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Public preferences for the return of research results in genetic research Recent policies specifying criteria about which individual research results to return leave considerable discretion to researchers.
Policy preferences were measured using 12 tasks in which respondents chose between two groupings of the policy principles. All eight principles were positively endorsed by participants (all P 0.003), with priority placed on providing results at no cost and returning well validated results for treatable and serious diseases. Providing detailed result reports was more highly valued than providing staff to explain results (P = 0.0005). Receiving results about major changes in risk was marginally disvalued by those unlikely to participate (P = 0.35).Large scale studies that pair genetic samples with participants medical data have become an important staple of biomedical research. As understanding of gene relationships grows, genotypic data collected by researchers may hold increasing clinical or pandora jewery personal value for research participants. Decreasing costs of exome and genome sequencing and the growth of population and clinic based biobanks mean that some clinically relevant genomic variants are likely to be identified in large numbers of research participants.1Studies have shown that genetic research participants are interested in receiving, and may expect some, individual research results (IRRs) in return for participating.2,3,4,5,6,7,8,9,10,11 A public survey about a possible large cohort study found that 90% of participants wanted to learn their IRRs regardless of the utility of the findings; 75% said they would be less likely to participate in a study that did not return IRRs.8 Discussion about IRRs has shifted from the question of whether IRRs should be returned to deliberations regarding which results should be returned, when, and in what manner. Evidence of this shift can be found in emerging guidelines that suggest that researchers and clinicians may have an ethical obligation to return at least some results.12,13,14 Although these guidelines specify some criteria about which IRRs to return, considerable discretion is left to researchers.12,14 For example, the 2010 National Heart, Lung, and Blood Institute guidelines state that individual genetic results should be offered to study participants if the finding has important well established health implications, the finding is actionable, the test is analytically valid, and the study participant has opted to receive the information during an informed consent process.14 Under this National Heart, Lung, and Blood Institute guideline, one study found that researchers using whole how much is a pandora charm bracelet exome sequencing could unearth between 3,955 and 12,579 findings per participant that could qualify for disclosure.15 Another study simulated the return of incidental findings by first classifying 2,016 genes linked to Mendelian disorders into based on their clinical utility and validity. Initial clinical recommendations by the American College of Medical Genetics and Genomics (ACMG) advised that clinical laboratories performing whole exome or whole genome sequencing report findings from 57 genes related to 30 serious actionable conditions, regardless of patient age or preference, and estimated that 1% of reports would include one of these variants.18 It is not clear whether any of these recommendations could or should be used to decide what researchers should divulge; current financial, regulatory, staff, and logistic burdens would make returning 4,000 findings to a single participant impossible. These examples illustrate that there are multiple, widely varying resources that a researcher might use, appropriately or inappropriately, to prioritize what to return.19,20 Considerable inputs will be required to help researchers make these decisions, while balancing policies, participant preferences, the financial and logistic burdens of returning IRRs, and the integrity of their research.This study contributes to the ongoing discussion about returning IRRs by measuring the policy preferences of a critical stakeholder in genetic research This research used a conjoint experiment to assess public preferences for eight principles related to the return of research results in a hypothetical large cohort study and to examine whether the priorities for a results policy differ between respondents who would or would not be willing to participate in the study. Additional questions measured general opinions about the study and the return of research results.To inform the design of the survey, 10 focus groups conducted in three US cities explored the types of research results that people valued, the importance of clinical validity and utility, and preferences for communicating IRRs. The focus group study, reported on elsewhere,10 collected opinions on several current issues in the debate related to IRRs, including the following: (i) whether to return IRRs,21,22,23,24,25 (ii) the evidence required to support return of a given result,12,14,26 (iii) the criteria defining which results to return,12,14 (iv) the financial and clinical support needed to provide results,10,14 and (v) whether returning IRRs would influence participant enrollment and retention.8 The focus group study found several attributes of IRRs that might influence research participants interest in the information. These included whether the result is associated with a common disease, a serious disease, or a condition for which treatment is available; whether the result is associated with a large change in risk; and whether the risk estimate is well validated or might change over time. The availability of detailed result reports and study staff to explain them were also seen as important. Many expected that results would be provided at no cost to research participants. These were not the only factors that appeared to influence whether someone would want an IRR, but they were among the most important factors observed.Building on this work, an online survey was developed. The conjoint experiment that is the focus of this study was part of a larger survey instrument designed to measure public attitudes about the design of a national cohort study proposed by the National Human Genome Research Institute27 that would follow 500,000 Americans over time to study genetic and environmental causes of disease.28 The broader survey focused on several aspects of biobank participation, including study design preferences, privacy concerns, broad consent, and the return of IRRs.The survey was conducted online in English and Spanish, according to respondent preference. Sample selection and survey administration was managed by Knowledge Networks (KN, which has since become the KnowledgePanel, run by the company GfK).29 During the field study period of 29 April May 2011, potential respondents aged 18 years and older were randomly selected from KN Web enabled master panel of 35,000 US residents. For households without Internet access, KN provides a laptop computer and an Internet connection to complete the surveys. Black non Hispanics and Hispanics were oversampled. Hispanics were sampled from KN KnowledgePanel Latino panel, which comprises a representative sample of US adults who identify with Hispanic culture and values. The Hispanic sample was stratified to include equal numbers of individuals who chose to take the survey in English or in Spanish.Survey respondents viewed English or Spanish versions of a 3 minute video describing the proposed study. Respondents who could not view the video saw a written script of the video, accompanied by a diagram of study components. Hyperlinks to the study description and definitions were available throughout the survey (Supplementary Table S1 online). Respondents were then asked about their support for, and willingness to participate in, the study as well as their interest in receiving IRRs. The survey was qualified by the Johns Hopkins University Institutional Review Board as exempt (application NA_00040539).Because of the length of the survey, half of the respondents were randomly selected to participate in the conjoint experiment discussed here; the other half participated in a conjoint experiment measuring preferences for overall study design. The hallmark of conjoint analysis is that it forces participants to make a series of trade offs, in this case between different principles of a policy to return IRRs. This technique provides important information about which principles of a results policy will determine whether it is viewed favorably and quantifies how each attribute is valued by the respondents by forcing them to reveal their preferences through a structured series of choice experiments. The eight IRR policy principles, which were presented to participants as they appear in Table 1, were selected based on our previous survey and focus group research and by reviewing the relevant scientific literature, policy statements, and guidelines addressing the return of IRRs.8,10,12,14,21,22,23Respondents were told, study planners have decided to offer to return some individual research results to interested participants. Over the course of a 10 year study like this, there may be hundreds or thousands of results for each participant. Therefore study planners will need to figure out which individual results to return and how to return them. Then, in a series of 12 choice tasks (exemplified in Figure 1), the policy principles were divided into two mutually exclusive groups, and respondents were asked to choose their preferred policy.To identify which of the eight factors were most valued and whether preferences differed between those who would and would not participate in the proposed study, we constructed paired comparison choice tasks using an orthogonal array. A total of 256 profiles combining subsets of the eight principles that could guide return of IRRs can be derived. Policy profiles for the conjoint exercises were created using a 28 array from the SAS catalog30; the principles were separated into two subsets A and policy/plan B.31,32,33 Consistent with good research practices,34 the experimental design characteristics were verified, and the resulting experiment was perfectly orthogonal. In each of the 12 tasks, respondents were asked to choose the policy (A or B) they would prefer if they were a participant in the study. No further explanation or justification was required, and the tasks were forced choices.An initial pilot study (9 February 2011; n = 68) evaluated survey length, logic, skip patterns, and wording. Five cognitive interviews evaluated respondent comprehension of the conjoint experiment. A second pilot (18 March 2011; n = 72) looked for an order effect because the conjoint exercise could precede or follow a battery of questions that might influence response. The conditional logistic regression does not allow for respondent characteristics, such as age or willingness to participate, to be entered into the regression because each respondent acts as his/her own control in the regression, which measures differences in individual responses to experimentally controlled variations in the IRR policies.Results focus on the value that respondents placed on each factor as represented by the parameter estimate from the conditional logistic regression. Overall differences between respondents who would and would not participate in the cohort study were estimated through stratified regression, and differences in values of each principle were tested using t tests and the Wald test.A 57% survey response rate yielded 1,523 respondents who participated in the conjoint exercise, and the 1,515 respondents (99.4%) providing complete data on the conjoint exercise served as the pandora charm bracelet for kids basis of the analyses below. Both weighted and unweighted demographic distributions of the complete sample and those completing the conjoint analysis were comparable to those of the US 2010 Census (Supplementary Table S1 online). Two in three respondents were able to watch the introductory video; the remainder read the study description. No differences were noted between those who watched the video and read the description with respect to the findings below.Immediately after viewing or reading the study description, 56% said that they would definitely (16%) or probably (40%) participate in the study, and 44% said that they would probably not (30%) or definitely not (14%) participate (see Supplementary Table S1 online). Furthermore, 78% would be interested in receiving their IRRs if they participated in the study, 9% would not be interested, and 13% were not sure. Given a choice, 57% said they would want all of their IRRS, 32% would choose to receive only the results for that can be prevented or treated, and 12% not want or need any individual research results. Slightly more than half (56%) agreed would be fair if I only received the results of findings for diseases that can be prevented or treated 62% of those likely to take part in the study agreed with this statement.Determinants of preferences for a return of results policySummarizing the views of all respondents who completed the conjoint analysis, all eight principles of a potential policy to return IRRs significantly and positively influenced preference for the policy (Figure 2). The most attractive attribute tested was results at no cost to research participants. The remaining seven attributes can be divided into two categories: types of results to return, and provisions for returning them. After returning results at no cost, the next most attractive principles reflected the types of results that should be returned related to treatable and serious diseases, and results in which the genotype association has been confirmed. Although respondents viewed the return of IRRs about common diseases and major changes in risk positively, these pandora bracelet buy characteristics were significantly less important. Respondents valued a detailed result report more than having study staff available to discuss results.Overall, the relative ranking of the principles was similar in those willing (n = 861) and unwilling (n = 654) to participate (Figure 3). In both groups, providing results at no cost was the most attractive attribute (odds ratio (OR) of finding the policy acceptable = 1.82 in those willing to participate; OR = 1.89 in those unwilling; P = 0.25). Returning results for treatable diseases (OR = 1.69 and 1.
59, respectively; P = 0.09) was the second most important attribute tested. In both groups, respondents placed a significantly higher value on receiving reports with detailed interpretations than having study staff available to discuss results.
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