Ochieng Joseph, Kwagala Betty, Barugahare John, Möller Marlo, Moodley Keymanthri
Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
Division of Medical Ethics and Law, University of Stellenbosch, Division of Medical Ethics and Law, Cape Town, South Africa.
J Med Ethics. 2024 Dec 23;50(12):829-834. doi: 10.1136/jme-2022-108885.
Genetic testing presents unique ethical challenges for research and clinical practice, particularly in low-resource settings. To address such challenges, context-specific understanding of ethical, legal and social issues is essential. Return of genetics and genomics research (GGR) results remains an unresolved yet topical issue particularly in African settings that lack appropriate regulation and guidelines. Despite the need to understand what is contextually acceptable, there is a paucity of empirical research and literature on what constitutes appropriate practice with respect to GGR.The study assessed patients' awareness, experiences and perceptions regarding genetic testing and the return of GGR results in a hypothetical context.
This cross-sectional study employed a qualitative exploratory approach. Respondents were patients attending the medical outpatient unit of Mulago National Hospital. Three deliberative focus group discussions involving 18 respondents were conducted. Data were analysed through thematic analysis.
Three main themes and several subthemes were identified. Most respondents were aware of genetic testing, supportive of GGR and receiving results. However, only a few had undergone genetic testing due to cost constraints. They articulated the need for adequate information and genetic counselling to inform decision-making. Privacy of results was important to respondents while others were willing to share results.
There was general awareness and support for GGR and the return of results. Stigmatisation emerged as a barrier to disclosure of results for some. Global health inequity impacts access and affordability of genetic testing and counselling in Africa and should be addressed as a matter of social justice.
基因检测给研究和临床实践带来了独特的伦理挑战,尤其是在资源匮乏的环境中。为应对此类挑战,对伦理、法律和社会问题进行因地制宜的理解至关重要。遗传学和基因组学研究(GGR)结果的反馈仍然是一个尚未解决但备受关注的问题,特别是在缺乏适当监管和指导方针的非洲地区。尽管需要了解在当地何种情况是可接受的,但关于GGR的适当做法,实证研究和文献却很匮乏。该研究在一个假设情境中评估了患者对基因检测以及GGR结果反馈的知晓度、经历和看法。
这项横断面研究采用了定性探索性方法。受访者是穆拉戈国家医院门诊部的患者。进行了三次有18名受访者参与的审议性焦点小组讨论。通过主题分析对数据进行了分析。
确定了三个主要主题和几个子主题。大多数受访者知晓基因检测,支持GGR并接受结果。然而,由于费用限制,只有少数人进行过基因检测。他们明确表示需要足够的信息和遗传咨询来辅助决策。结果的隐私对受访者很重要,而其他人则愿意分享结果。
对GGR及结果反馈普遍存在知晓和支持。对一些人来说,污名化成为了结果披露的障碍。全球健康不平等影响了非洲基因检测和咨询的可及性和可承受性,应作为社会正义问题加以解决。