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      Return of individual research results from genomic research: A systematic review of stakeholder perspectives

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          Abstract

          Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.

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          Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology

          The American College of Medical Genetics and Genomics (ACMG) previously developed guidance for the interpretation of sequence variants. 1 In the past decade, sequencing technology has evolved rapidly with the advent of high-throughput next generation sequencing. By adopting and leveraging next generation sequencing, clinical laboratories are now performing an ever increasing catalogue of genetic testing spanning genotyping, single genes, gene panels, exomes, genomes, transcriptomes and epigenetic assays for genetic disorders. By virtue of increased complexity, this paradigm shift in genetic testing has been accompanied by new challenges in sequence interpretation. In this context, the ACMG convened a workgroup in 2013 comprised of representatives from the ACMG, the Association for Molecular Pathology (AMP) and the College of American Pathologists (CAP) to revisit and revise the standards and guidelines for the interpretation of sequence variants. The group consisted of clinical laboratory directors and clinicians. This report represents expert opinion of the workgroup with input from ACMG, AMP and CAP stakeholders. These recommendations primarily apply to the breadth of genetic tests used in clinical laboratories including genotyping, single genes, panels, exomes and genomes. This report recommends the use of specific standard terminology: ‘pathogenic’, ‘likely pathogenic’, ‘uncertain significance’, ‘likely benign’, and ‘benign’ to describe variants identified in Mendelian disorders. Moreover, this recommendation describes a process for classification of variants into these five categories based on criteria using typical types of variant evidence (e.g. population data, computational data, functional data, segregation data, etc.). Because of the increased complexity of analysis and interpretation of clinical genetic testing described in this report, the ACMG strongly recommends that clinical molecular genetic testing should be performed in a CLIA-approved laboratory with results interpreted by a board-certified clinical molecular geneticist or molecular genetic pathologist or equivalent.
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            Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

            Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
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              Recommendations for reporting of secondary findings in clinical exome and genome sequencing, 2016 update (ACMG SF v2.0): a policy statement of the American College of Medical Genetics and Genomics.

              Disclaimer: These recommendations are designed primarily as an educational resource for medical geneticists and other healthcare providers to help them provide quality medical services. Adherence to these recommendations is completely voluntary and does not necessarily assure a successful medical outcome. These recommendations should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed toward obtaining the same results. In determining the propriety of any specific procedure or test, the clinician should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. Clinicians are encouraged to document the reasons for the use of a particular procedure or test, whether or not it is in conformance with this statement. Clinicians also are advised to take notice of the date this statement was adopted and to consider other medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.To promote standardized reporting of actionable information from clinical genomic sequencing, in 2013, the American College of Medical Genetics and Genomics (ACMG) published a minimum list of genes to be reported as incidental or secondary findings. The goal was to identify and manage risks for selected highly penetrant genetic disorders through established interventions aimed at preventing or significantly reducing morbidity and mortality. The ACMG subsequently established the Secondary Findings Maintenance Working Group to develop a process for curating and updating the list over time. We describe here the new process for accepting and evaluating nominations for updates to the secondary findings list. We also report outcomes from six nominations received in the initial 15 months after the process was implemented. Applying the new process while upholding the core principles of the original policy statement resulted in the addition of four genes and removal of one gene; one gene did not meet criteria for inclusion. The updated secondary findings minimum list includes 59 medically actionable genes recommended for return in clinical genomic sequencing. We discuss future areas of focus, encourage continued input from the medical community, and call for research on the impact of returning genomic secondary findings.Genet Med 19 2, 249-255.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                8 November 2021
                2021
                : 16
                : 11
                : e0258646
                Affiliations
                [1 ] Melbourne Law School, University of Melbourne, Carlton, Australia
                [2 ] Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, Australia
                [3 ] Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
                [4 ] Leuven Institute for Human Genetics and Society, Leuven, Belgium
                [5 ] Policy, Ethics and Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle, United Kingdom
                [6 ] Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
                [7 ] School of Art, Media and American Studies, University of East Anglia, Norwich, United Kingdom
                [8 ] Ada Lovelace Institute, London, United Kingdom
                [9 ] Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
                [10 ] Newcastle upon Tyne NHS Foundation Hospitals Trust, Northern Genetics Service, Centre for Life, Newcastle, United Kingdom
                [11 ] Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
                [12 ] McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
                [13 ] Department of Paediatrics, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Parkville, Australia
                [14 ] Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
                [15 ] Harvard Medical School, Boston, Massachusetts, United States of America
                [16 ] Mass General Brigham, Boston, Massachusetts, United States of America
                [17 ] Broad Institute, Boston, Massachusetts, United States of America
                [18 ] Ariadne Labs, Boston, Massachusetts, United States of America
                [19 ] PHG Foundation, University of Cambridge, Cambridge, United Kingdom
                [20 ] Cancer Division, Garvan Institute of Medical Research, Sydney, Australia
                [21 ] International Cancer Genome Consortium, University of Glasgow, Glasgow, United Kingdom
                [22 ] Centre of Genomics and Policy, McGill University, Montreal, Canada
                [23 ] Northumbria University, Newcastle, United Kingdom
                [24 ] Genomics England, Queen Mary University of London, London, United Kingdom
                [25 ] Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge, United Kingdom
                [26 ] National Center for Tumour Diseases (NCT), Section of Translational Medical Ethics, University of Heidelberg, Heidelberg, Germany
                [27 ] University of Glasgow, Glasgow, United Kingdom
                [28 ] Newcastle University, Newcastle, United Kingdom
                Imam Abdulrahman Bin Faisal University, SAUDI ARABIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-6290-545X
                https://orcid.org/0000-0001-9289-0968
                https://orcid.org/0000-0002-6794-3826
                https://orcid.org/0000-0001-7789-5197
                https://orcid.org/0000-0002-4191-0663
                Article
                PONE-D-21-02012
                10.1371/journal.pone.0258646
                8575249
                34748551
                d2375555-f561-45c7-9b57-59523b176f82
                © 2021 Vears et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 January 2021
                : 2 October 2021
                Page count
                Figures: 5, Tables: 7, Pages: 71
                Funding
                Funded by: Medical Research Future Fund
                Award ID: 76749
                Award Recipient :
                Funded by: ESRC
                Award ID: ES/S008349/1
                Award Recipient :
                Funded by: Medical Research Council (GB)
                Award ID: MR/N01104X/1 and MR/N01104X/2
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 213422/Z/18/Z
                Award Recipient :
                Funded by: EU Horizon 2020 programme
                Award ID: 824989
                Award Recipient :
                Funded by: Canada Research Chair in Law and Medicine
                Award Recipient :
                Funded by: Genome Quebec
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100008762, Genome Canada;
                Award Recipient :
                Funded by: Canada Institute of Health Research
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: HL143295, TR003201
                Award Recipient :
                Funded by: Franca Fund
                Award Recipient :
                Funded by: The Research Council of Norway
                Award ID: 296162/F50
                Award Recipient :
                Funded by: Can-SHARE Connect
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 206194
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 213422/Z/18/Z
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100010269, Wellcome Trust;
                Award ID: 213422/Z/18/Z
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100010269, Wellcome Trust;
                Award ID: 213422/Z/18/Z
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100010269, Wellcome Trust;
                Award ID: 213422/Z/18/Z
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100010269, Wellcome Trust;
                Award ID: 213422/Z/18/Z
                Award Recipient :
                Funded by: Medical Research Council (GB)
                Award ID: MR/N01104X/1 and MR/N01104X/2
                Award Recipient :
                Funded by: Medical Research Council (GB)
                Award ID: MR/N01104X/1 and MR/N01104X/2
                Award Recipient :
                Funded by: Medical Research Council (GB)
                Award ID: MR/N01104X/1 and MR/N01104X/2
                Award Recipient :
                Funded by: Medical Research Council (GB)
                Award ID: MR/N01104X/1 and MR/N01104X/2
                Award Recipient :
                Funded by: Medical Research Council (GB)
                Award ID: MR/N01104X/1 and MR/N01104X/2
                Award Recipient :
                Funded by: ESRC
                Award ID: ES/S008349/1
                Award Recipient :
                Funded by: ESRC
                Award ID: ES/S008349/1
                Award Recipient :
                Funded by: ESRC
                Award ID: ES/S008349/1
                Award Recipient :
                Funded by: ESRC
                Award ID: ES/S008349/1
                Award Recipient :
                Funded by: ESRC
                Award ID: ES/S008349/1
                Award Recipient :
                Funded by: EU Horizon 2020 programme
                Award ID: 824989
                Award Recipient :
                Funded by: EU Horizon 2020 programme
                Award ID: 824989
                Award Recipient :
                Funded by: EU Horizon 2020 programme
                Award ID: 824989
                Award Recipient :
                This work was supported by the Australian Government through the Medical Research Future Fund, as part of the Genomics Health Futures Mission (Grant number 76749 - DV). We are grateful for funding support from ESRC, MRC and Wellcome Trust (METADAC, Grant agreements MR/N01104X/1, ES/S008349/1, MR/N01104X/2, 213422/Z/18/Z - MJM, MB, JC, JTM, MM, SJR; 206194 - CP) and the EU Horizon 2020 programme (EUCAN-connect, Grant agreement ID: 824989 - MJM, MB, JTM, MM), and the Canada Research Chair in Law and Medicine; Genome Quebec; Genome Canada (BMK); Canada Institute of Health Research (BMK), the NIH (Grants HL143295, TR003201 - RG), the Franca Fund (RG) and Biobank Norway funded by The Research Council of Norway < https://www.forskningsradet.no/en/>, (grant number 296162/F50 – IBL). We acknowledge Can-SHARE Connect (2019-2020): Supporting the Regulatory and Ethics Work Stream of the Global Alliance for Genomics and Health_GA4GH.
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