适应概念框架,让不同利益相关者参与基因组/精准医学研究。
Adapting a conceptual framework to engage diverse stakeholders in genomic/precision medicine research.
机构信息
Division of Community Health Sciences, School of Public Health, Mile Square Health Center, University of Illinois, Chicago, Illinois, USA.
Hunter-Bellevue School of Nursing, Hunter College, New York, New York, USA.
出版信息
Health Expect. 2022 Aug;25(4):1478-1485. doi: 10.1111/hex.13486. Epub 2022 Mar 30.
INTRODUCTION
Genomic/precision medicine offers a remarkable opportunity to improve health and address health disparities. Genomic medicine is the study of genes and their interaction with health. Precision medicine is an approach to disease prevention and treatment that considers individual variability in genes, environment and lifestyle. Conclusions from studies lacking diversity may hinder generalizability as genomic variation occurs within and between populations. Historical factors, such as medical mistrust, ethical issues related to decision making, and data sharing pose complex challenges that may further widen inequities in genomic/precision medicine if not appropriately addressed. Although few biomedical studies integrate priorities of community partners into their conceptual framework, effective implementation of genomic/precision medicine research calls for the involvement of diverse stakeholders to expand traditional unidirectional models of engagement in clinical research towards authentic bidirectional collaboration.
METHODS
A multipronged approach was used integrating an evidence-based literature review and best practices in developing and evaluating the engagement of diverse stakeholders in genomic and precision medicine research. This was combined with expert consensus building to adapt a conceptual model from a community engagement framework to addressing genomics to be scalable to engagement science, which is challenging to genomic/precision medicine research.
RESULTS
The final enhanced conceptual framework is composed of four overarching dimensions now inclusive of domains in trust, exploitation, discrimination, privacy risk, stigmatization, prior harms/injustices, failure to recognize coexisting governments, intersectionality and research transformation. This conceptual framework proposes effective participant research engagement strategies for upstream relationship building, distinct from downstream recruitment strategies in which the goal is enrolment.
CONCLUSION
To further shape the evolution of genomic/precision medicine research, it is important to leverage existing partnerships, engage participants beyond recruitment and embrace diverse perspectives.
PATIENT OR PUBLIC CONTRIBUTION
In preparation of this manuscript, the perspectives of the community partners on the impact of engaging in genomic/precision medicine research beyond research participation were integrated into this conceptual framework from various guided listening sessions held in diverse communities.
简介
基因组/精准医学为改善健康和解决健康差距提供了一个显著的机会。基因组医学是研究基因及其与健康的相互作用。精准医学是一种疾病预防和治疗方法,考虑了个体基因、环境和生活方式的个体差异。缺乏多样性的研究结论可能会阻碍普遍性,因为基因组变异在人群内部和之间发生。历史因素,如医疗不信任、与决策相关的伦理问题以及数据共享,如果不加以适当解决,可能会进一步扩大基因组/精准医学中的不平等。尽管少数生物医学研究将社区合作伙伴的优先事项纳入其概念框架,但要有效实施基因组/精准医学研究,需要让不同利益相关者参与进来,扩大传统的临床研究单向参与模式,向真正的双向合作转变。
方法
采用多管齐下的方法,综合了循证文献综述和在基因组和精准医学研究中发展和评估多元化利益相关者参与的最佳实践。结合专家共识,将来自社区参与框架的一个概念模型进行调整,以解决可扩展到参与科学的基因组问题,这对基因组/精准医学研究来说具有挑战性。
结果
最终增强的概念框架由四个总体维度组成,现在包括信任、利用、歧视、隐私风险、污名化、先前的伤害/不公正、未能认识到共存的政府、交叉性和研究转化等领域。该概念框架提出了有效的参与者研究参与策略,用于建立上游关系,与下游招募策略不同,后者的目标是招募。
结论
为了进一步推动基因组/精准医学研究的发展,重要的是要利用现有伙伴关系,超越招募阶段,让参与者参与进来,并接受多元化的观点。
患者或公众贡献
在准备这份手稿时,社区合作伙伴对参与基因组/精准医学研究超越研究参与的影响的观点被整合到了这个概念框架中,这些观点来自在不同社区举行的各种指导性听力会议。