Currently, there is little known about patient preferences on the use of medical records and patient data and the ethical issues related to privacy, confidentiality, informed consent and return of results, particularly in the context of EMRs. In addition, there is a dearth of data on patient preferences for specific governance strategies. This is particularly true of patients who identify with groups underrepresented in medical research. To address this gap, the proposed study will assess patients' preferences for how their clinical data and samples should be accessed, used and managed in the governance of EMRs and biobanking. We will use a mixed methods approach in triangulating data from semi-structured individual interviews, focus groups and a quantitative survey of attitudes of patients from diverse populations. We anticipate that our findings will have direct implications fo policies on data use and sharing by hospitals and clinics, as well as for institutional review boards and researchers.
The specific aims of this research are:
Aim 1 : To assess and compare patient attitudes towards use and governance of clinical data and samples in a racially and ethnically diverse patient population, with an emphasis on: a) perception and weighing of tradeoffs between the risks and benefits; b) preferences for and acceptability of collecting, using and sharing clinical data and samples under boundary conditions; c) attitudes regarding trust and its relationship to governance strategies; d) the reasons for these preferences and attitudes and; e) the factors that contribute to various preferences and attitudes.
Aim 2 : To identify factors associated with attitudes and preferences towards clinical data and sample use, sharing and governance.

Public Health Relevance

While there is a growing body of literature on patient preferences with regards to clinical data use, including attitudes towards privacy, sharing, informed consent and returning individual results of clinical significance, there are still many important unknowns. Our study will provide generalizable data from actual clinical contexts in which to assess the diversity of patient attitudes and preferences regarding research on a range of clinical data types and data sharing. Our diverse sample population allows us to explore the influence of culture ambiguity. We will build on our current work to produce videos in multiple languages that illustrate the different ways that clinical data and samples are collected, used and shared for a variety of purposes. Our study aims to shed light on patients' preferences for policy options and governance processes that go beyond traditional informed consent choices and procedures, and that are applicable to situations of regulatory

National Institute of Health (NIH)
National Library of Medicine (NLM)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Vanbiervliet, Alan
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Stanford University
Schools of Medicine
United States
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Cho, Mildred K; Varsava, Nina; Kraft, Stephanie A et al. (2018) Metaphors matter: from biobank to a library of medical information. Genet Med 20:802-805
Kraft, Stephanie A; Cho, Mildred K; Gillespie, Katherine et al. (2018) Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research. Am J Bioeth 18:3-20
Lee, Sandra S-J; Cho, Mildred K; Kraft, Stephanie A et al. (2018) ""I don't want to be Henrietta Lacks"": diverse patient perspectives on donating biospecimens for precision medicine research. Genet Med :