role in hip fracture patients, especially around the perioperative period, though compliance with these devices is a significant problem. Fondaparinux is the most effective pharmacological thromboprophylactic therapy following hip fracture surgery and can be used for extended prophylaxis after hospital discharge. A number of the recently published recommendations from the National Institute for Health and Clinical Excellence do not take into account the best available evidence specifically in patients undergoing hip fracture surgery, with findings from elective arthroplasty patients being extrapolated. Well-designed randomised trials are needed to determine the role of combined thromboprophylaxis, graduated compression stockings and newer oral anticoagulants so that appropriate recommendations can be made in patients undergoing hip fracture surgery.
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Affiliation(s)
- GS Matharu
- Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Birmingham B29 6JD, UK,
| | - KM Porter
- Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Birmingham B29 6JD, UK
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47
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Abstract
Soft-tissue ankle injuries are extremely common and frequently present in the emergency department or to the general practitioner. The lateral ligament complex is most commonly affected, usually following an injury with the ankle in an inverted, plantar-flexed position. The diagnosis is usually clinical, and delayed examination and reassessment 3—5 days after injury is recommended as pain and swelling hinder accurate assessment immediately following injury. Applying the Ottawa ankle rules can reduce the number of unnecessary radiographs. Treatment is usually non-operative with the focus on controlling ankle swelling and pain, and early restoration of ankle movements. Surgical repair of ligaments may be indicated in certain cases, though the role of surgery in the acute setting remains unclear. In the present review, we discuss the anatomy, mechanism of injury, risk factors, clinical presentation, diagnosis, treatment and outcome of soft-tissue ankle injuries as well as consider how such injuries may be prevented.
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Affiliation(s)
- GS Matharu
- Academic Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK,
| | - PS Najran
- Academic Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK
| | - KM Porter
- Academic Department of Trauma, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK
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48
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Abstract
Fractures of the radial head and neck are common injuries that largely result from a fall onto an outstretched hand. They can range from simple injuries amenable to conservative management, to complex injuries requiring operative intervention. Undisplaced and minimally displaced fractures can usually be managed non-operatively with satisfactory results. Open reduction and internal fixation (ORIF) is generally indicated for significantly displaced or complex fractures, with radial head replacement reserved for cases refractory to ORIF. However, there remains debate regarding optimal treatment of complex radial head fractures and further evidence is required before definitive management guidelines can be produced.
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Affiliation(s)
- Edward Laugharne
- SpR Trauma and Orthopaedics, West Midlands Deanery, Birmingham B17 9RS, UK,
| | - KM Porter
- Selly Oak Hospital, Birmingham B29 6JD, UK
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Porter KM. Additional Benefits to HEAS Transfer. Ann R Coll Surg Engl 2008; 90:349; author reply 349. [DOI: 10.1308/003588408x285793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- KM Porter
- Department of Clinical Traumatology, Selly Oak Hospital Birmingham, UK
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Abstract
Tourniquets are an effective means of arresting life-threatening external haemorrhage from limb injury. Their use has not previously been accepted practice for pre-hospital civilian trauma care because of significant concerns regarding the potential complications. However, in a few rare situations tourniquet application will be necessary and life-saving. This review explores the potential problems and mistrust of tourniquet use; explains the reasons why civilian pre-hospital tourniquet use may be necessary; defines the clear indications for tourniquet use in external haemorrhage control; and provides practical information on tourniquet application and removal. Practitioners need to familiarise themselves with commercial pre-hospital tourniquets and be prepared to use one without irrational fear of complications in the appropriate cases.
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Affiliation(s)
- C Lee
- Academic Department of Traumatology, West Midlands, UK.
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