Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research
Open accessAbstract
With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: (1) Address the role of history and experience on trust, (2) engage concerns about potential group harm, (3) address cultural values and communication barriers, and (4) integrate patient values and expectations into oversight and governance structures.
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An African American participant feared being put into a certain racially determined category because of genetic information which is much more present in that specific ethnic group.
“In a qualitative study, an African American participant explained this more precisely: this participant feared being put into a certain racially determined category because of genetic information which is much more present in that specific ethnic group [98].”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
In Results, under “Overview: Building a trustworthy research enterprise” (page unavailable), an African American participant worries that research will place people in racially determined “bubbles” with different paths based on ethnicity. The passage does not say that the participant feared categorization because particular genetic information is much more prevalent in their ethnic group. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAmong patients there is also a high readiness to participate in trials and donate data or biospecimens.
“Among patients there is also a high readiness to participate in trials and donate data or biospecimens [62, 70, 72, 76, 77, 98, 99], but trust in professionals [98, 101], costs, receiving counseling about test results and privacy [101], as well as the donor’s religion and culture [98] seem to be important for the decision.”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
The Results (Overview: Building a trustworthy research enterprise; page unavailable) report general willingness among focus-group participants to contribute data and biospecimens, subject to informed consent. They do not establish high readiness among patients generally to participate in trials; the Discussion (Strengths and limitations; page unavailable) cautions that the focus-group findings are not generalizable to the broader U.S. population. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome patients mention the hacking of financial or online data and emphasize the need for harsh penalties as an indication that data security cannot be guaranteed.
“As an indication that data security cannot be guaranteed, some patients mention the hacking of financial or online data and emphasize the need for harsh penalties [98].”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Many patients would prefer to have the right to withdraw their consent at any time of the study.
“Many would therefore prefer to have the right to withdraw their consent at any time of the study [98].”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Patients from different ethnic groups express skepticism about the consent process and are suspicious about whether all consented rules are actually followed.
“With regard to participation in research, patients from different ethnic groups express skepticism about the consent process and are suspicious about whether all consented rules are actually followed.”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Although there is generally a high willingness among patients to donate data and biospecimens for precision medicine research, one study also suggests that patients expect a corresponding countervalue when pharmaceutical companies earn large sums of money from drug development that was made possible by patients' donations.
“Although there is generally a high willingness among patients to donate data and biospecimens for precision medicine research, one study also suggests that patients expect a corresponding countervalue when pharmaceutical companies earn large sums of money from drug development that was made possible by patients' donations.”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Some participants in the study argued that if biospecimens contributes to corporate profit, patients should be compensated.
“Some participants in the study argued that if biospecimens contributes to corporate profit, patients should be compensated [98, 115].”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Trust in professionals, costs, receiving counseling about test results and privacy, as well as the donor's religion and culture seem to be important for the decision to participate in trials and donate data or biospecimens.
“Among patients there is also a high readiness to participate in trials and donate data or biospecimens [62, 70, 72, 76, 77, 98, 99], but trust in professionals [98, 101], costs, receiving counseling about test results and privacy [101], as well as the donor’s religion and culture [98] seem to be important for the decision.”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Some people would like to be compensated for their donation if pharmaceutical companies gain a high profit with it.
“Nevertheless, some people would like to be compensated for their donation if pharmaceutical companies gain a high profit with it [98, 115].”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
Some patients also worry that if a drug is not prescribed frequently enough, pharmaceutical companies will raise the price or stop its production.
“Some patients also worry that if a drug is not prescribed frequently enough, pharmaceutical companies will raise the price or stop its production [98].”
From Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis (2021) · cites this paper as [98]
The Results section (‘Patients fear inappropriate data use’; page unavailable) reports concerns about pharmaceutical companies developing costly treatments, but not about prices rising or production stopping when a drug is prescribed infrequently. Searches for infrequent prescribing, price increases, and discontinued production found no passage addressing that concern. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Kraft, S. A., Cho, M. K., Gillespie, K., Halley, M., Varsava, N., Ormond, K. E., Luft, H. S., Wilfond, B. S., & Lee, S. S.-J.
- Affiliations
- Seattle Children's Research Institute (US)
- Stanford University (US)
- Palo Alto Medical Foundation (US)
- Corresponding author
- Kraft, Stephanie A.
- ORCID
- Venue
- The American Journal of Bioethics
- Publisher
- Informa UK Limited
- Published
- 2018-04-03
- Volume
- 18
- Issue
- 4
- Pages
- 3-20
- ISSN
- 1526-5161 (ISSN-L)
- 1536-0075
- PMC
- PMC6173191
- OpenAlex
- W2796040354
- Cited by
- 271
- References
- 4
- Citations by year
- 2026: 24 · 2025: 33 · 2024: 27 · 2023: 56 · 2022: 28 · 2021: 36 · 2020: 30 · 2019: 14 · 2018: 23
- FWCI
- 24.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Bioethics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- Palo Alto Medical Foundation
- U.S. National Library of Medicine (R01LM012180)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
- Keywords
- patient trust, research consent, health data research, institutional trustworthiness, cultural values, communication barriers, research governance
- MeSH terms
- Respect, Communication, Community-Institutional Relations, Data Collection, Ethnicity, Humans, Informed Consent, Patient Participation, Research Personnel, Residence Characteristics, Focus Groups, Biological Specimen Banks, Patient Selection, Ethics, Research, Trust, Biomedical Research, Genetic Research, Racial Groups, Precision Medicine
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