The ethics of how to manage incidental findings

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Date: June 10, 2014
Publisher: CMA Impact Inc.
Document Type: Viewpoint essay
Length: 1,430 words
Lexile Measure: 1820L

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Incidental findings are becoming increasingly common as advanced medical technologies are used in research and clinical care. These potentially relevant findings fall outside the primary purpose for conducting a test or procedure. Incidental findings may be anticipated (known to be potentially associated with the test) or unanticipated (not typically associated). Secondary findings are actively sought but not the primary reason for testing.

In Canada, there is relatively little formal ethical guidance to help clinicians and researchers determine their obligations and responsibilities regarding incidental findings, including when it is ethically responsible or required to disclose such findings to patients. Guidance documents for clinicians usually mention the issue only briefly or not at all. Even the latest edition of the Tri-Council Policy Statement, Canada's main ethical guideline concerning research involving humans, has less than half a page on the topic. (1) In the United States, the Presidential Commission for the Study of Bioethical Issues recently issued a 146-page report, "Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts," (2) which will be a useful resource for Canadian physicians and researchers who must make increasingly complex decisions around managing incidental findings. The report describes key considerations that inform management of incidental findings in an excellent analysis of evidence and 17 general and context-specific recommendations.

One important consideration is the potential for either beneficial or harmful consequences to arise for patients and research participants when incidental findings are disclosed and further investigated. Discovery of a life-threatening tumour while imaging a participant in a research study may lead to life-saving surgery that removes the tumour. Conversely, acting on the discovery of an unusual mass found in a research context could lead to burdensome diagnostic workups or follow-ups, harms from medical procedures, anxiety and unnecessary costs, without corresponding benefit to the patient. Since the 1960s, when mammography was first tested in a randomized controlled trial, there has been great enthusiasm for the idea that information from medical tests can prevent disease and reduce mortality. (3) A great number of screening tests are now promoted, with the accompanying imperative to act on incidental findings, which may...

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Gale Document Number: GALE|A371191248