Research participants struggle to understand test results
Åsa Grauman, PhD student at the Centre for Research Ethics & Bioethics, asked people who participated in the large SCAPIS study how they perceived the test results they received after taking part in the project. They value the health screening, but identify shortcomings in the communication of test results.
The SCAPIS (Swedish CArdioPulmonary bioImage Study) research programme is a population study involving extensive measurements of 30,000 Swedes aged 50–64. The aim of the project is to find risk markers that allow prediction of who is at risk of cardiopulmonary disease, and prevention of this disease before it occurs. The study is a collaboration among six university hospitals in Sweden, funded primarily by the Swedish Heart-Lung Foundation.
People aged 50-65 need health screenings. Both to bring attention to their risk levels and to detect risk factors in time, before the strike of a heart attack. SCAPIS participants went through thorough health examinations, with both ultrasound and x-rays used to detect signs of cardiovascular disease. After, they received a written report of selected test results.
Åsa Grauman, PhD student at CRB, examined how participants perceived the test results, how test results influenced their lives and their perceptions of the risk of cardiovascular disease.
"People often rely on our general health level and bodily symptoms when they are assessing their risk of heart infarction. This is a bad idea. Risk factors, such as high blood pressure and high cholesterol levels show no symptoms, and arteriosclerosis is silent. The first symptoms of cardiovascular disease can be very serious, or even deadly", says Åsa Grauman.
Test results from SCAPIS did not contain enough information to increase participants’ knowledge of their own cardiovascular risk. The report provided no guidance on how to decrease the risk. If participants had an increased risk of cardiovascular disease, they were referred to a primary or secondary care provider. All participants received a report with selected test results. In an article recently published in Patient Education and Counselling, Åsa Grauman describes how participants had difficulties interpreting the report.
"For example, some were concerned about the test results from the coronary angiography. They did not understand what they meant, what was normal and what was not", Åsa Grauman explains.
SCAPIS participants who partook in Åsa Grauman’s study describe that if the report had been a total assessment of their health, and not a presentation of separate test results, this would have helped their understanding.
Many factors contribute to the total risk of cardiovascular disease. Lifestyle is particularly important. However, participants were inclined to simplify the causal relationships. They spoke in terms of either/or, and attributed heart attacks to individual causes, such as either genetics or stress levels. Heredity was a major factor in the participants' perceived risk of cardiovascular disease.
The participants who found out they were at risk, with coronary stenosis or heightened cholesterol levels, were grateful for this opportunity. They could now be treated, and they felt safe in healthcare hands. Sometimes, finding out they were at risk was a motivation for lifestyle change.
"It was a sign they “had not done enough”. Participants with “normal” test results experienced something similar. Their lifestyle was “good” and there was no need for improvement. Test results was proof that their current lifestyle would not cause cardiovascular disease. This positive interpretation could give a false assurance. Running the risk of continuing bad habits that can increase the risk of heart infarction, simply because these habits have not resulted in clinical findings yet", says Åsa Grauman.
Despite the flawed communication of test results, SCAPIS participants valued the health screening. They realised that as they age, they need more frequent health screenings. From SCAPIS, they got the opportunity to discover health risks early, an opportunity to fix them and a confirmation that their health was under control. And they got the opportunity to prevent future heart infarctions.
Grauman, Å., Hansson, M., James, S., Veldwijk, J., Höglund, A. (2019). Exploring research participants’ perceptions of cardiovascular risk information – room for improvement and empowerment. Patient Education and Counselling (Avaliable online) doi: 10.1016/j.pec.2019.03.010
More news from CRB
We’re looking for a PhD student in bioethics for a project on dietary advice and nutrition!
Uppsala University’s Centre for Research Ethics & Bioethics is looking for a doctoral student in bioethics, focusing on nutrition and dietary advice. The position is within Uppsala University’s graduate programme in medical humanities. Application deadline 7 October! Swedish required.
New list of 50 questionable bioethics journals
Predatory journals are a problem in all academic fields. For several years now, the CRB Ethics Blog has published a list of where not to publish in bioethics. And now, the 2022 list is available! The list includes 50 journals which are potentially predatory or whose quality of publications would deem them unacceptable to publish in. The article also includes resources listing high quality bioethics journals, as well as links to guidelines on ways to identify that a journal might be predatory or questionable.
Are you our new communications officer?
Our centre is a multidisciplinary research environment with a clear communications profile. We lead the communications work in several international research projects and run two research blogs. We are looking for a driven writer, who likes teamwork and appreciates high tempo. You will be working in projects, producing content for web, social media and newsletters, to fit different project channels.
Responsibility key to implementing guidelines for treating disorders of consciousness
A disorder of consciousness is a state where consciousness has been affected by devastating damage to the brain. The diagnosis and health care of patients suffering from these disorders raise several clinical as well as ethical issues. And researchers are still looking for ways to solve them. Recent guidelines, European and American, offer important recommendations for improving both diagnosis and treatment for this patients group. But according to Michele Farisco and Arleen Salles, there is still some challenges to overcome. Ethical as well as practical.
We’re hiring! Looking for a PhD student in medical ethics
Uppsala University’s Centre for Research Ethics & Bioethics is looking for a PhD student for a project on the ethical foundations for assessment of severity as a priority criterion in health care. Swedish required, apply before 22 April!
Indicators and criteria of consciousness for behaviourally unresponsive patients
Identifying and quantifying residual consciousness in patients with disorders of consciousness is notoriously challenging but increasingly urgent. There is a high rate of misdiagnosis among patients suffering from these disorders, particularly between vegetative states/unresponsive wakefulness syndrome and minimally conscious states. A recent BMC Medical Ethics publication explores how operational indicators previously introduced to assess consciousness in non-human animals and artificial intelligence can be relevant and have an ethical impact on the diagnosis and care of patients with disorders of consciousness.
The neuroethics contribution to AI ethics and regulation
The AI ethics research field is growing rapidly. So is the number of guidelines issued to provide operational recommendations to manage the ethical issues raised by AI design, development and implementation. In a recent Neuroethics publication, Michele Farisco, Kathinka Evers and Arleen Salles suggest some of the applied issues covered by these guidelines can in fact be properly assessed only on the basis of a preliminary conceptual analysis. And that embracing neuroethical methodology can help tackle the practical ethical challenges of AI.
Empirical ethics to explore the acceptability of AI in healthcare
Breast cancer is the leading cause of cancer-related death among women worldwide. Early detection is key for successful treatment and researchers are now exploring how artificial intelligence (AI) can be used to interpret mammogram scans. As part of the newly launched project AICare, Uppsala University’s Centre for Research Ethics & Bioethics are using empirical research to support ethical discussion about using AI-based tools in the health care system.
Being at risk for heart disease affects perceived importance of own risk factors
How someone understands an illness also affects their attitudes to taking preventive action. A recent study investigated how Swedes aged 40 to 70 perceive the cause of heart infarctions and their beliefs about how much they can influence their own personal risk. Results show a high level of awareness among the participants about the causal impact of risk factors such as obesity, hypertension, smoking, and lack of exercise, on heart disease. However, people having those risk factors were less convinced about the casual link between their own risk factor and having a heart attack.
New professor "I want to vitalise research in clinical medical ethics"
On 1 February 2022, Niklas Juth joins the Department of Public Health & Carin Sciences and the Centre for Research Ethics & Bioethics in his new role as professor in medical ehics. With the ambition to vitalise research in clinical medical ethics.
Niklas Juth new chair in Medical Ethics at Uppsala University & Region Uppsala
The health care system is dealing with ethical dilemmas on a daily basis. Both in relation to diagnosis and treatment, and issues that concern access to care and health care organisation. Medical ethics is a priority for Uppsala University and Region Uppsala, who together have established a chair in Medical Ethics at the Department of Public Health and Caring Sciences. The new professor will also be involved in work at the Centre for Research Ethics & Bioethics. On 1 February 2022, the position will be filled by Niklas Juth, who will work together with the region and Faculty of medicine to develop our approaches to medical ethics.
Anna T. Höglund new professor in Care Ethics
The asymmetrical relationship between patients and health care professionals raises ethical concern: Bringing the ethics of nursing and care to the fore in health care settings. On 1 December 2021, Anna T. Höglund was promoted to Professor in Care Ethics and Gender Studies, strengthening our profile on clinical ethical issues.
Policy brief on fighting antibiotic resistance
Antibiotic resistance is a global threat to health and development. But the way we behave can either slow this process down or speed it up. Antibiotic resistance is a collective problem. It is also a shared responsibility. And it is not limited to medical antibiotic use. Whether it is choices made in the dairy aisle or by ensuring vaccinations are up-to-date before travelling, the effectiveness of our efforts to to curb antibiotic resistance will depend on our behaviour.
Scientific evidence for treatment of resignation syndrome
Resignation syndrome affects children and adolescents who seek asylum in Sweden. In a study of 13 children suffering from the condition, researchers found that those who were separated from the rest of their family recovered. Being issued a residence permit was not necessary for their recovery. The results of this study were published in European Child & Adolescent Psychiatry.
Screen4Care: Accelerating Diagnosis for Rare Disease Patients Through Genetic Newborn Screening & AI
Today an international public-private consortium of 35 partners announced the launch of Screen4Care – a research project that aims to significantly shorten the time required for rare disease diagnosis and efficient intervention by utilising genetic newborn screening and advanced analysis methods such as machine learning. The project will run for a period of five years with a total budget of EUR 25 million provided by the Innovative Medicines Initiative (IMI 2 JU), a joint undertaking of the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA).
European Academic Integrity Week 2021
To support the occasion of the Global Ethics Day 2021 on Wednesday 20 October 2021, ENAI together with Uppsala University has organised European Academic Integrity Week 2021 (EAIW) which takes place from 18 October to 22 October 2021. European Academic Integrity Week 2021 will be celebrated in the same way as last year: With a series of lunch-time webinars, starting at 12:00 CEST, each lasting 90 minutes. There will be no webinar on Wednesday as this day will be free for your national or institutional activities. The webinars are free and everybody is welcome to register!
Many underestimate their own risk of cardiovascular disease
The Swedish public is becoming increasingly sedentary and are exercising less and less. At the same time, two million Swedes live with cardiovascular disease, which is the leading cause of death in Sweden. Still, the results from a study based on findings from the Swedish Cardiopulmonary Bioimage Study, or SCAPIS for short, show one in three underestimates their risk of developing cardiovascular disease. Research supported by the Swedish Heart Lung Foundation: Hjärt-Lungfonden.
7 medical faculties agree on compulsory research ethics course
Sweden's seven medical faculties in Sweden have agreed that their staff should take a course in research ethics. All new employees who do research or teach within the Disciplinary Domain of Medicine and Pharmacy that are employed for at least a year will take a course in research ethics during their first year at Uppsala university.
YouTube videos about clinical trials for children with cancer fall short
Parents of children with cancer sometimes look for information about clinical trials on the internet. We know very little about what they find. In a recent study, researchers from Uppsala University’s Centre for research ethics & bioethics analyse the content, quality and reliability of YouTube videos about such clinical trials. It turns out potential benefits are largely overrepresented. While risks are mentioned in passing or not at all.
51 percent of researchers sometimes cheat
A recent study shows 51% of researchers in the Netherlands are occasionally guilty of questionable research practices. Some by being insufficient as mentors or supervisors, others by only citing research that supports their own findings. 8% are guilty of misconduct, like fabricating or manipulating results. This is alarming, says Stefan Eriksson, Director of Uppsala University’s Centre for research ethics & bioethics.
When are we willing to share our health data?
The health care system, research projects, and authorities, as well as many companies, depend on people sharing their health data digitally. In a recent study, Jennifer Viberg Johansson and her co-authors examine under which circumstances people are willing to share such information.
Policy brief: Informing the public about cardiovascular risk
Any health care interventions should be made after careful consideration of the benefits and risks for the individual. But experts and the general public sometimes have different views on what the benefit actually is. By examining which groups benefit from health care efforts, they can be directed towards particularly vulnerable groups and individuals. In a newly issued policy brief, Åsa Grauman reveals her recommendations for how best to inform the public about cardiovascular risk.
Full time position to look at preferences for newborn genetic screening
We are looking for a full time researcher to investigate the preferences that parents and healthcare professionals have in relation to screening and genetic testing of newborns. This is a full time position for two years, based at the centre, but working in an international research project. Application deadline 19 July 2021.
Bringing patients' views into medical approvals
Patients want to have a say in decisions that affect their health. But decision-makers have not had the tools to listen. Patient preference studies offers just that: a tool for decision-makers to collect, and for patients to give, representative and well-informed input. Karin Schölin Bywall’s dissertation reveals when and how including patient preferences in regulatory decision-making.
One in three underestimate their risk of heart infarction
One in three underestimate their own risk of cardiovascular disease. Many are good at understanding risks and risk factors when they pertain to other people. A recent study reveals that when it comes to our own risk, many of us appear to have a blind spot. In an interview, Åsa Grauman reveals how this finding could help improve risk communication in health care.
Looking for new preference studies postdoc!
We are looking for a postdoc researcher to work on an international project looking at parents' and health care professionals' preferences for screening and genetic testing for rare diseases in newborn children. And for attempting to identify patients by looking at the symptoms listed in their medical records using an algorithm. How this information is perceived will be explored using an instrument to measure Empowerment. Application deadline 12 July 2021!
Do educational tools influence what patients prefer?
Stakeholders across the medical product life cycle are eager to find out what patients prefer. From the pharmaceutical companies that develop new treatments, to the authorities that decide if they should become available to patients, and at what price. But to be useful in decision-making, the patient preferences collected need to be informed. A recent Patient Education and Counseling publication explores the use of educational tools in patient preference studies, and finds that sometimes, they influence patients’ preferences.
Fighting antibiotic resistance: We can do better!
In the shadow of the corona pandemic lurks the next global health crisis. Antibiotic resistance is one of the biggest threats to global health, food security, and development today and can affect anyone, of any age, in any country. Although antibiotic resistance is something that can happen regardless of what we do, unnecessary use of antibiotics is speeding up the process. On March 15, Mirko Ancillotti will defend his thesis. His research is an in-depth look at why we use antibiotics responsibly, why we sometimes do not, and what encourages us to do better.
Launch of EU Research Project “ENLIGHTENme”: Exploring the Impact of Urban Lighting on Health and Wellbeing
An interdisciplinary consortium of 22 partners will perform in-depth studies in three European cities to develop innovative, evidence-based policies to improve citizens’ quality of life addressing indoor and outdoor lighting. Our Deborah Mascalzoni will contribute her expertise in research ethics and bioethics.
Are you our new Professor of Medical Ethics?
Medical ethics is an interdisciplinary subject of research and education that critically, analytically and empirically studies the ethical and moral aspects of biomedical research and clinical practice. Speak Swedish well enough to teach? We are looking for a new Professor of Medical Ethics to strenghten our clincal research profile. Application deadline 31 March 2020!
Neurotwin: New European project proposes a novel therapy for Alzheimer’s disease
Neurotwin is a new 48-month EIC Pathfinder project initiated in January 2021 that will develop hybrid brain models able to represent the effects of non-invasive electrical brain stimulation appropriate in the context of large-scale connectivity alterations and oscillatory deficits that are characteristic to some of the brain disorders, such as Alzheimer’s disease. Uppsala University’s Centre for Research Ethics & Bioethics (CRB) leads the ethics and philosophy component of the project.
No data, no policy: New project promotes gender equality action in seven European research institutions
A new European research project prepares the ground for structural changes to promote gender equality in public and private research organisations. Led by the University of Turin, the four-year MINDtheGEPs project will identify good practice and help shape measures to reduce gender imbalances in seven research institutions and generate data to support the development of national and European policy for gender equality in research performing organisations. Uppsala University’s Centre for Research Ethics & Bioethics (CRB) contributes communications expertise, working together with Elsevier to support impact through communications and dissemination strategies for the project.
Season's Greetings from CRB
2020 was not what we expected. We are happy to have contributed expertise and skill to inform the discussion on vaccines and ethical guidance for intensive care. Now we look forward to new projects, new publications, new collaborations and a happy new 2021!! Want to stay connected? Follow our work on the Ethics Blog!
Pandemic – decision-making, communication & vaccination: See you at Smer’s ethics day 2020!
Ethical dilemmas are part of preparing for pandemics, and part of fighting contagion. The Swedish National Council on Medical Ethic’s (Smer) Ethics Day 2020 will consist of three webinars, all focusing on pandemics. Our Jessica Nihlén Fahlquist will participate in a panel discussion on vaccines against Covid-19.
Ethical, social and psychological impacts of genomic risk communication
Biomedical research is constantly finding new ways to detect genetic variation and link the findings to diseases and to the effects of various drug treatments. The amount of information that it produces keeps increasing, but we are still not sure how to manage it. Researchers who took part in the six-year Mind the Risk project coordinated from the Centre for Research Ethics & Bioethics have published their findings in an anthology focussed on genetic risk communication.
Academic integrity series for European Academic Integrity Week
We are hosting four lunch webinars in association with European Network for Academic Integrity during European Academic Integrity Week, 19-23 October. One for each day of the week except Wednesday the 21st, Global Ethics Day, when we are encouraging everyone to organise events at their home organisations.
New way to tailor treatment of acute myologic leukaemia
Using biomedical analyses, a new algorithm and integrating patient preferences, researchers in Italy, Spain, France, Germany, Finland, and Sweden will spend 3 years developing new treatments for acute myologic leukaemia, a cancer type of cancer where personalised treatment has not previously been available.
Culturally shaping developing minds
Are we socially steering evolution by influencing the cultural imprints to be stored in our brains? Recent neuroscientific findings would say so. In a recent paper, Kathinka Evers discusses the potential of being ‘epigenetically proactive’ and adapting our social structures to benefit brain development.
Space, time: bridging the epistemic gap of brain & mind
How do we become ourselves? How does neuronal activity turn into consciousness and the self? One of nature’s great scientific mysteries is the ‘common currency’ of brain and mind. Georg Northoff, Soren Wainio-Theberge and Kathinka Evers suggest looking for a ‘Spatiotemporal Neuroscience’ to dissolve the brain-mind puzzle.
Corona vaccine(s) should not be a race to the finish line
A brand new virus, the first pandemic in modern time, and in January or February 2021, we are expecting vaccine approvals. It has been a year, but is that enough? What might the consequences be of this race to the finish line? Jessica Nihlén Fahlquist, associate professor and lecturer at Uppsala University’s Centre for Research Ethics & Bioethics, spoke to Radio Sweden and raised her concerns about a race to the finish line.
Genomic data sharing requires public trust
Genomics research relies on the ability for clinicians, and researchers to share genetic data with each other across the world. The largest ever survey on global public attitudes towards genomic research and data sharing was just published in American Journal of Human Genetics. Lack of trust in who data is shared with could significantly hinder genomic research. With less than half of the respondents saying they would be happy for their genetic information to be shared for more than one purpose, the results send a call to action for the genomic research community to build public trust.
Russian vaccine development raises important questions about transparency and trust
The Russian Covid-19 vaccine and the lack of transparency of the research about it could have a negative impact on the public’s perception of vaccines, and their trust in government authorities. But it also raises other important questions, such as how we should deal with research from less democratic countries?
Working and living during the Covid-19 crisis: recommendations from the Human Brain Project
The Covid-19 pandemic has changed the wat we work and live, moving much of it online. But how do we make sure that digital works is successful, and becomes a valuable experience? In a recent issue of the Journal of Responsible Technology, the Human Brain Project’s Karin Grasenick and Manuel Guerrero writes about responsible research and innovation and digital inclusiveness during the Covid-19 crisis and the I-Include initiative.
Ethical choices in a pandemic
During the coronavirus pandemic, many ethical questions come to the fore. How should care services prioritise among severely ill patients? And how far should the rights of individuals be restricted? There are various ethical perspectives, think Anna T Höglund and Jessica Nihlén Fahlquist, researchers at the Centre for Research Ethics and Bioethics (CRB) in Uppsala.
Cancer treatment no better in clinical trials
Many belive cancer patients who take part in clinical trials receive better treatment than others. A recent study from researchers at Uppsala University, published in BMC Cancer, pokes a hole in that theory. The authors, concluding that there is no quality evidence to support the idea that patients who participate in clinical trials have better outcomes.
What demands can we place on physicians during the COVID-crisis?
Physicians have a responsibility to protect patients’ autonomy, do no harm, to do good and to divide resources fairly. But how these ethical principles are interpreted in practice can differ from physician to physicians. For whom are they supposed to do good, for example? For the patient, a patient group or society as a whole? With limited resources and large demand, these questions are more crucial than ever. And different interpretation can create conflict.
Research podcast on ethical crossroads in a pandemic
The corona pandemic brings a lot of ethical issues to the fore. For example about priorities in the health care system, or limiting individual's rights to protect those that are vulnerable. Episode 47 of Uppsala University’s' "Forskarpodden" talks about public health ethics with CRB's Anna T. Höglund and Jessica Nihlén Fahlquist (in Swedish).
What should we eat? An ethical framework for well-grounded food choices
Being an ethically aware consumer today is difficult. Partly because there are so many aspects to take into account, and partly because it is difficult to find trustworthy and reliable information to base your food choices on. But that does not mean there is no point in thinking about what could constitute an ethical choice of food. Anna T. Höglund explores ethical food choices in a recent publication.
Swedish obstetric routines changed after criticized study: Too soon?
Decisions to induce prolonged pregnancies in week 41 instead of 42 were made in two Swedish healthcare regions as a result of the Swepis study. Now, the study is facing criticism. External researchers are critical to conclusions drawn by the authors and that clinical routines have changed before the study has been reviewed in its entirety.
Governance and ethics of health care in focus
Governance and ethics was the theme at the Swedish National Council on Medical Ethics' Ethics Day 2019. Among the presenters was Anna T. Höglund, associate professor of ethics at the Centre for Research Ethics & Bioethics at Uppsala University. Together with Erika Falkenström, she presented on the subject of "Ethics in policy and governance: What ethical competence do health care decision-makers need?".