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Haas MA, Madelli EO, Brown R, Prictor M, Boughtwood T. Evaluation of CTRL: a web application for dynamic consent and engagement with individuals involved in a cardiovascular genetic disorders cohort. Eur J Hum Genet 2024; 32:61-68. [PMID: 37709947 PMCID: PMC10772119 DOI: 10.1038/s41431-023-01454-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
There has been keen interest in whether dynamic consent should be used in health research but few real-world studies have evaluated its use. Australian Genomics piloted and evaluated CTRL ('control'), a digital consent tool incorporating granular, dynamic decision-making and communication for genomic research. Individuals from a Cardiovascular Genetic Disorders Flagship were invited in person (prospective cohort) or by email (retrospective cohort) to register for CTRL after initial study recruitment. Demographics, consent choices, experience surveys and website analytics were analysed using descriptive statistics. Ninety-one individuals registered to CTRL (15.5% of the prospective cohort and 11.8% of the retrospective cohort). Significantly more males than females registered when invited retrospectively, but there was no difference in age, gender, or education level between those who did and did not use CTRL. Variation in individual consent choices about secondary data use and return of results supports the desirability of providing granular consent options. Robust conclusions were not drawn from satisfaction, trust, decision regret and knowledge outcome measures: differences between CTRL and non-CTRL cohorts did not emerge. Analytics indicate CTRL is acceptable, although underutilised. This is one of the first studies evaluating uptake and decision making using online consent tools and will inform refinement of future designs.
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Affiliation(s)
- Matilda A Haas
- Australian Genomics, Parkville, VIC, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
| | - Evanthia O Madelli
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Rosie Brown
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
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Prictor M. Data Breach Notification Laws-Momentum Across the Asia-Pacific Region. J Bioeth Inq 2023; 20:567-570. [PMID: 38082137 DOI: 10.1007/s11673-023-10324-w] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/17/2023] [Indexed: 03/16/2024]
Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, 3053, VIC, Australia.
- Centre for Digital Transformation of Health, The University of Melbourne, Carlton, VIC, 3053, Australia.
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Prictor M, Rychkova M. Recording our genes: Stakeholder views on genetic test results in networked electronic medical records. HEALTH INF MANAG J 2023; 52:194-203. [PMID: 35615807 DOI: 10.1177/18333583221090969] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In Australia, national policy prioritises the integration of clinical genetic data with networked electronic medical records (EMRs) for enhanced coordination of care and clinical decision-making. Objective: To examine the needs, privacy expectations and concerns of patients, family members, patient advocates and clinicians in relation to the use of networked EMRs for clinical genetic information. Method: Purposive sampling was used to recruit 27 participants for a semi-structured qualitative interview, primarily over Zoom. The interviews were audio and video-recorded and externally transcribed. Interview transcripts were then coded and analysed in NVivo, using an inductive thematic approach. Results: Thematic analysis revealed diverse preferences regarding genetic information access and handling across participants, with five core themes being identified: degree of access and control; central role of genetic professionals as information gatekeepers; complexities of familial implications; external risks; and law, governance and policy; all strong themes that emerged across numerous participants. Conclusion: This project yielded unprecedented and significant insights into the views, needs and concerns of key stakeholders in Australia regarding the inclusion of health-related genetic test results in networked EMRs. Implications: These findings provide a critical reference point for much-needed law reform and policy-making around genetic test results in Australia.
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Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia
- Centre for Digital Transformation of Health, The University of Melbourne, Carlton, VIC, Australia
| | - Maria Rychkova
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia
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Prictor M. WHERE DOES RESPONSIBILITY LIE? ANALYSING LEGAL AND REGULATORY RESPONSES TO FLAWED CLINICAL DECISION SUPPORT SYSTEMS WHEN PATIENTS SUFFER HARM. Med Law Rev 2023; 31:1-24. [PMID: 35856156 PMCID: PMC9969406 DOI: 10.1093/medlaw/fwac022] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Clinical decision support systems (CDSSs) are digital healthcare information systems that apply algorithms to patient data to generate tailored recommendations. They are designed to support, but neither dictate nor execute, clinical decisions. CDSSs can introduce new risks, both by design features that heighten clinician burden and by outright errors that generate faulty recommendations for care. In the latter instance, if such unintercepted recommendations were to result in harm to the patient, novel legal questions emerge. Does legal responsibility for this harm lie with the clinician, the software developer or both? What is the clearest path to a remedy? Further, how does the Australian regulatory framework provide for oversight and redress? This article analyses the potential forms of legal redress in negligence, contract and under statutory consumer law, for the patient and the clinician. It also examines the Australian regulatory framework, specifically in relation to the Australian Competition and Consumer Commission and the Therapeutic Goods Administration, and reflects on the framework's adequacy to protect patients and clinicians. It finds that the regulatory approach and the contour of legal risk still centre upon the clinician's duty to exercise decisional autonomy and to intercept flawed recommendations generated by algorithmic errors within CDSSs.
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Burchill LJ, Kotevski A, Duke DLM, Ward JE, Prictor M, Lamb KE, Kennedy M. Ethics guidelines use and Indigenous governance and participation in Aboriginal and Torres Strait Islander health research: a national survey. Med J Aust 2023; 218:89-93. [PMID: 36253955 PMCID: PMC10952733 DOI: 10.5694/mja2.51757] [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: 03/03/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the use of NHMRC Indigenous research guidelines by Australian researchers and the degree of Aboriginal and Torres Strait Islander governance and participation in Indigenous health research. DESIGN, SETTING, PARTICIPANTS Cross-sectional survey of people engaged in Indigenous health research in Australia, comprising respondents to an open invitation (social media posts in general and Indigenous health research networks) and authors of primary Indigenous health research publications (2015-2019) directly invited by email. MAIN OUTCOME MEASURES Reported use of NHMRC guidelines for Indigenous research; reported Indigenous governance and participation in Indigenous health research. RESULTS Of 329 people who commenced the survey, 247 people (75%) provided responses to all questions, including 61 Indigenous researchers (25%) and 195 women (79%). The NHMRC guidelines were used "all the time" by 206 respondents (83%). Most respondents (205 of 247, 83%) reported that their research teams included Indigenous people, 139 reported dedicated Indigenous advisory boards (56%), 91 reported designated seats for Indigenous representatives on ethics committees (37%), and 43 reported Indigenous health research ethics committees (17%); each proportion was larger for respondents working in Indigenous community-controlled organisations than for those working elsewhere. More than half the respondents reported meaningful Indigenous participation during five of six research phases; the exception was data analysis (reported as apparent "none" or "some of the time" by 143 participants, 58%). CONCLUSIONS Indigenous health research in Australia is largely informed by non-Indigenous world views, led by non-Indigenous people, and undertaken in non-Indigenous organisations. Re-orientation and investment are needed to give control of the framing, design, and conduct of Indigenous health research to Indigenous people.
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Affiliation(s)
- Luke J Burchill
- Royal Melbourne HospitalMelbourneVIC
- The University of MelbourneMelbourneVIC
| | - Aneta Kotevski
- Royal Melbourne HospitalMelbourneVIC
- The University of MelbourneMelbourneVIC
| | - Daniel LM Duke
- Royal Melbourne HospitalMelbourneVIC
- The University of MelbourneMelbourneVIC
| | - Jeanette E Ward
- Nulungu Research Institute, the University of Notre Dame AustraliaBroomeWA
| | | | - Karen E Lamb
- Centre for Epidemiology and Biostatisticsthe University of MelbourneMelbourneVIC
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6
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Keel S, Lingham G, Misra N, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna R, Mariotti S, Mathenge W, Matoto E, Müeller A, Rabiu M, Rasengane T, Resnikoff S, Wormald R, Yasmin S, Zhao J, Evans JR, Cieza A, Chan VF, Chen Y, Chinnery H, Dodson S, Downie L, Gordon I, Ghadiri N, Govender Poonsamy P, Han X, Hui F, Jackson ML, Lawrenson J, Ning Lee C, McGuinness M, Murray C, Newsham D, van Nispen R, Prictor M, Puri L, Ramke J, Reekie I, Safi S, Scheetz J, Shen S, Silveira S, Thakur S, Virgili G, Yong AC, Zhang J, Ziaei M, Ali MA, AlObaida IA, AlShamlan FT, Alsulaiman SM, Amissah-Arthur KN, Ang M, Azad R, Bell K, Bharadwaj SR, Booysen DJ, Branchevski S, Bosch V, Brossard-Barbosa N, Chen Y, Craig JP, Dada T, Dichoso CA, Duerksen R, Ebri A, Erdmann I, Freddo T, Flanagan J, Gammoh Y, Gupta N, Hendicott P, Husni MA, Jonathan Jackson A, Jadoon MZ, Januleviciene I, Jeeva I, Jimenez MSS, Kocur I, Kreis A, Kyei S, Lan W, Loy MJV, Marmamula S, Minto LH, Muhit M, Nsubuga NH, Ogundipe A, Okonkwo ON, Olawoye OO, Ouertani AM, Ovenseri-Ogbomo G, Özkan SB, Patel B, Paula JS, Rahi JS, Ravilla RD, Senanayake NS, Sil AK, Solebo AL, Sousa RARC, Tennant MTS, van Staden DB, Wazir JF, Webber AL, Yorston D, Zin A, Faal HB, Keeffe J, McGrath CE. Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review. JAMA Ophthalmol 2022; 140:1229-1238. [PMID: 36394836 DOI: 10.1001/jamaophthalmol.2022.4716] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Importance Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed. Objective To describe the key outcomes of the PECI development. Evidence Review A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review. Findings Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI. Conclusions and Relevance This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland.,Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia
| | - Neha Misra
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, United Kingdom.,Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology, Universidad de Valladolid, Valladolid, Spain.,CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Ching-Yu Cheng
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rohit Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | | | - Andreas Müeller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Tuwani Rasengane
- Department of Optometry, University of the Free State, Bloemfontein, South Africa.,Universitas Hospital, Bloemfontein, South Africa
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Brien Holden Vision Institute, Sydney, Australia.,Organisation pour la Prévention de la Cécité, Paris, France
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Eye Research Center Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Ving Fai Chan
- for the Package of Eye Care Interventions Development Group
| | - Yanxian Chen
- for the Package of Eye Care Interventions Development Group
| | - Holly Chinnery
- for the Package of Eye Care Interventions Development Group
| | - Sarity Dodson
- for the Package of Eye Care Interventions Development Group
| | - Laura Downie
- for the Package of Eye Care Interventions Development Group
| | - Iris Gordon
- for the Package of Eye Care Interventions Development Group
| | - Nima Ghadiri
- for the Package of Eye Care Interventions Development Group
| | | | - Xiaotong Han
- for the Package of Eye Care Interventions Development Group
| | - Flora Hui
- for the Package of Eye Care Interventions Development Group
| | | | - John Lawrenson
- for the Package of Eye Care Interventions Development Group
| | - Chan Ning Lee
- for the Package of Eye Care Interventions Development Group
| | | | - Craig Murray
- for the Package of Eye Care Interventions Development Group
| | - David Newsham
- for the Package of Eye Care Interventions Development Group
| | | | - Megan Prictor
- for the Package of Eye Care Interventions Development Group
| | - Lila Puri
- for the Package of Eye Care Interventions Development Group
| | | | - Ian Reekie
- for the Package of Eye Care Interventions Development Group
| | - Sare Safi
- for the Package of Eye Care Interventions Development Group
| | - Jane Scheetz
- for the Package of Eye Care Interventions Development Group
| | - Sunny Shen
- for the Package of Eye Care Interventions Development Group
| | - Sue Silveira
- for the Package of Eye Care Interventions Development Group
| | - Sahil Thakur
- for the Package of Eye Care Interventions Development Group
| | - Gianni Virgili
- for the Package of Eye Care Interventions Development Group
| | - Ai Chee Yong
- for the Package of Eye Care Interventions Development Group
| | - Justine Zhang
- for the Package of Eye Care Interventions Development Group
| | - Mohammed Ziaei
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Marcus Ang
- for the Package of Eye Care Interventions Development Group
| | | | - Kristin Bell
- for the Package of Eye Care Interventions Development Group
| | | | - Dirk J Booysen
- for the Package of Eye Care Interventions Development Group
| | | | - Vanessa Bosch
- for the Package of Eye Care Interventions Development Group
| | | | - Yi Chen
- for the Package of Eye Care Interventions Development Group
| | | | - Tanuj Dada
- for the Package of Eye Care Interventions Development Group
| | | | | | - Anne Ebri
- for the Package of Eye Care Interventions Development Group
| | - Irmela Erdmann
- for the Package of Eye Care Interventions Development Group
| | - Thomas Freddo
- for the Package of Eye Care Interventions Development Group
| | - John Flanagan
- for the Package of Eye Care Interventions Development Group
| | - Yazan Gammoh
- for the Package of Eye Care Interventions Development Group
| | - Neeru Gupta
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Irfan Jeeva
- for the Package of Eye Care Interventions Development Group
| | | | - Ivo Kocur
- for the Package of Eye Care Interventions Development Group
| | - Andreas Kreis
- for the Package of Eye Care Interventions Development Group
| | - Samuel Kyei
- for the Package of Eye Care Interventions Development Group
| | - Weizhong Lan
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Mohammad Muhit
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | | | - Seyhan B Özkan
- for the Package of Eye Care Interventions Development Group
| | - Bina Patel
- for the Package of Eye Care Interventions Development Group
| | - Jayter S Paula
- for the Package of Eye Care Interventions Development Group
| | - Jugnoo S Rahi
- for the Package of Eye Care Interventions Development Group
| | | | | | - Asim Kumar Sil
- for the Package of Eye Care Interventions Development Group
| | | | - Raúl ARC Sousa
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Ann L Webber
- for the Package of Eye Care Interventions Development Group
| | - David Yorston
- for the Package of Eye Care Interventions Development Group
| | - Andrea Zin
- for the Package of Eye Care Interventions Development Group
| | - Hannah B Faal
- for the Package of Eye Care Interventions Development Group
| | - Jill Keeffe
- for the Package of Eye Care Interventions Development Group
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Thabrew H, Aljawahiri N, Kumar H, Bowden N, Milne B, Prictor M, Jordan V, Breedvelt J, Shepherd T, Hetrick S. 'As Long as It's Used for Beneficial Things': An Investigation of non-Māori, Māori and Young People's Perceptions Regarding the Research use of the Aotearoa New Zealand Integrated Data Infrastructure (IDI). J Empir Res Hum Res Ethics 2022; 17:471-482. [PMID: 35849389 DOI: 10.1177/15562646221111294] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Aotearoa New Zealand Integrated Data Infrastructure (IDI) is a national database containing a wide range of data about people and households. There is limited information about public views regarding its use for research.A qualitative study was undertaken to examine the views of forty individuals attending a large hospital in Auckland, including those of Māori ethnicity and young people. Semi-structured interview data were analysed using Braun and Clarke's method of thematic analysis.Seven key themes emerged: 1) Limited knowledge about medical data held in national databases; 2) Conditional support for the use of the IDI, including for research; 3) Concerns regarding the misuse of IDI data; 4) The importance of privacy; 5) Different views regarding consent for use of data for research; 6) Desire for access to personal data and the results of research; and 7) Concerns regarding third party and commercial use. Young people and those of Māori ethnicity were more wary of data misuse than others.Although there is reasonable support for the secondary use of public administrative data in the IDI for research, there is more work to be done to ensure ethical and culturally appropriate use of this data via improved consent privacy management processes and researcher training.
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Affiliation(s)
- Hiran Thabrew
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,Consult Liaison Team, 36716Starship Hospital, Auckland, New Zealand
| | - Noor Aljawahiri
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Harshali Kumar
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- 161293Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start National Science Challenge, Liggins Institute, The University of Auckland, Auckland, New Zealand.,589107Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Megan Prictor
- Health, Law and Emerging Technologies programme, 90147Melbourne Law School, The University of Melbourne, Carlton, Australia
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, 62710Faculty of Medical and Health Sciences, Auckland, New Zealand
| | | | - Toni Shepherd
- Consult Liaison Team, 36716Starship Hospital, Auckland, New Zealand
| | - Sarah Hetrick
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Prictor M. Clinical Software and Bad Decisions: The "Practice Fusion" Settlement and Its Implications. J Bioeth Inq 2022; 19:187-190. [PMID: 35403964 PMCID: PMC9233625 DOI: 10.1007/s11673-022-10187-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Parkville, VIC, 3010, Australia.
- Centre for Digital Transformation of Health, The University of Melbourne, Parkville, VIC, 3010, Australia.
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9
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Kariotis TC, Prictor M, Chang S, Gray K. Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review. J Med Internet Res 2022; 24:e30405. [PMID: 35507393 PMCID: PMC9118021 DOI: 10.2196/30405] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023] Open
Abstract
Background The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. Objective This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. Methods We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions. Results The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. Conclusions We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
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Affiliation(s)
- Timothy Charles Kariotis
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia.,Melbourne School of Government, The University of Melbourne, Carlton, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Carlton, Australia.,Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
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10
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Bell J, Prictor M, Davenport L, O'Brien L, Wake M. Digital Mega-Studies as a New Research Paradigm: Governing the Health Research of the Future. J Empir Res Hum Res Ethics 2021; 16:344-355. [PMID: 34498950 DOI: 10.1177/15562646211041492] [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: 11/15/2022]
Abstract
'Digital Mega-Studies' are entirely or extensively digitised, longitudinal, population-scale initiatives, collecting, storing, and making available individual-level research data of different types and from multiple sources, shaped by technological developments and unforeseeable risks over time. The Australian 'Gen V' project exemplifies this new research paradigm. In 2019, we undertook a multidisciplinary, multi-stakeholder process to map Digital Mega-Studies' key characteristics, legal and governance challenges and likely solutions. We conducted large and small group processes within a one-day symposium and directed online synthesis and group prioritisation over subsequent weeks. We present our methods (including elicitation, affinity mapping and prioritisation processes) and findings, proposing six priority governance principles across three areas-data, participation, trust-to support future high-quality, large-scale digital research in health.
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Affiliation(s)
- Jessica Bell
- Melbourne Law School, 90147University of Melbourne, Carlton, Victoria, Australia.,School of Law, 2707University of Warwick, Coventry, West Midlands, UK
| | - Megan Prictor
- Melbourne Law School, 90147University of Melbourne, Carlton, Victoria, Australia
| | - Lauren Davenport
- 34361Murdoch Children's Research Institute, Parkville, Australia
| | - Lynda O'Brien
- 34361Murdoch Children's Research Institute, Parkville, Australia
| | - Melissa Wake
- 34361Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Liggins Institute, 1415University of Auckland, Auckland, New Zealand
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11
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Manski-Nankervis JA, Alexander K, Biezen R, Jones J, Hunter B, Emery J, Lumsden N, Boyle D, Gunn J, McMorrow R, Prictor M, Taylor M, Hallinan C, Chondros P, Janus E, McIntosh J, Nelson C. Towards optimising chronic kidney disease detection and management in primary care: Underlying theory and protocol for technology development using an Integrated Knowledge Translation approach. Health Informatics J 2021; 27:14604582211008227. [PMID: 33853414 DOI: 10.1177/14604582211008227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Worldwide, Chronic Kidney Disease (CKD), directly or indirectly, causes more than 2.4 million deaths annually with symptoms generally presenting late in the disease course. Clinical guidelines support the early identification and treatment of CKD to delay progression and improve clinical outcomes. This paper reports the protocol for the codesign, implementation and evaluation of a technological platform called Future Health Today (FHT), a software program that aims to optimise early detection and management of CKD in general practice. FHT aims to optimise clinical decision making and reduce practice variation by translating evidence into practice in real time and as a part of quality improvement activities. This protocol describes the co-design and plans for implementation and evaluation of FHT in two general practices invited to test the prototype over 12 months. Service design thinking has informed the design phase and mixed methods will evaluate outcomes following implementation of FHT. Through systematic application of co-design with service users, clinicians and digital technologists, FHT attempts to avoid the pitfalls of past studies that have failed to accommodate the complex requirements and dynamics that can arise between researchers and service users and improve chronic disease management through use of health information technology.
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Affiliation(s)
| | | | | | - Julia Jones
- Department of Nephrology, Western Health, Australia.,Western Health Chronic Disease Alliance, Australia.,University of Melbourne, Australia
| | | | | | - Natalie Lumsden
- Department of Nephrology, Western Health, Australia.,Western Health Chronic Disease Alliance, Australia
| | | | | | | | | | | | | | | | - Edward Janus
- Western Health Chronic Disease Alliance, Australia.,University of Melbourne, Australia.,General Internal Medicine Unit, Western Health, Australia
| | | | - Craig Nelson
- Department of Nephrology, Western Health, Australia.,Western Health Chronic Disease Alliance, Australia.,University of Melbourne, Australia
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12
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Haas MA, Teare H, Prictor M, Ceregra G, Vidgen ME, Bunker D, Kaye J, Boughtwood T. 'CTRL': an online, Dynamic Consent and participant engagement platform working towards solving the complexities of consent in genomic research. Eur J Hum Genet 2021; 29:687-698. [PMID: 33408362 PMCID: PMC8115139 DOI: 10.1038/s41431-020-00782-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
The complexities of the informed consent process for participating in research in genomic medicine are well-documented. Inspired by the potential for Dynamic Consent to increase participant choice and autonomy in decision-making, as well as the opportunities for ongoing participant engagement it affords, we wanted to trial Dynamic Consent and to do so developed our own web-based application (web app) called CTRL (control). This paper documents the design and development of CTRL, for use in the Australian Genomics study: a health services research project building evidence to inform the integration of genomic medicine into mainstream healthcare. Australian Genomics brought together a multi-disciplinary team to develop CTRL. The design and development process considered user experience; security and privacy; the application of international standards in data sharing; IT, operational and ethical issues. The CTRL tool is now being offered to participants in the study, who can use CTRL to keep personal and contact details up to date; make consent choices (including indicate preferences for return of results and future research use of biological samples, genomic and health data); follow their progress through the study; complete surveys, contact the researchers and access study news and information. While there are remaining challenges to implementing Dynamic Consent in genomic research, this study demonstrates the feasibility of building such a tool, and its ongoing use will provide evidence about the value of Dynamic Consent in large-scale genomic research programs.
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Affiliation(s)
- Matilda A Haas
- Australian Genomics Health Alliance, Parkville, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Harriet Teare
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK
| | - Megan Prictor
- Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | | | - Miranda E Vidgen
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - David Bunker
- Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK.,Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics Health Alliance, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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13
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Prictor M, Taylor M, Kaye J, Emery J, Nelson C, Manski-Nankervis JA. Clinical Decision Support Systems and Medico-Legal Liability in Recall and Treatment: A Fresh Examination. J Law Med 2020; 28:132-144. [PMID: 33415896] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clinical decision support systems (CDSSs) provide a valuable tool for clinicians to aid in the care of patients with chronic disease. Various questions have emerged about their implications for the doctor's legal duty of care to their patients, in terms of recognition of risk, recall, testing and treatment. In this article, through an analysis of Australian legislation and international case law, we address these questions, considering the potential impact of CDSSs on doctors' liability in negligence. We conclude that the appropriate use of a well-designed CDSS should minimise, rather than heighten, doctor's potential liability. It should support optimal patient care without diminishing the capacity of the doctor to make individualised decisions about recall, testing and treatment for each patient. We foreshadow that in the future doctors in Australia may have a duty to use available well-established software systems in patient care.
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Affiliation(s)
| | - Mark Taylor
- Melbourne Law School, The University of Melbourne
| | - Jane Kaye
- Melbourne Law School, The University of Melbourne; Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford
| | - Jon Emery
- Department of General Practice, The University of Melbourne; Centre for Cancer Research, The University of Melbourne
| | - Craig Nelson
- Western Health Chronic Disease Alliance, Department of Nephrology, Western Health; Department of Medicine - Western Health, The University of Melbourne
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, The University of Melbourne; Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, The University of Melbourne
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14
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Prictor M, Johnston C, Hyatt A. Overt and covert recordings of health care consultations in Australia: some legal considerations. Med J Aust 2020; 214:119-123.e1. [PMID: 33131072 DOI: 10.5694/mja2.50838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Megan Prictor
- Melbourne Law School, University of Melbourne, Melbourne, VIC
| | | | - Amelia Hyatt
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC
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Prictor M, Huebner S, Teare HJA, Burchill L, Kaye J. Australian Aboriginal and Torres Strait Islander Collections of Genetic Heritage: The Legal, Ethical and Practical Considerations of a Dynamic Consent Approach to Decision Making. J Law Med Ethics 2020; 48:205-217. [PMID: 32342777 DOI: 10.1177/1073110520917012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dynamic Consent (DC) is both a model and a specific web-based tool that enables clear, granular communication and recording of participant consent choices over time. The DC model enables individuals to know and to decide how personal research information is being used and provides a way in which to exercise legal rights provided in privacy and data protection law. The DC tool is flexible and responsive, enabling legal and ethical requirements in research data sharing to be met and for online health information to be maintained. DC has been used in rare diseases and genomics, to enable people to control and express their preferences regarding their own data. However, DC has never been explored in relationship to historical collections of bioscientific and genetic heritage or to contexts involving Aboriginal and Torres Strait Islander people (First Peoples of Australia). In response to the growing interest by First Peoples throughout Australia in genetic and genomic research, and the increasing number of invitations from researchers to participate in community health and wellbeing projects, this article examines the legal and ethical attributes and challenges of DC in these contexts. It also explores opportunities for including First Peoples' cultural perspectives, governance, and leadership as a method for defining (or redefining) DC on cultural terms that engage best practice research and data analysis as well as respect for meaningful and longitudinal individual and family participation.
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Affiliation(s)
- Megan Prictor
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Sharon Huebner
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Harriet J A Teare
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Luke Burchill
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Jane Kaye
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
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16
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Prictor M, Lewis MA, Newson AJ, Haas M, Baba S, Kim H, Kokado M, Minari J, Molnár-Gábor F, Yamamoto B, Kaye J, Teare HJA. Dynamic Consent: An Evaluation and Reporting Framework. J Empir Res Hum Res Ethics 2019; 15:175-186. [DOI: 10.1177/1556264619887073] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Dynamic consent (DC) is an approach to consent that enables people, through an interactive digital interface, to make granular decisions about their ongoing participation. This approach has been explored within biomedical research, in fields such as biobanking and genomics, where ongoing contact is required with participants. It is posited that DC can enhance decisional autonomy and improve researcher–participant communication. Currently, there is a lack of evidence about the measurable effects of DC-based tools. This article outlines a framework for DC evaluation and reporting. The article draws upon the evidence for enhanced modes of informed consent for research as the basis for a logic model. It outlines how future evaluations of DC should be designed to maximize their quality, replicability, and relevance based on this framework. Finally, the article considers best-practice for reporting studies that assess DC, to enable future research and implementation to build upon the emerging evidence base.
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Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
| | | | - Ainsley J. Newson
- Sydney Health Ethics, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matilda Haas
- Australian Genomics Health Alliance, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | | | - Hannah Kim
- Yonsei University, Seoul, Republic of Korea
| | | | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, CiRA, Kyoto University, Japan
| | | | | | - Jane Kaye
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
- University of Oxford, Oxford, United Kingdom
| | - Harriet J. A. Teare
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
- University of Oxford, Oxford, United Kingdom
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17
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Abstract
My Health Record (MyHR) is Australia's national personally-controlled electronic health record. Initially established in 2012, it moved from an opt-in to an opt-out system in 2018. This paper considers the privacy aspects of MyHR shared health summary. Drawing on Nissenbaum's theory of privacy as contextual integrity, we argue that the shift in the event-specific nature of information sharing leads to MyHR breaching contextual integrity. As per Nissenbaum's decision heuristic for contextual integrity, we evaluate this breach through a reflection on the changing nature of health care, including patient empowerment, and the greater complexity of care. It is evident that more needs to be known about the benefits of shared health summaries, as well as the actual use of MyHR by clinicians and patients. Though we focus on MyHR, this evaluation has broader applicability to other national electronic health records and electronic shared health summaries.
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Affiliation(s)
- Timothy Kariotis
- School of Computing and Information Systems, University of Melbourne, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, University of Melbourne, Australia
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18
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Kariotis T, Prictor M, Gray K, Chang S. Mind the Gap: Information Sharing Between Health, Mental Health and Social Care Services. Stud Health Technol Inform 2019; 266:101-107. [PMID: 31397309 DOI: 10.3233/shti190780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Information sharing is key to integrated, collaborative, and continuous care. People with a lived experience of mental illness may access several services across the health, mental health and social care sectors, which creates challenges for information sharing. The health informatics community has traditionally not prioritised social care informatics. However, with the growing role of social care in the lives of people with complex health conditions, now is the time when we must consider the articulation between health informatics and social care informatics in Australia. This paper reports the results of a qualitative study to understand the current context of information sharing between health, mental health and social care services. Interviews and focus groups with nine clinicians, caseworkers and support workers were undertaken. Thematic analysis supported the development of several themes. These include the growing role of social care services, the importance of trust and the challenge created by the complexity of conditions people can present with when accessing social care services. To ensure the growing range of social care services do not get left behind with the increasing digitisation of the Australian health system, the health informatics community should prioritise the inclusion of social care informatics in its scope of practice.
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Affiliation(s)
- Timothy Kariotis
- School of Computing and Information Systems, The University of Melbourne, Victoria, Australia
| | | | - Kathleen Gray
- Health and Biomedical Informatics Centre, The University of Melbourne
| | - Shanton Chang
- School of Computing and Information Systems, The University of Melbourne, Victoria, Australia
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19
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Prictor M, Teare HJA, Kaye J. Equitable Participation in Biobanks: The Risks and Benefits of a "Dynamic Consent" Approach. Front Public Health 2018; 6:253. [PMID: 30234093 PMCID: PMC6133951 DOI: 10.3389/fpubh.2018.00253] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 06/28/2018] [Accepted: 08/15/2018] [Indexed: 01/28/2023] Open
Abstract
Participation in biobanks tends to favor certain groups—white, middle-class, more highly-educated—often to the exclusion of others, such as indigenous people, the socially-disadvantaged and the culturally and linguistically diverse. Barriers to participation, which include age, location, cultural sensitivities around human tissue, and issues of literacy and language, can influence the diversity of samples found in biobanks. This has implications for the generalizability of research findings from biobanks being able to be translated into the clinic. Dynamic Consent, which is a digital decision-support tool, could improve participants' recruitment to, and engagement with, biobanks over time and help to overcome some of the barriers to participation. However, there are also risks that it may deepen the “digital divide” by favoring those with knowledge and access to digital technologies, with the potential to decrease participant engagement in research. When applying a Dynamic Consent approach in biobanking, researchers should give particular attention to adaptations that can improve participant inclusivity, and evaluate the tool empirically, with a focus on equity-relevant outcome measures. This may help biobanks to fulfill their promise of enabling translational research that is relevant to all.
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Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia
| | - Harriet J A Teare
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia.,Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia.,Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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20
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Abstract
In the United Kingdom (UK), transfer of genomic data to third countries is regulated by data protection legislation. This is a composite of domestic and European Union (EU) law, with EU law to be adopted as domestic law when Brexit takes place. In this paper we consider the content of data protection legislation and the likely impact of Brexit on transfers of genomic data from the UK to other countries. We examine the advice by regulators not to rely upon consent as a lawful basis for processing under data protection law, at least not when personal data are used for research purposes, and consider some of the other ways in which the research context can qualify an individual's ability to exercise control over processing operations. We explain how the process of pseudonymization is to be understood in the context of transfer of genomic data to third parties, as well as how adequacy of data protection in a third country is to be determined in general terms. We conclude with reflections on the future direction of UK data protection law post Brexit with the reclassification of the UK itself as a third country.
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Affiliation(s)
- M J Taylor
- HeLEX@Melbourne, Melbourne Law School, University of Melbourne, Carlton, Australia.
| | - S E Wallace
- Population and Public Health Sciences, Department of Health Sciences, University of Leicester, Leicester, UK
- Nuffield Department of Population Health, Centre for Health, Law and Emerging Technologies ("HeLEX"), University of Oxford, Oxford, UK
| | - M Prictor
- HeLEX@Melbourne, Melbourne Law School, University of Melbourne, Carlton, Australia
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Abstract
BACKGROUND Informed consent is a critical component of clinical research. Different methods of presenting information to potential participants of clinical trials may improve the informed consent process. Audio-visual interventions (presented, for example, on the Internet or on DVD) are one such method. We updated a 2008 review of the effects of these interventions for informed consent for trial participation. OBJECTIVES To assess the effects of audio-visual information interventions regarding informed consent compared with standard information or placebo audio-visual interventions regarding informed consent for potential clinical trial participants, in terms of their understanding, satisfaction, willingness to participate, and anxiety or other psychological distress. SEARCH METHODS We searched: the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, issue 6, 2012; MEDLINE (OvidSP) (1946 to 13 June 2012); EMBASE (OvidSP) (1947 to 12 June 2012); PsycINFO (OvidSP) (1806 to June week 1 2012); CINAHL (EbscoHOST) (1981 to 27 June 2012); Current Contents (OvidSP) (1993 Week 27 to 2012 Week 26); and ERIC (Proquest) (searched 27 June 2012). We also searched reference lists of included studies and relevant review articles, and contacted study authors and experts. There were no language restrictions. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing audio-visual information alone, or in conjunction with standard forms of information provision (such as written or verbal information), with standard forms of information provision or placebo audio-visual information, in the informed consent process for clinical trials. Trials involved individuals or their guardians asked to consider participating in a real or hypothetical clinical study. (In the earlier version of this review we only included studies evaluating informed consent interventions for real studies). DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion and extracted data. We synthesised the findings using meta-analysis, where possible, and narrative synthesis of results. We assessed the risk of bias of individual studies and considered the impact of the quality of the overall evidence on the strength of the results. MAIN RESULTS We included 16 studies involving data from 1884 participants. Nine studies included participants considering real clinical trials, and eight included participants considering hypothetical clinical trials, with one including both. All studies were conducted in high-income countries.There is still much uncertainty about the effect of audio-visual informed consent interventions on a range of patient outcomes. However, when considered across comparisons, we found low to very low quality evidence that such interventions may slightly improve knowledge or understanding of the parent trial, but may make little or no difference to rate of participation or willingness to participate. Audio-visual presentation of informed consent may improve participant satisfaction with the consent information provided. However its effect on satisfaction with other aspects of the process is not clear. There is insufficient evidence to draw conclusions about anxiety arising from audio-visual informed consent. We found conflicting, very low quality evidence about whether audio-visual interventions took more or less time to administer. No study measured researcher satisfaction with the informed consent process, nor ease of use.The evidence from real clinical trials was rated as low quality for most outcomes, and for hypothetical studies, very low. We note, however, that this was in large part due to poor study reporting, the hypothetical nature of some studies and low participant numbers, rather than inconsistent results between studies or confirmed poor trial quality. We do not believe that any studies were funded by organisations with a vested interest in the results. AUTHORS' CONCLUSIONS The value of audio-visual interventions as a tool for helping to enhance the informed consent process for people considering participating in clinical trials remains largely unclear, although trends are emerging with regard to improvements in knowledge and satisfaction. Many relevant outcomes have not been evaluated in randomised trials. Triallists should continue to explore innovative methods of providing information to potential trial participants during the informed consent process, mindful of the range of outcomes that the intervention should be designed to achieve, and balancing the resource implications of intervention development and delivery against the purported benefits of any intervention.More trials, adhering to CONSORT standards, and conducted in settings and populations underserved in this review, i.e. low- and middle-income countries and people with low literacy, would strengthen the results of this review and broaden its applicability. Assessing process measures, such as time taken to administer the intervention and researcher satisfaction, would inform the implementation of audio-visual consent materials.
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Affiliation(s)
| | | | - Megan Prictor
- School of Public Health and Human Biosciences, La Trobe UniversityCochrane Consumers and Communication Review GroupBundooraAustralia3086
| | - Deirdre Fetherstonhaugh
- La Trobe UniversityAustralian Centre for Evidence Based Aged Care (ACEBAC)BundooraAustralia3086
| | - Barbara Parker
- La Trobe UniversityAustralian Institute for Primary Care & Ageing, Faculty of Health SciencesBundooraAustralia3086
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2014:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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Prictor M, Hill S. Cochrane Consumers and Communication Review Group: leading the field on health communication evidence. J Evid Based Med 2013; 6:216-20. [PMID: 24325413 DOI: 10.1111/jebm.12066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/27/2013] [Indexed: 01/11/2023]
Abstract
This paper presents an overview of the history and achievements of the Cochrane Consumers and Communication Review Group, part of the international Cochrane Collaboration. It surveys the Group's establishment and structure, the scope of its Cochrane Reviews and the growth in its publication output over its 16-year history. The paper examines the Group's developmental work in interventions and outcomes related to patient communication and involvement, as well as methodological resources for review authors. It also outlines the Review Group's research partnerships with state, national and international agencies, particularly in the areas of chronic disease management, medicines use, public involvement, and vaccines communication. The Group's strong contribution to an evidence-base for health communication and participation are acknowledged.
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Affiliation(s)
- Megan Prictor
- Cochrane Consumers and Communication Review Group, School of Public Health and Human Biosciences, Faculty of Health Sciences, La Trobe University, Australia
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Abstract
BACKGROUND In mental health services, the past several decades has seen a slow but steady trend towards employment of past or present consumers of the service to work alongside mental health professionals in providing services. However the effects of this employment on clients (service recipients) and services has remained unclear.We conducted a systematic review of randomised trials assessing the effects of employing consumers of mental health services as providers of statutory mental health services to clients. In this review this role is called 'consumer-provider' and the term 'statutory mental health services' refers to public services, those required by statute or law, or public services involving statutory duties. The consumer-provider's role can encompass peer support, coaching, advocacy, case management or outreach, crisis worker or assertive community treatment worker, or providing social support programmes. OBJECTIVES To assess the effects of employing current or past adult consumers of mental health services as providers of statutory mental health services. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 3), MEDLINE (OvidSP) (1950 to March 2012), EMBASE (OvidSP) (1988 to March 2012), PsycINFO (OvidSP) (1806 to March 2012), CINAHL (EBSCOhost) (1981 to March 2009), Current Contents (OvidSP) (1993 to March 2012), and reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials of current or past consumers of mental health services employed as providers ('consumer-providers') in statutory mental health services, comparing either: 1) consumers versus professionals employed to do the same role within a mental health service, or 2) mental health services with and without consumer-providers as an adjunct to the service. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data. We contacted trialists for additional information. We conducted analyses using a random-effects model, pooling studies that measured the same outcome to provide a summary estimate of the effect across studies. We describe findings for each outcome in the text of the review with considerations of the potential impact of bias and the clinical importance of results, with input from a clinical expert. MAIN RESULTS We included 11 randomised controlled trials involving 2796 people. The quality of these studies was moderate to low, with most of the studies at unclear risk of bias in terms of random sequence generation and allocation concealment, and high risk of bias for blinded outcome assessment and selective outcome reporting.Five trials involving 581 people compared consumer-providers to professionals in similar roles within mental health services (case management roles (4 trials), facilitating group therapy (1 trial)). There were no significant differences in client quality of life (mean difference (MD) -0.30, 95% confidence interval (CI) -0.80 to 0.20); depression (data not pooled), general mental health symptoms (standardised mean difference (SMD) -0.24, 95% CI -0.52 to 0.05); client satisfaction with treatment (SMD -0.22, 95% CI -0.69 to 0.25), client or professional ratings of client-manager relationship; use of mental health services, hospital admissions and length of stay; or attrition (risk ratio 0.80, 95% CI 0.58 to 1.09) between mental health teams involving consumer-providers or professional staff in similar roles.There was a small reduction in crisis and emergency service use for clients receiving care involving consumer-providers (SMD -0.34 (95%CI -0.60 to -0.07). Past or present consumers who provided mental health services did so differently than professionals; they spent more time face-to-face with clients, and less time in the office, on the telephone, with clients' friends and family, or at provider agencies.Six trials involving 2215 people compared mental health services with or without the addition of consumer-providers. There were no significant differences in psychosocial outcomes (quality of life, empowerment, function, social relations), client satisfaction with service provision (SMD 0.76, 95% CI -0.59 to 2.10) and with staff (SMD 0.18, 95% CI -0.43 to 0.79), attendance rates (SMD 0.52 (95% CI -0.07 to 1.11), hospital admissions and length of stay, or attrition (risk ratio 1.29, 95% CI 0.72 to 2.31) between groups with consumer-providers as an adjunct to professional-led care and those receiving usual care from health professionals alone. One study found a small difference favouring the intervention group for both client and staff ratings of clients' needs having been met, although detection bias may have affected the latter. None of the six studies in this comparison reported client mental health outcomes.No studies in either comparison group reported data on adverse outcomes for clients, or the financial costs of service provision. AUTHORS' CONCLUSIONS Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management services.There is low quality evidence that involving consumer-providers in mental health teams results in a small reduction in clients' use of crisis or emergency services. The nature of the consumer-providers' involvement differs compared to professionals, as do the resources required to support their involvement. The overall quality of the evidence is moderate to low. There is no evidence of harm associated with involving consumer-providers in mental health teams.Future randomised controlled trials of consumer-providers in mental health services should minimise bias through the use of adequate randomisation and concealment of allocation, blinding of outcome assessment where possible, the comprehensive reporting of outcome data, and the avoidance of contamination between treatment groups. Researchers should adhere to SPIRIT and CONSORT reporting standards for clinical trials.Future trials should further evaluate standardised measures of clients' mental health, adverse outcomes for clients, the potential benefits and harms to the consumer-providers themselves (including need to return to treatment), and the financial costs of the intervention. They should utilise consistent, validated measurement tools and include a clear description of the consumer-provider role (eg specific tasks, responsibilities and expected deliverables of the role) and relevant training for the role so that it can be readily implemented. The weight of evidence being strongly based in the United States, future research should be located in diverse settings including in low- and middle-income countries.
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Affiliation(s)
- Veronica Pitt
- National Trauma Research Institute, The Alfred Hospital, Monash UniversityLevel 4, 89 Commercial RoadMelbourneVictoriaAustralia3004
| | - Dianne Lowe
- Australian Institute for Primary Care & Ageing, La Trobe UniversityCentre for Health Communication and ParticipationBundooraVICAustralia3086
| | - Sophie Hill
- La Trobe UniversityCentre for Health Communication and Participation, Australian Institute for Primary Care & AgeingBundooraVICAustralia3086
| | - Megan Prictor
- Australian Institute for Primary Care & Ageing, La Trobe UniversityCochrane Consumers and Communication Review GroupBundooraVICAustralia3086
| | - Sarah E Hetrick
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, Australian Institute for Primary Care & AgeingBundooraVICAustralia3086
| | - Lynda Berends
- Turning Point Alcohol & Drug Centre54‐62 Gertrude StFitzroyVICAustralia3065
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Prictor M. The sideshow or the circus? The role for public interest organisations at inquests. J Law Med 2012; 20:320-332. [PMID: 23431850] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Recent changes in coronial law in Australian jurisdictions have enabled inquests to adopt an expanded scope and have facilitated the participation of family members and other interested parties. Public interest bodies have increasingly sought to have input to coronial policy and practice. This article examines the involvement by public interest organisations in Australian inquests over recent years. These organisations adopt various roles in inquests, including the representation and support of family members of the deceased, and the pursuit of policy and legislative changes. A further role is that of participation in specific inquests as an "interested party", in order to provide relevant expertise, shape the scope of the inquiry, and illuminate systemic issues which may have contributed to a death. This article considers the legal framework for the involvement of public interest organisations, and critically reflects upon the main purposes and effects of such intervention.
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Affiliation(s)
- Megan Prictor
- La Trobe University School of Law, Bundoora, Australia.
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Abstract
BACKGROUND Communication with children and adolescents with cancer about their disease and treatment and the implications of these is an important aspect of good quality care. It is often poorly performed in practice. Various interventions have been developed that aim to enhance communication involving children or adolescents with cancer. OBJECTIVES To assess the effects of interventions for improving communication with children and/or adolescents about their cancer, its treatment and their implications, updating the 2003 version of this review. SEARCH STRATEGY In April 2006 we updated searches of the following sources: CENTRAL (The Cochrane Library, issue 1 2006); MEDLINE (Ovid), (2003 to March week 5 2006); EMBASE (Ovid) (2003 to 2006 week 13); PsycINFO (Ovid) (2003 to March week 5 2006); CINAHL (Ovid) (2003 to March week 5 2006); ERIC (CSA) (earliest to 2006); Sociological Abstracts (CSA) (earliest to 2006); Dissertation Abstracts: (2002 to 6 April 2006).In 2003 we conducted searches of CENTRAL; MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Sociological Abstracts and Dissertation Abstracts.For the initial (2001) publication of this review we also searched the following databases: PsycLIT; Cancerlit; Sociofile; Health Management Information Consortium; ASSIA; LISA; PAIS; Information Science Abstracts; JICST; Pascal; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; MANTIS.We also searched the bibliographies of studies assessed for inclusion, and contacted experts in the field. SELECTION CRITERIA Randomised and non-randomised controlled trials, and before and after studies, evaluating the effects of interventions for improving communication with children and/or adolescents about their cancer, treatment and related issues. DATA COLLECTION AND ANALYSIS Data relating to the interventions, populations and outcomes studied and the design and methodological quality of included studies were extracted by one review author and checked by another review author. We present a narrative summary of the results. MAIN RESULTS One new study met the criteria for inclusion; in total we have included ten studies involving 438 participants. Studies were diverse in terms of the interventions evaluated, study designs used, types of people who participated and the outcomes measured.One study of a computer-assisted education programme reported improvements in knowledge and understanding about blood counts and cancer symptoms. One study of a CD-ROM about leukaemia reported an improvement in children's feelings of control over their health. One study of art therapy as support for children during painful procedures reported an increase in positive, collaborative behaviour. Two out of two studies of school reintegration programs reported improvements in some aspects of psychosocial wellbeing (one in anxiety and one in depression), social wellbeing (two in social competence and one in social support) and behavioural problems; and one reported improvements in physical competence. One newly-identified study of a multifaceted interactive intervention reported a reduction in distress (as measured by heart rate) related to radiation therapy.Two studies of group therapy, one of planned play and story telling, and one of a self-care coping intervention, found no significant effects on the psychological or clinical outcomes measured. AUTHORS' CONCLUSIONS Interventions to enhance communication involving children and adolescents with cancer have not been widely or rigorously assessed. The weak evidence that exists suggests that some children and adolescents with cancer may derive some benefit from specific information-giving programs, from support before and during particular procedures, and from interventions that aim to facilitate their reintegration into school and social activities. More research is needed to investigate the effects of these and other related interventions.
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Affiliation(s)
- Rita Ranmal
- Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, UK, WC1X 8SH
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Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities. Cochrane Database Syst Rev 2007; 2007:CD004808. [PMID: 17443556 PMCID: PMC6464838 DOI: 10.1002/14651858.cd004808.pub3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Contracts are a verbal or written agreement that a patient makes with themselves, with healthcare practitioners, or with carers, where participants commit to a set of behaviours related to the care of a patient. Contracts aim to improve the patients' adherence to treatment or health promotion programmes. OBJECTIVES To assess the effects of contracts between patients and healthcare practitioners on patients' adherence to treatment, prevention and health promotion activities, the stated health or behaviour aims in the contract, patient satisfaction or other relevant outcomes, including health practitioner behaviour and views, health status, reported harms, costs, or denial of treatment as a result of the contract. SEARCH STRATEGY We searched: the Cochrane Consumers and Communication Review Group's Specialised Register (in May 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2004, issue 1); MEDLINE 1966 to May 2004); EMBASE (1980 to May 2004); PsycINFO (1966 to May 2004); CINAHL (1982 to May 2004); Dissertation Abstracts. A: Humanities and Social Sciences (1966 to May 2004); Sociological Abstracts (1963 to May 2004); UK National Research Register (2000 to May 2004); and C2-SPECTR, Campbell Collaboration (1950 to May 2004). SELECTION CRITERIA We included randomised controlled trials comparing the effects of contracts between healthcare practitioners and patients or their carers on patient adherence, applied to diagnostic procedures, therapeutic regimens or any health promotion or illness prevention initiative for patients. Contracts had to specify at least one activity to be observed and a commitment of adherence to it. We included trials comparing contracts with routine care or any other intervention. DATA COLLECTION AND ANALYSIS Selection and quality assessment of trials were conducted independently by two review authors; single data extraction was checked by a statistician. We present the data as a narrative summary, given the wide range of interventions, participants, settings and outcomes, grouped by the health problem being addressed. MAIN RESULTS We included thirty trials, all conducted in high income countries, involving 4691 participants. Median sample size per group was 21. We examined the quality of each trial against eight standard criteria, and all trials were inadequate in relation to three or more of these standards. Trials evaluated contracts in addiction (10 trials), hypertension (4 trials), weight control (3 trials) and a variety of other areas (13 trials). Sixteen trials reported at least one outcome that showed statistically significant differences favouring the contracts group, five trials reported at least one outcome that showed differences favouring the control group and 26 trials reported at least one outcome without differences between groups. Effects on adherence were not detected when measured over longer periods. AUTHORS' CONCLUSIONS There is limited evidence that contracts can potentially contribute to improving adherence, but there is insufficient evidence from large, good quality studies to routinely recommend contracts for improving adherence to treatment or preventive health regimens.
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Affiliation(s)
- X Bosch-Capblanch
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK L35QA.
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Prictor M, Hill S, Mackenzie A, Stoelwinder J, Harmsen M. Interventions (non-pharmacological) for preparing children and adolescents for hospital care. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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