Genetic research and testing in critical care: surrogates' perspective.
OBJECTIVE
Genetic testing is increasingly a component of clinical research in critical illness and has potential for integration into routine care. This study explored the perspectives of surrogate decision-makers (SDMs) for acutely ill patients with respect to social, legal, and ethical aspects of genetic testing.


METHODS
Medical and surgical intensive care units in an urban tertiary care hospital.


METHODS
Questionnaires administered to SDMs for critically ill patients over a 12-month period.


RESULTS
A majority of eligible SDMs participated (117/146; 80.8%). SDMs were more likely to permit genetic testing for purposes of diagnosing a treatable life-threatening disease (114/117; 97.4%) or chronic disease (111/117; 94.9%) than for an untreatable life-threatening illness (95/117; 81.2%) (p < .001). SDMs were receptive to testing to explain familial traits (112/117; 95.7%) or ethnic traits (105/117; 89.7%) (p = .131). SDMs were concerned about potential for economic discrimination, with a majority expressing reluctance to permit testing if employers (93/117; 79.5%), health insurers (90/117; 76.9%), or life insurers (92/117; 78.6%) could access results. There was a greater willingness to allow participation in studies in which data were collected anonymously (90/117; 76.9%) vs. nonanonymously (75/117; 64.1%) (p = .04). Finally, SDMs placed greater trust in universities and nonprofit organizations (107/117; 91.4%) than either the federal government (75/117; 64.1%) or pharmaceutical companies (46/117; 39.3%) to perform genetic research (p < .01).


CONCLUSIONS
SDMs expressed concerns regarding economic discrimination, confidentiality of data, and trust in entities conducting clinical investigation that may represent barriers both to performing studies in which genetic information is collected and to implementation of gene-based technologies in the critical care environment.
Freeman
Bradley D
BD
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Kennedy
Carie R
CR
Coopersmith
Craig M
CM
Zehnbauer
Barbara A
BA
Buchman
Timothy G
TG
D035843:Biomedical Research / Q000941:ethics*; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D005820:Genetic Testing / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D020458:Third-Party Consent / Q000941:ethics*