Managing Incidental Findings in the Genomic Era

Disclosing the prospect or discovery of genomic IFs to clinical patients or prospective research subjects is an area fraught with ethical, legal, social, and practical challenges. These challenges are being magnified with the advent of Genome Wide Association Studies (GWAS) and Chromosomal Microarray Analysis (CMA). The potential for identifying IFs and how this potential should be addressed for GWAS, CMA, and other genomic research and clinical applications is a novel prospect with which researchers, clinicians, research subjects, patients, and policy makers have limited experience. The Purpose of this research is to examine how the prospect of IFs is addressed in the context of GWAS and CMA, and to identify key areas for future research and consideration in the longer-term effort to promote ethically, legally, and socially sound policies and best practices for the management of genomic IFs. The Specific Aims of the research project are to: 1) examine how the prospect of genomic IFs is currently articulated in patient education and informed consent materials in research and related clinical application; 2) determine how the issues surrounding genomic IFs are defined and how they would preferably be handled from the perspectives of: a) health professionals, including clinicians working with genomic technologies and investigators conducting genomic research; b) IRBs, including IRB Chairs potentially involved in the review of genomic protocols or protocols making use of genomic tools such as CMA; and c) diverse members of the public, including representatives of different ethnic, cultural and religious groups, and parents of children who have had CMA testing; 3) synthesize data from Aims 1 and 2 into a model taxonomy of genomic IF issues and stakeholder preferences and perceptions that has the potential to support decisions regarding disclosure and discovery of IFs in genomic testing and research; and, 4) disseminate the taxonomy to stakeholder groups for their assessment of its utility in weighing factors affecting decisions regarding disclosure of IFs in genomic testing and their identification of priorities relevant to issues surrounding IFs in genomic research and clinical practice. Data will be obtained and analyzed from surveys and interview with researchers using GWAS, clinicians using CMA, and a cross section of public stakeholders. Baseline data here will be highly valuable in terms of identifying possible trends and gaps in upfront disclosure of genomic IFs, and will serve as a baseline for recommendations concerning future research and practice guidelines in this area. This research study will be among the first to explore the prospect and discovery of IFs in GWAS and CMA, to generate a taxonomy with the potential to support decision making related to the prospect and discovery of genomic IFs, and to identify opportunities for future research and dialogue in this important area of ethical concern.