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Approaching confidentiality at a familial level in genomic medicine: a focus group study with healthcare professionals
  1. Sandi Dheensa1,
  2. Angela Fenwick1,
  3. Anneke Lucassen1,2
  1. 1Faculty of Medicine, Clinical Ethics and Law, University of Southampton, Southampton General Hospital, Southampton, UK
  2. 2Wessex Clinical Genetics Service, Princess Anne Hospital, University Hospitals Southampton Foundation Trust, Southampton, UK
  1. Correspondence to Dr Sandi Dheensa; s.dheensa{at}soton.ac.uk

Abstract

Objectives Clinical genetics guidelines from 2011 conceptualise genetic information as confidential to families, not individuals. The normative consequence of this is that the family's interest is the primary consideration and genetic information is shared unless there are good reasons not to do so. We investigated healthcare professionals' (HCPs') views about, and reasoning around, individual and familial approaches to confidentiality and how such views influenced their practice.

Method 16 focus groups with 80 HCPs working in/with clinical genetics services were analysed, drawing on grounded theory.

Results Participants raised seven problems with, and arguments against, going beyond the individual approach to confidentiality. These problems fell into two overlapping categories: ‘relationships’ and ‘structures’. Most participants had never considered ways to—or thought it was impossible to—treat familial genetic information and personal information differently. They worried that putting the familial approach into practice could disrupt family dynamics and erode patient trust in the health service. They also thought they had insufficient resources to share information and feared that sharing might change the standard of care and make them more vulnerable to liability.

Conclusions A familial approach to confidentiality has not been accepted or adopted as a standard, but wider research suggests that some of the problems HCPs perceived are surmountable and sharing in the interest of the family can be achieved. However, further research is needed to explore how personal and familial genetic information can be separated in practice. Our findings are relevant to HCPs across health services who are starting to use genome tests as part of their routine investigations.

  • MEDICAL ETHICS
  • GENETICS
  • QUALITATIVE RESEARCH

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Twitter Follow Sandi Dheensa @sandi_dheensa

  • Contributors SD conducted the focus groups and led on data analysis and writing the manuscript. AL and AF facilitated data analysis and provided critical feedback on several drafts of the manuscript. AL co-authored the original papers about the joint account approach that framed this work.

  • Funding This work was supported by the Wellcome Trust: grant number 110486/Z/15/Z.

  • Competing interests None declared.

  • Ethics approval Approved by Hampshire B NRES committee south central (13/SC/0041) on 25/02/13.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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