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Published in: BMC Medical Informatics and Decision Making 1/2018

Open Access 01-12-2018 | Research article

Sharing longitudinal, non-biological birth cohort data: a cross-sectional analysis of parent consent preferences

Authors: Kiran Pohar Manhas, Shawn X. Dodd, Stacey Page, Nicole Letourneau, Carol E. Adair, Xinjie Cui, Suzanne C. Tough

Published in: BMC Medical Informatics and Decision Making | Issue 1/2018

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Abstract

Background

Mandates abound to share publicly-funded research data for reuse, while data platforms continue to emerge to facilitate such reuse. Birth cohorts (BC) involve longitudinal designs, significant sample sizes and rich and deep datasets. Data sharing benefits include more analyses, greater research complexity, increased opportunities for collaboration, amplification of public contributions, and reduced respondent burdens. Sharing BC data involves significant challenges including consent, privacy, access policies, communication, and vulnerability of the child. Research on these issues is available for biological data, but these findings may not extend to BC data. We lack consensus on how best to approach these challenges in consent, privacy, communication and autonomy when sharing BC data. We require more stakeholder engagement to understand perspectives and generate consensus.

Methods

Parents participating in longitudinal birth cohorts completed a web-based survey investigating consent preferences for sharing their, and their child’s, non-biological research data. Results from a previous qualitative inquiry informed survey development, and cognitive interviewing methods (n = 9) were used to improve the question quality and comprehension. Recruitment was via personalized email, with email and phone reminders during the 14-day window for survey completion.

Results

Three hundred and forty-six of 569 parents completed the survey in September 2014 (60.8%). Participants preferred consent processes for data sharing in future independent research that were less-active (i.e. no consent or opt-out). Parents’ consent preferences are associated with their communication preferences. Twenty percent (20.2%) of parents generally agreed that their child should provide consent to continue participating in research at age 12, while 25.6% felt decision-making on sharing non-biological research data should begin at age 18.

Conclusions

These finding reflect the parenting population’s preference for less project-specific permission when research data is non-biological and de-identified and when governance practices are highly detailed and rigourous. Parents recognize that children should become involved in consent for secondary data use, but there is variability regarding when and how involvement occurs. These findings emphasize governance processes and participant notification rather than project-specific consent for secondary use of de-identified, non-biological data. Ultimately, parents prefer general consent processes for sharing de-identified, non-biological research data with ultimate involvement of the child.
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Literature
4.
go back to reference Canadian Institutes of Health Research. CIHR response and action plan - 2011 international review panel recommendations. Ottawa: Government of Canada; 2011. Canadian Institutes of Health Research. CIHR response and action plan - 2011 international review panel recommendations. Ottawa: Government of Canada; 2011.
8.
go back to reference Warren SD, Brandeis LD. The right to privacy. Harv Law Rev. 1890;4(5):193–220.CrossRef Warren SD, Brandeis LD. The right to privacy. Harv Law Rev. 1890;4(5):193–220.CrossRef
9.
10.
go back to reference Solove DJ. A Brief History of Information Privacy Law. In: Mathews KJ, editor. Proskauer on Privacy: A Guide to Privacy and Data Secruity Law in the Information Age. New York: Practising Law Institute; 2006. Solove DJ. A Brief History of Information Privacy Law. In: Mathews KJ, editor. Proskauer on Privacy: A Guide to Privacy and Data Secruity Law in the Information Age. New York: Practising Law Institute; 2006.
11.
go back to reference Solove DJ. HIPAA turns 10: analyzing the past, present, and future impact. J Am Health Inf Manag Assoc. 2013;84:22–8. Solove DJ. HIPAA turns 10: analyzing the past, present, and future impact. J Am Health Inf Manag Assoc. 2013;84:22–8.
12.
go back to reference Service Alberta and the Office of the Information and Privacy Commissioner. A Guide for Businesses and Organizations on the Personal Information and Privacy Act. Edmonton: Service Alberta; 2008. Service Alberta and the Office of the Information and Privacy Commissioner. A Guide for Businesses and Organizations on the Personal Information and Privacy Act. Edmonton: Service Alberta; 2008.
13.
go back to reference Canadian Institutes of Health Research, National Sciences and engineering research council, and Social Sciences and Humanities Research Council of Canada. Tri-Council policy statement: ethical conduct of research involving humans. 2010. Canadian Institutes of Health Research, National Sciences and engineering research council, and Social Sciences and Humanities Research Council of Canada. Tri-Council policy statement: ethical conduct of research involving humans. 2010.
14.
go back to reference Stoddart J, Chan B, Joly Y. The European Union’s adequacy approach to privacy and international data sharing in Health Research. J Law Med Ethics. 2016;44(1):143–55.CrossRef Stoddart J, Chan B, Joly Y. The European Union’s adequacy approach to privacy and international data sharing in Health Research. J Law Med Ethics. 2016;44(1):143–55.CrossRef
15.
go back to reference Caulfield T. Consent, privacy & research biobanks. GenEdit. 2010;1:10–6. Caulfield T. Consent, privacy & research biobanks. GenEdit. 2010;1:10–6.
16.
go back to reference Master Z, Nelson E, Murdoch B, Caulfield T. Biobanks, consent and claims of consensus. Nat Methods. 2012;9(9):885–8.CrossRef Master Z, Nelson E, Murdoch B, Caulfield T. Biobanks, consent and claims of consensus. Nat Methods. 2012;9(9):885–8.CrossRef
17.
go back to reference Golding J, Jones R, Brune MN, Pronczuk J. Why carry out a longitudinal birth survey? Paediatr Perinat Epidemiol. 2009;23(Suppl 1):1–14.CrossRef Golding J, Jones R, Brune MN, Pronczuk J. Why carry out a longitudinal birth survey? Paediatr Perinat Epidemiol. 2009;23(Suppl 1):1–14.CrossRef
18.
go back to reference Ries NM. Growing up as a research subject: ethical and legal issues in birth cohort studies involving genetic research. Health Law J. 2007;15:1–42.PubMed Ries NM. Growing up as a research subject: ethical and legal issues in birth cohort studies involving genetic research. Health Law J. 2007;15:1–42.PubMed
19.
go back to reference Ries NM, LeGrandeur J, Caulfield T. Handling ethical, legal and social issues in birth cohort studies involving genetic research: responses from studies in six countries. BMC Med Ethics. 2010;11:4.CrossRef Ries NM, LeGrandeur J, Caulfield T. Handling ethical, legal and social issues in birth cohort studies involving genetic research: responses from studies in six countries. BMC Med Ethics. 2010;11:4.CrossRef
20.
go back to reference Samuel J, Ries NM, Malkin D, Knoppers BM. Biobanks and longitudinal studies: where are the children? GenEdit. 2008;6(3):1–8. Samuel J, Ries NM, Malkin D, Knoppers BM. Biobanks and longitudinal studies: where are the children? GenEdit. 2008;6(3):1–8.
21.
go back to reference Cambon-Thomsen A, Rial-Sebbag E, Knoppers BM. Trends in ethical and legal frameworks for the use of human biobanks. Eur Respir J. 2007;30(2):373–82.CrossRef Cambon-Thomsen A, Rial-Sebbag E, Knoppers BM. Trends in ethical and legal frameworks for the use of human biobanks. Eur Respir J. 2007;30(2):373–82.CrossRef
22.
go back to reference Laurie G. Reflexive governance in biobanking: on the value of policy led approaches and the need to recognise the limits of law. Hum Genet. 2011;130(3):347–56.CrossRef Laurie G. Reflexive governance in biobanking: on the value of policy led approaches and the need to recognise the limits of law. Hum Genet. 2011;130(3):347–56.CrossRef
23.
go back to reference Knoppers BM, Avard D, Cardinal G, Glass KC. Science and society: children and incompetent adults in genetic research: consent and safeguards. Nat Rev Genet. 2002;3(3):221–5.CrossRef Knoppers BM, Avard D, Cardinal G, Glass KC. Science and society: children and incompetent adults in genetic research: consent and safeguards. Nat Rev Genet. 2002;3(3):221–5.CrossRef
24.
go back to reference Knoppers BM, Saginur M. The babel of genetic data terminology. Nat Biotechnol. 2005;23(8):925–7.CrossRef Knoppers BM, Saginur M. The babel of genetic data terminology. Nat Biotechnol. 2005;23(8):925–7.CrossRef
25.
go back to reference Kosseim P, Dove ES, Baggaley C, Meslin EM, Cate FH, Kaye J, Harris JR, Knoppers BM. Building a data sharing model for global genomic research. Genome Biol. 2014;15(8):430.CrossRef Kosseim P, Dove ES, Baggaley C, Meslin EM, Cate FH, Kaye J, Harris JR, Knoppers BM. Building a data sharing model for global genomic research. Genome Biol. 2014;15(8):430.CrossRef
26.
go back to reference Bertier G, Carrot-Zhang J, Ragoussis V, Joly Y. Integrating precision cancer medicine into healthcare-policy, practice, and research challenges. Genome Med. 2016;8(1):108.CrossRef Bertier G, Carrot-Zhang J, Ragoussis V, Joly Y. Integrating precision cancer medicine into healthcare-policy, practice, and research challenges. Genome Med. 2016;8(1):108.CrossRef
27.
go back to reference Caulfield T, Chandrasekharan S, Joly Y, Cook-Deegan R. Harm, hype and evidence: ELSI research and policy guidance. Genome Med. 2013;5(3):21.CrossRef Caulfield T, Chandrasekharan S, Joly Y, Cook-Deegan R. Harm, hype and evidence: ELSI research and policy guidance. Genome Med. 2013;5(3):21.CrossRef
28.
go back to reference Joly Y, Dove ES, Knoppers BM, Bobrow M, Chalmers D. Data sharing in the post-genomic world: the experience of the international Cancer genome consortium (ICGC) data access compliance office (DACO). PLoS Comput Biol. 2012;8(7):e1002549.CrossRef Joly Y, Dove ES, Knoppers BM, Bobrow M, Chalmers D. Data sharing in the post-genomic world: the experience of the international Cancer genome consortium (ICGC) data access compliance office (DACO). PLoS Comput Biol. 2012;8(7):e1002549.CrossRef
29.
go back to reference Joly Y, Dyke SO, Knoppers BM, Pastinen T. Are data sharing and privacy protection mutually exclusive? Cell. 2016;167(5):1150–4.CrossRef Joly Y, Dyke SO, Knoppers BM, Pastinen T. Are data sharing and privacy protection mutually exclusive? Cell. 2016;167(5):1150–4.CrossRef
30.
go back to reference McGuire AL, Basford M, Dressler LG, Fullerton SM, Koenig BA, Li R, McCarty CA, Ramos E, Smith ME, Somkin CP, et al. Ethical and practical challenges of sharing data from genome-wide association studies: the eMERGE consortium experience. Genome Res. 2011;21(7):1001–7.CrossRef McGuire AL, Basford M, Dressler LG, Fullerton SM, Koenig BA, Li R, McCarty CA, Ramos E, Smith ME, Somkin CP, et al. Ethical and practical challenges of sharing data from genome-wide association studies: the eMERGE consortium experience. Genome Res. 2011;21(7):1001–7.CrossRef
31.
go back to reference Gurwitz D, Fortier I, Lunshof JE, Knoppers BM. Research ethics. Children and population biobanks. Science (New York, N.Y.). 2009;325(5942):818–9.CrossRef Gurwitz D, Fortier I, Lunshof JE, Knoppers BM. Research ethics. Children and population biobanks. Science (New York, N.Y.). 2009;325(5942):818–9.CrossRef
32.
go back to reference Adair CE, Holland AC, Patterson ML, Mason KS, Goering PN, Hwang SW. Cognitive interviewing methods for questionnaire pre-testing in homeless persons with mental disorders. J Urban Health. 2012;89(1):36–52.CrossRef Adair CE, Holland AC, Patterson ML, Mason KS, Goering PN, Hwang SW. Cognitive interviewing methods for questionnaire pre-testing in homeless persons with mental disorders. J Urban Health. 2012;89(1):36–52.CrossRef
33.
go back to reference Hens K, Cassiman JJ, Nys H, Dierickx K. Children, biobanks and the scope of parental consent. Eur J Hum Genet. 2011;19(7):735–9.CrossRef Hens K, Cassiman JJ, Nys H, Dierickx K. Children, biobanks and the scope of parental consent. Eur J Hum Genet. 2011;19(7):735–9.CrossRef
34.
go back to reference Hens K, Levesque E, Dierickx K. Children and biobanks: a review of the ethical and legal discussion. Hum Genet. 2011;130(3):403–13.CrossRef Hens K, Levesque E, Dierickx K. Children and biobanks: a review of the ethical and legal discussion. Hum Genet. 2011;130(3):403–13.CrossRef
35.
go back to reference Hens K, Nys H, Cassiman JJ, Dierickx K. The return of individual research findings in paediatric genetic research. J Med Ethics. 2011;37(3):179–83.CrossRef Hens K, Nys H, Cassiman JJ, Dierickx K. The return of individual research findings in paediatric genetic research. J Med Ethics. 2011;37(3):179–83.CrossRef
36.
go back to reference El Emam K, Buckeridge D, Tamblyn R, Neisa A, Jonker E, Verma A. The re-identification risk of Canadians from longitudinal demographics. BMC Med Inform Decis Mak. 2011;11:46.CrossRef El Emam K, Buckeridge D, Tamblyn R, Neisa A, Jonker E, Verma A. The re-identification risk of Canadians from longitudinal demographics. BMC Med Inform Decis Mak. 2011;11:46.CrossRef
37.
go back to reference Samuel J, Knoppers BM, Avard D. Paediatric biobanks: what makes them so unique? J Paediatr Child Health. 2012;48(2):E1–3.CrossRef Samuel J, Knoppers BM, Avard D. Paediatric biobanks: what makes them so unique? J Paediatr Child Health. 2012;48(2):E1–3.CrossRef
38.
go back to reference Dove ES, Black E, Avard D, Knoppers BM. Charting the privacy landscape in Canadian Paediatric biobanks. Health Law J. 2013;20:1–46.CrossRef Dove ES, Black E, Avard D, Knoppers BM. Charting the privacy landscape in Canadian Paediatric biobanks. Health Law J. 2013;20:1–46.CrossRef
39.
go back to reference Brakewood B, Poldrack RA. The ethics of secondary data analysis: considering the application of Belmont principles to the sharing of neuroimaging data. NeuroImage. 2013;82:671–6.CrossRef Brakewood B, Poldrack RA. The ethics of secondary data analysis: considering the application of Belmont principles to the sharing of neuroimaging data. NeuroImage. 2013;82:671–6.CrossRef
40.
go back to reference O'Doherty KC, Burgess MM, Edwards K, Gallagher RP, Hawkins AK, Kaye J, McCaffrey V, Winickoff DE. From consent to institutions: designing adaptive governance for genomic biobanks. Soc Sci Med. 2011;73(3):367–74.CrossRef O'Doherty KC, Burgess MM, Edwards K, Gallagher RP, Hawkins AK, Kaye J, McCaffrey V, Winickoff DE. From consent to institutions: designing adaptive governance for genomic biobanks. Soc Sci Med. 2011;73(3):367–74.CrossRef
41.
go back to reference Godard B, Schmidtke J, Cassiman JJ, Ayme S. Data storage and DNA banking for biomedical research: informed consent, confidentiality, quality issues, ownership, return of benefits. A professional perspective. Eur J Hum Genet. 2003;11(Suppl 2):S88–122.CrossRef Godard B, Schmidtke J, Cassiman JJ, Ayme S. Data storage and DNA banking for biomedical research: informed consent, confidentiality, quality issues, ownership, return of benefits. A professional perspective. Eur J Hum Genet. 2003;11(Suppl 2):S88–122.CrossRef
42.
go back to reference Brothers KB, Clayton EW. Parental perspectives on a pediatric human non-subjects biobank. AJOB Prim Res. 2012;3(3):21–9.CrossRef Brothers KB, Clayton EW. Parental perspectives on a pediatric human non-subjects biobank. AJOB Prim Res. 2012;3(3):21–9.CrossRef
43.
go back to reference Joseph JW, Neidich AB, Ober C, Ross LF. Empirical data about women's attitudes toward a biobank focused on pregnancy outcomes. Am J Med Genet A. 2008;146a(3):305–11.CrossRef Joseph JW, Neidich AB, Ober C, Ross LF. Empirical data about women's attitudes toward a biobank focused on pregnancy outcomes. Am J Med Genet A. 2008;146a(3):305–11.CrossRef
44.
go back to reference Neidich AB, Joseph JW, Ober C, Ross LF. Empirical data about women's attitudes towards a hypothetical pediatric biobank. Am J Med Genet A. 2008;146a(3):297–304.CrossRef Neidich AB, Joseph JW, Ober C, Ross LF. Empirical data about women's attitudes towards a hypothetical pediatric biobank. Am J Med Genet A. 2008;146a(3):297–304.CrossRef
45.
go back to reference Burstein MD, Robinson JO, Hilsenbeck SG, McGuire AL, Lau CC. Pediatric data sharing in genomic research: attitudes and preferences of parents. Pediatrics. 2014;133(4):690–7.CrossRef Burstein MD, Robinson JO, Hilsenbeck SG, McGuire AL, Lau CC. Pediatric data sharing in genomic research: attitudes and preferences of parents. Pediatrics. 2014;133(4):690–7.CrossRef
46.
go back to reference Jenkins MM, Reed-Gross E, Rasmussen SA, Barfield WD, Prue CE, Gallagher ML, Honein MA. Maternal attitudes toward DNA collection for gene-environment studies: a qualitative research study. Am J Med Genet A. 2009;149a(11):2378–86.CrossRef Jenkins MM, Reed-Gross E, Rasmussen SA, Barfield WD, Prue CE, Gallagher ML, Honein MA. Maternal attitudes toward DNA collection for gene-environment studies: a qualitative research study. Am J Med Genet A. 2009;149a(11):2378–86.CrossRef
47.
go back to reference Halverson CM, Ross LF. Attitudes of African-American parents about biobank participation and return of results for themselves and their children. J Med Ethics. 2012;38(9):561–6.CrossRef Halverson CM, Ross LF. Attitudes of African-American parents about biobank participation and return of results for themselves and their children. J Med Ethics. 2012;38(9):561–6.CrossRef
48.
go back to reference Fernandes DM, Roland AP, Morris MC. Parental opinions regarding an opt-out consent process for inpatient pediatric prospective observational research in the US. Pragmat Obs Res. 2017;8:1–8.CrossRef Fernandes DM, Roland AP, Morris MC. Parental opinions regarding an opt-out consent process for inpatient pediatric prospective observational research in the US. Pragmat Obs Res. 2017;8:1–8.CrossRef
49.
go back to reference Hens K, Nys H, Cassiman JJ, Dierickx K. The storage and use of biological tissue samples from minors for research: a focus group study. Public Health Genomics. 2011;14(2):68–76.CrossRef Hens K, Nys H, Cassiman JJ, Dierickx K. The storage and use of biological tissue samples from minors for research: a focus group study. Public Health Genomics. 2011;14(2):68–76.CrossRef
50.
go back to reference Gammelgaard A, Knudsen LE, Bisgaard H. Perceptions of parents on the participation of their infants in clinical research. Arch Dis Child. 2006;91(12):977–80.CrossRef Gammelgaard A, Knudsen LE, Bisgaard H. Perceptions of parents on the participation of their infants in clinical research. Arch Dis Child. 2006;91(12):977–80.CrossRef
51.
go back to reference Audrey S, Brown L, Campbell R, Boyd A, Macleod J. Young people's views about consenting to data linkage: findings from the PEARL qualitative study. BMC Med Res Methodol. 2016;16:34.CrossRef Audrey S, Brown L, Campbell R, Boyd A, Macleod J. Young people's views about consenting to data linkage: findings from the PEARL qualitative study. BMC Med Res Methodol. 2016;16:34.CrossRef
52.
go back to reference Manhas KP, Mitchell I. (dis)-trust in transitioning ventilator-dependent children from hospital to homecare. Nurs Ethics. 2015;22(8):913–27.CrossRef Manhas KP, Mitchell I. (dis)-trust in transitioning ventilator-dependent children from hospital to homecare. Nurs Ethics. 2015;22(8):913–27.CrossRef
53.
go back to reference Manhas KP, Page S, Dodd SX, Letourneau N, Ambrose A, Cui X, Tough SC. Parent perspectives on privacy and governance for a pediatric repository of non-biological, research data. J Empir Res Hum Res Ethics. 2015;10(1):88–99.CrossRef Manhas KP, Page S, Dodd SX, Letourneau N, Ambrose A, Cui X, Tough SC. Parent perspectives on privacy and governance for a pediatric repository of non-biological, research data. J Empir Res Hum Res Ethics. 2015;10(1):88–99.CrossRef
54.
go back to reference Manhas KP, Page S, Dodd SX, Letourneau N, Ambrose A, Cui X, Tough SC. Parental perspectives on consent for participation in large-scale, non-biological data repositories. Life Sci Soc Policy. 2016;12:1.CrossRef Manhas KP, Page S, Dodd SX, Letourneau N, Ambrose A, Cui X, Tough SC. Parental perspectives on consent for participation in large-scale, non-biological data repositories. Life Sci Soc Policy. 2016;12:1.CrossRef
55.
go back to reference McDonald SW, Lyon AW, Benzies KM, McNeil DA, Lye SJ, Dolan SM, Pennell CE, Bocking AD, Tough SC. The all our babies pregnancy cohort: design, methods, and participant characteristics. BMC Pregnancy Childbirth. 2013;13(Suppl 1):S2.CrossRef McDonald SW, Lyon AW, Benzies KM, McNeil DA, Lye SJ, Dolan SM, Pennell CE, Bocking AD, Tough SC. The all our babies pregnancy cohort: design, methods, and participant characteristics. BMC Pregnancy Childbirth. 2013;13(Suppl 1):S2.CrossRef
56.
go back to reference Kaplan BJ, Giesbrecht GF, Leung BM, Field CJ, Dewey D, Bell RC, Manca DP, O'Beirne M, Johnston DW, Pop VJ, et al. The Alberta pregnancy outcomes and nutrition (APrON) cohort study: rationale and methods. Matern Child Nutr. 2014;10(1):44–60.CrossRef Kaplan BJ, Giesbrecht GF, Leung BM, Field CJ, Dewey D, Bell RC, Manca DP, O'Beirne M, Johnston DW, Pop VJ, et al. The Alberta pregnancy outcomes and nutrition (APrON) cohort study: rationale and methods. Matern Child Nutr. 2014;10(1):44–60.CrossRef
57.
go back to reference Willis GB: Cognitive interviewing: A “how to” guide. 1999. Willis GB: Cognitive interviewing: A “how to” guide. 1999.
58.
go back to reference De Leeuw ED, Hox JJ, Dillman DA (eds). International Handbook of Survey Methodology. New York: Taylor & Francis Group; 2008. De Leeuw ED, Hox JJ, Dillman DA (eds). International Handbook of Survey Methodology. New York: Taylor & Francis Group; 2008.
59.
go back to reference Leung BM, McDonald SW, Kaplan BJ, Giesbrecht GF, Tough SC. Comparison of sample characteristics in two pregnancy cohorts: community-based versus population-based recruitment methods. BMC Med Res Methodol. 2013;13:149.CrossRef Leung BM, McDonald SW, Kaplan BJ, Giesbrecht GF, Tough SC. Comparison of sample characteristics in two pregnancy cohorts: community-based versus population-based recruitment methods. BMC Med Res Methodol. 2013;13:149.CrossRef
60.
go back to reference Dodd SXM, K. P, Page S, Letourneau N, Cui X, Tough SC. Governance and privacy in a provincial data repository: a cross-sectional analysis of longitudinal birth cohort parent Participants’ perspectives on sharing adult vs. child research data. Madrid: DATA 2017: 6th international conference on data science, technology and applications conference and proceedings; 2017. p. 1–8. http://www.scitepress.org/Papers/2017/64308/64308.pdf. Dodd SXM, K. P, Page S, Letourneau N, Cui X, Tough SC. Governance and privacy in a provincial data repository: a cross-sectional analysis of longitudinal birth cohort parent Participants’ perspectives on sharing adult vs. child research data. Madrid: DATA 2017: 6th international conference on data science, technology and applications conference and proceedings; 2017. p. 1–8. http://​www.​scitepress.​org/​Papers/​2017/​64308/​64308.​pdf.
Metadata
Title
Sharing longitudinal, non-biological birth cohort data: a cross-sectional analysis of parent consent preferences
Authors
Kiran Pohar Manhas
Shawn X. Dodd
Stacey Page
Nicole Letourneau
Carol E. Adair
Xinjie Cui
Suzanne C. Tough
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2018
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-018-0683-x

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