Harmonising the human biobanking consent process: an Irish experience

Harmonising the human biobanking consent process: an Irish experience
Open Letter
Lydia O’Sullivan, Tomás Carroll, Niamh Clarke, Sarah Cooper, Ann Cullen, Laura Gorman, Billy McCann, Blánaid Mee, Nicola Miller, Verena Murphy, Máiréad Murray, Jackie O’Leary, Sharon O’Toole, Emma Snapes, Suzanne Bracken
HRB Open Research, 17 September 2021; 4(96)
Open Access
Abstract
Biobanks are repositories of human biological samples and data. They are an important component of clinical research in many disease areas and often represent the first step toward innovative treatments. For biobanks to operate, researchers need human participants to give their samples and associated health data. In Ireland, research participants must provide their freely given informed consent for their samples and data to be taken and used for research purposes. Biobank staff are responsible for communicating the relevant information to participants prior to obtaining their consent, and this communication process is supported by documentation in the form of Participant Information Leaflets and Informed Consent Forms (PILs/ICFs). PILs/ICFs should be concise, intelligible, and contain relevant information. While not a substitute for layperson and research staff discussions, PILs and ICFs ensure that a layperson has enough information to make an informed choice to participate or not. However, PILs/ICFs are often lengthy, contain technical language and can be complicated and onerous for a layperson to read. The introduction of the General Data Protection Regulation (GDPR) and the related Irish Health Research Regulation (HRR) presented additional challenges to the Irish biobank community. In May 2019, the National Biobanking Working Group (NBWG) was established in Ireland. It consists of members from diverse research backgrounds located in universities, hospitals and research centres across Ireland and a public/patient partner. The NBWG aimed to develop a suite of resources for health research biobanks via robust and meaningful patient engagement, which are accessible, GDPR/HRR-compliant and could be used nationally, including a PIL/ICF template. This open letter describes the process whereby this national biobank PIL/ICF template was produced. The development of this template included review by the Patient Voice in Cancer Research, led by Professor Amanda McCann at University College Dublin and the Health Research Data Protection Network.

Collecting Biospecimens and Obtaining Biobank Consent From Patients in an Academic Health Care Setting

Collecting Biospecimens and Obtaining Biobank Consent From Patients in an Academic Health Care Setting
T.J. Kasperbauer, Amy Waltz, Brenda Hudson, Bridget Hawryluk, Courtney Moore, Karen Schmidt,
Peter H. Schwartz
Academic Medicine, 14 September 2021
Abstract
Academic health centers and health systems increasingly ask patients to enroll in research biobanks as part of standard care, raising important practical and ethical questions for integrating biobank consent processes into health care settings. This article aims to assist academic health centers and health systems considering implementing these integrated consent processes by outlining the 5 main issues—and the key practical and ethical considerations for each issue—that Indiana University Health and the Indiana Biobank faced when integrating biobank consent into their health system, as well as the key obstacles encountered. The 5 main issues to consider include the specimen to collect (leftover, new collection, or add-ons to clinical tests), whether to use opt-in or opt-out consent, where to approach patients, how to effectively use digital tools for consent, and how to appropriately simplify consent information.

The value of consent for biobanking

The value of consent for biobanking
News & Views
Elizabeth Bromley, Dmitry Khodyakov
Nature Human Behaviour, 23 August 2021
Excerpt
Biobanks facilitate large-scale tests of hypotheses that may advance health, but whether biobanking participants adequately comprehend the potential uses of their data should concern researchers and the public. Consent matters because it provides a singular safeguard and a participatory mechanism to influence science’s production of new forms of power…

Communicating With Diverse Patients About Participating in a Biobank: A Randomized Multisite Study Comparing Electronic and Face-to-Face Informed Consent Processes

Communicating With Diverse Patients About Participating in a Biobank: A Randomized Multisite Study Comparing Electronic and Face-to-Face Informed Consent Processes
Research Article
Christian M. Simon, Kai Wang, Laura A. Shinkunas, Daniel T. Stein, Paul Meissner, Maureen Smith, Rebecca Pentz, David W. Klein
Journal of Empirical Research on Human Research Ethics, 19 August 2021
Abstract
Some individuals’ understanding of informed consent (IC) information may improve with electronic delivery, but others may benefit from face-to-face (F2F). This randomized, multisite study explores how individuals from diverse backgrounds understand electronic IC documents versus F2F, their confidence in understanding, and enrollment in research. A total of 501 patients at two U.S. biobanks with diverse populations participated. There were no overall differences between electronic and F2F understanding, but F2F predicted higher confidence in understanding and enrollment. Ethnicity and a higher educational level predicted higher understanding and confidence. Study findings suggest that electronic consent may lead to better understanding for non-Hispanic patients of higher socioeconomic status. F2F processes may lead to better understanding and higher enrollment of patients from Hispanic and lower socioeconomic levels. Researchers should carefully consider how they implement electronic IC processes and whether to maintain an F2F process to better address the needs and limitations of some populations.

Vulnerabilities of Cancer Patients and Their Effects on Informed Consent for Biobanking

Vulnerabilities of Cancer Patients and Their Effects on Informed Consent for Biobanking
Mason Kyle, Diana Cortez, Blaze Carbonell, Edgar Masmila, Alfredo Molinolo, and Sharmeela Kaushal
Biopreservation and Biobanking, 4 August 2021
Introduction
The biorepository (BR) at the Moores Cancer Center (MCC) of the University of California, San Diego is a College of American Pathologists (CAP)-accredited biobanking core that performs informed patient consent, tissue collection, characterisation, storage, and distributiom under Institutional Review Board (IRB)-approved protocol. The informed consent process is the key element that allows the BR to procure and distribute human biospecimens and associated patient information for research…

Thinking about the idea of consent in data science genomics: How ‘informed’ is it?

Thinking about the idea of consent in data science genomics: How ‘informed’ is it?
Original Article
Jennifer Greenwood, Andrew Crowden
Nursing Philosophy, 12 May 2021
Abstract
In this paper we argue that ‘informed’ consent in Big Data genomic biobanking is frequently less than optimally informative. This is due to the particular features of genomic biobanking research which render it ethically problematic. We discuss these features together with details of consent models aimed to address them. Using insights from consent theory, we provide a detailed analysis of the essential components of informed consent which includes recommendations to improve consent performance. In addition, and using insights from philosophy of mind and language and psycholinguistics we support our analyses by identifying the nature and function of concepts (ideas) operational in human cognition and language together with an implicit coding/decoding model of human communication. We identify this model as the source of patients/participants poor understanding. We suggest an alternative, explicit model of human communication, namely, that of relevance-theoretic inference which obviates the limitations of the code model. We suggest practical strategies to assist health service professionals to ensure that the specific information they provide concerning the proposed treatment or research is used to inform participants’ decision to consent. We do not prescribe a standard, formal approach to decision-making where boxes are ticked; rather, we aim to focus attention towards the sorts of considerations and questions that might usefully be borne in mind in any consent situation. We hope that our theorising will be of real practical benefit to nurses and midwives working on the clinical and research front-line of genomic science.

Incorporating Biobank Consent into a Healthcare Setting: Challenges for Patient Understanding

Incorporating Biobank Consent into a Healthcare Setting: Challenges for Patient Understanding
Research Article
J. Kasperbauer, Karen K. Schmidt, Ariane Thomas, Susan M. Perkins, Peter H. Schwartz
American Journal of Bioethics, 4 December 2020
Abstract
Background
Biobank participants often do not understand much of the information they are provided as part of the informed consent process, despite numerous attempts at simplifying consent forms and improving their readability. We report the first assessment of biobank enrollees’ comprehension under an “integrated consent” process, where patients were asked to enroll in a research biobank as part of their normal healthcare experience. A number of healthcare systems have implemented similar integrated consent processes for biobanking, but it is unknown how much patients understand after enrolling under these conditions.
Methods
We recruited patients who enrolled in a biobank while in a healthcare setting when receiving ordinary care. We assessed knowledge of consent materials using 11 true/false questions drawn from a well-known biobank knowledge test. After reviewing the results from 114 participants, we revised the consent form and repeated the knowledge assessment with 144 different participants.
Results
Participants scored poorly on the knowledge test in both rounds, with no significant differences in overall scores or individual items between the rounds. In Phase 1, participants answered 53% of the questions correctly, 25% incorrectly, and 22% “I don’t know.” In Phase 2, participants answered 53% of questions correctly, 24% incorrectly, and 23% “I don’t know.” Participants scored particularly poorly on questions about data sharing and accessing medical records.
Conclusions
Enrollees under an integrated consent model had significant misunderstandings that persisted despite an attempt to improve information specifically about those topics in a consent form. These results raise challenges for current approaches that attribute misunderstanding to overly complex consent forms. They also suggest that the pressures of the clinic may compound other problems with patient understanding of biobank consent. As health systems increasingly blend research and care, they may need to rethink their approach to educating patients about participation in a biobank.

Context-Relative Norms Determine the Appropriate Type of Consent in Clinical Biobanks: Towards a Potential Solution for the Discrepancy between the General Data Protection Regulation and the European Data Protection Board on Requirements for Consent

Context-Relative Norms Determine the Appropriate Type of Consent in Clinical Biobanks: Towards a Potential Solution for the Discrepancy between the General Data Protection Regulation and the European Data Protection Board on Requirements for Consent
Original Research/Scholarship
Indrakusuma, S. Kalkman, M. J. W. Koelemay, R. Balm & D. L. Willems
Science and Engineering Ethics, 13 October 2020
Open Access
Abstract
Clinical biobanks processing data of participants in the European Union (EU) fall under the scope of the General Data Protection Regulation (GDPR), which among others includes requirements for consent. These requirements are further specified by the Article 29 Working Party (WP29)—an EU advisory body currently known as the European Data Protection Board (EDPB). Unfortunately, their guidance is cause for some confusion. While the GDPR allows participants to give broad consent for research when specific research purposes are still unknown, the WP29 guidelines suggest that additional consent for specific uses should be obtained in addition to broad consent when this becomes applicable. This discrepancy elicits the question whether clinical biobanks can fail the requirement of consent if they obtain broad consent, but not a specific consent for each biomedical study. We analysed this discrepancy within the framework of contextual integrity, in order to describe the context-relative informational norms that govern information flows in clinical biobanks. However, our analysis demonstrates that there is no uniform set of norms that can be applied to all clinical biobanks. As such, neither the GDPR nor the WP29 guidance can act as a “one size fits all” approach to all clinical biobanks. Rather, differences between clinical biobanks—especially regarding the scientific aims and patient populations—make the case for context-relative norms that determine the appropriate type of consent.

Research participant understanding and engagement in an institutional, self‐consent biobank model

Research participant understanding and engagement in an institutional, self‐consent biobank model
Original Article
Andrew Schmanski, Emily Roberts, Marilyn Coors, Stephen J. Wicks, Jaron Arbet, Rachel Weber, Kristy Crooks, Kathleen C. Barnes, Matthew R. G. Taylor
Journal of Genetic Counselling, 20 September 2020
Abstract
The number of institutional and governmental biobanks and the target enrollment sizes of modern biobanks are increasing, affording more opportunities for the public to participate in biobanking efforts. In parallel with these expansions are pressures to increase the efficiency of obtaining informed consent using shorter consent forms that cover a broader scope of research and increasingly include provisions for return of research or clinical genetic test results to participants. Given these changes, how well these participants understand genetics, their level of understanding of what they are consenting to, and their wishes to engage longitudinally and receive biobank results are not well understood. We surveyed participants in a large, medical system‐based biobank who had enrolled through a two‐page, self‐consent process about their baseline knowledge of genetics, understanding and recall of the consent process, wishes for future contact and engagement, and level of interest in receiving clinical genetic testing results. A total of 856 consented persons participated in the survey (67% women; 67% white). Participants’ general reported genetics knowledge was relatively high (mean 11.60 of 15 questions answered correctly) as was recall of key elements from the two‐page consent form. Overall participant enthusiasm for future contact by the biobank and for receiving clinical genetic testing results was high. The use of a two‐page, self‐consent process in a large, institutional biobank resulted in high levels of consent recall and enthusiasm for future ongoing engagement and receipt of genetic testing results by participants.

Enabling data sovereignty for patients through digital consent enforcement

Enabling data sovereignty for patients through digital consent enforcement
Arno Appenzeller, Ewald Rode profile imageEwald Rode, Erik  Krempel profile imageErik Krempel, Jürgen Beyerer profile imageJürgen Beyerer
PETRA ’20: Proceedings of the 13th ACM International Conference on PErvasive Technologies Related to Assistive Environments, June 2020; 33 pp 1-4
Abstract
Digital medical data offers an opportunity to improve medical diagnosis and caregiving. While a single doctor might not have enough patients to spot significant factors, data becomes much more evaluable once different doctors combine their data. Data evaluation across multiple data sources will be more practical with the increasing level of digitalization. While the potential benefits of a broad data analysis are enormous, there is a huge potential privacy impact for patients. To cope with legal regulations, for example the European General Data Protection Regulation (GDPR) and to give patients more control over the usage of their data, new tools are needed. Digital distributed patient records need a mechanism to manage a digital declaration of consent. There are some concepts how to digitize medical consent, but still there is no complete workflow that automatically evaluates and enforces consent for the usage of personal medical data. In this paper we will present a continuous digital consent enforcement workflow. Patients can define a detailed declaration of consent for their medical data and researchers can request data through a dedicated interface that enforces that consent. We show the feasibility of this workflow by presenting a prototype implementation and evaluating the system against defined requirements for informed consent.