Returning Individual Genetic Results to Participants in Cohort Studies

摘要/摘要 方法学的进步现在允许使用全基因组关联研究(GWAS) 发现新的基因型-表型关联。GWAS提供了一个强大的工具来识别 基因对常见病和罕见病都有影响。与此同时，GWAs提高了 深刻而富有挑战性的伦理问题。最紧迫的问题来自于 GWAS将发现具有临床应用潜力的遗传信息的可能性 对个人参与者有意义。因此，调查人员将不可避免地面临这样的问题 是否应该向受试者披露全基因组扫描的个体基因结果。 评论员和伦理小组已经讨论了基因测试是否 结果应返回给研究参与者。大多数政策制定者主张谨慎 方法：应将披露限制在满足严格标准的少数结果子集 与风险的大小、表型的严重程度以及预防、治疗的有效性有关 或生殖干预。另一方面，关于研究参与者观点的有限数据 另一方面，表明强烈倾向于披露测试结果。然而，因为这些数据 是基于对单个问题的二分法回答，它们没有解决 与会者的意见对专家小组确定的对决策具有显著影响的因素很敏感 关于返回结果的问题。如果没有这样的信息，就不可能知道差距是否 参与者的观点和政策指引之间的关系正如数据所显示的那样深刻。 目前的建议旨在通过对1800名成员的因素调查来弥合这一差距 杰克逊和弗雷明翰心脏研究，两项有影响力的心血管队列研究 进行全球气候变化分析。具体地说，拟议的研究将评估标准是否突出 政策制定者对研究参与者对这些信息的渴望是可以预测的。这项研究 还将评估态度特征之间的关系(例如，对和的看法 关于遗传学的知识)和社会人口学特征(如年龄、教育)和 参与者对返回结果的渴望。调查结果将使我们能够评估 专家的观点和研究参与者的观点是一致的 这个令人烦恼的话题。这些数据将有助于形成关于返回的做法和政策 来自基因组研究的个人结果。

SUMMARY/ABSTRACT Methodological advances now permit the use of genome-wide association studies (GWAS) to discover novel genotype-phenotype associations. GWAS offer a powerful tool for identifying genetic contributions to both common and rare diseases. At the same time, GWAS raise profound and challenging ethical questions. The most pressing questions derive from the likelihood that GWAS will uncover genetic information with the potential to be clinically meaningful to individual participants. As a result, investigators will inevitably face the question of whether individual genetic results from genome-wide scans should be disclosed to subjects. Commentators and ethics panels have addressed the question of whether genetic test results should be returned to research participants. Most policymakers advocate a cautious approach: disclosure should be limited to a narrow subset of results that meet stringent criteria related to magnitude of risk, severity of phenotype, and availability of prophylactic, therapeutic or reproductive interventions. Limited data regarding research participants' views, on the other hand, suggest a strong preference for disclosure of test results. However, because these data are based upon dichotomous responses to single questions, they do not address whether participants' views are sensitive to the factors identified by expert panels as salient to decisions about return of results. Without such information, it is impossible to know whether the gap between participants' views and policy guidance is as profound as the data suggest. The present proposal aims to bridge this gap through a factorial survey of 1800 members of the Jackson and Framingham Heart Studies, two influential cardiovascular cohort studies that conduct GWAS. Specifically, the proposed study will evaluate whether the criteria highlighted by policymakers are predictive of research participants' desires for this information. The study will also evaluate the relationships between attitudinal characteristics (e.g., views on and knowledge about genetics) and sociodemographic characteristics (e.g., age, education) and participants' desires for return of results. The findings will permit assessment of the extent to which there is concordance between the views of experts and those of research participants on this vexing topic. These data will help shape practice and policy regarding the return of individual results from genomic research.