Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts (December 2013 Report of the Presidential Commission for the Study of Bioethical Issues)

TLDR

Genomic population research raises the possibility of incidental genetic anomalies that may affect participants’ current and future medical care. The report recommends that researchers anticipate incidental findings and develop plans specifying which results will be communicated to participants. A protocol‑by‑protocol approach, with return‑of‑results discussions included in consent agreements and IRB submissions, is suggested to guide investigators and IRBs. Adopting these recommendations will disrupt investigators and IRBs until consensus is reached on which results should be returned.

Abstract

Genomic population research increases the possibility of finding genetic coding anomalies that are not the primary object of research but may have significance for the current and future medical care of research participants and progeny. The December 2013 Report of the Presidential Commission for the Study of Bioethical Issues (Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts (http://bioethics.gov/sites/default/files/FINALAnticipateCommunicate_PCSBI_0.pdf)) recommends that a researcher anticipate these findings and make a plan that addresses which findings will be communicated to research participants and how. Following these recommendations will be disruptive for both investigators and institutional review boards (IRBs) until the research community reaches consensus, or a mechanism for evolving consensus, on which results should be returned to research participants. A protocol-by-protocol approach, though laborious, makes sense for both investigators and IRBs as the research community thinks through the implications of genomic research. Epidemiologists will note that discussion of the return of results and the plan for communicating findings should be included in both the participant consent agreement and the research protocol submitted to the IRB.