Alternatives to project-specific consent for access to personal information for health research: Insights from a public dialogue
1 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
2 Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Canada
3 School of Nursing, McMaster University, Hamilton, Canada
4 Department of Philosophy, McMaster University, Hamilton, Canada
5 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
6 Institute for Social Research, York University, Toronto, Canada
7 Biostatistics Unit, St. Joseph's Healthcare, Hamilton, Canada
BMC Medical Ethics 2008, 9:18 doi:10.1186/1472-6939-9-18Published: 19 November 2008
The role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.
We conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.
Broad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.
Because no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research.