Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA.
Genet Med. 2020 Feb;22(2):345-352. doi: 10.1038/s41436-019-0642-7. Epub 2019 Sep 3.
Large-scale array-based and sequencing studies have advanced our understanding of the genetic architecture of psychiatric disorders, but also increased the potential to generate an exponentially larger amount of clinically relevant findings. As genomic testing becomes more widespread in psychiatry research, urgency grows to establish best practices for offering return of results (RoR) to individuals at risk or diagnosed with a psychiatric disorder.
We interviewed an international sample (n = 39) of psychiatric genetics researchers to examine conceptualizations of "best practices" for RoR to individual research participants.
While the vast majority of researchers do not offer RoR, most believed medically actionable findings (85%) and clinically valid but non-medically actionable findings (54%) should be offered. Researchers identified three main areas for improvement: interfacing with individual participants; interdisciplinary training, guidance, and integration; and quality planning and resource allocation for returning results.
There are significant gaps between researchers' visions for "best" versus "actual" RoR practices. While researchers call for participant-centered practices, including consent practices that consider any special needs of participants with psychiatric disorders, return of individually meaningful results, and effective follow-up and provisions for treatment, the current reality is that consent and RoR practices lack standardized and evidence-based norms.
基于大规模阵列和测序的研究增进了我们对精神疾病遗传结构的理解,但也增加了产生数量呈指数级增长的临床相关发现的可能性。随着基因组测试在精神病学研究中越来越普及,迫切需要为有风险或被诊断患有精神疾病的个体建立提供结果回报 (RoR) 的最佳实践。
我们采访了一组国际精神病遗传学研究人员(n=39),以研究对个体研究参与者的 RoR 的“最佳实践”概念。
尽管绝大多数研究人员不提供 RoR,但大多数人认为应提供医学上可采取的发现(85%)和临床上有效的但非医学上可采取的发现(54%)。研究人员确定了三个需要改进的主要领域:与个体参与者的接口;跨学科培训、指导和整合;以及返回结果的质量规划和资源分配。
研究人员对“最佳”与“实际”RoR 实践的愿景存在显著差距。尽管研究人员呼吁采用以参与者为中心的实践,包括考虑到有精神疾病的参与者的任何特殊需求的同意实践、返回对个人有意义的结果,以及有效的随访和治疗规定,但目前的现实是,同意和 RoR 实践缺乏标准化和基于证据的规范。