Abstracts
Résumé
L’implantation d’une nouvelle technologie est une étape de la translation d’une découverte vers une application clinique. De nombreux modèles ont été proposés pour étudier une telle translation ; celui de Goering, Holland et Kelley met de l’avant des priorités qui résonnent avec la bioéthique. Nous proposons l’application d’un outil issu des sciences de l’implantation, le Consolidated Framework for Implementation Research (CFIR), pour identifier les enjeux éthiques d’une nouvelle technologie. Cet outil est conçu pour identifier les barrières et facilitateurs de l’implantation d’une technologie, et par le fait même s’inscrit dans le modèle de la recherche translationnelle. Nous prenons en exemple le test génomique prénatal non invasif (TGPNI). Ce test est offert dans certaines provinces du Canada en deuxième intention pour les personnes enceintes ayant une haute probabilité d’avoir un foetus avec une aneuploïdie. Des innovations potentielles du TGPNI sont de l’offrir comme test de première intention et d’étendre le nombre de conditions génétiques dépistées. Nous proposons donc d’utiliser le CFIR pour identifier les enjeux éthiques qui découlent des barrières et facilitateurs de ces innovations du TGPNI. En identifiant les barrières et facilitateurs de l’implantation d’une technologie, cet outil permet aux bioéthiciens de recourir à un outil éprouvé d’une autre discipline pour étudier des enjeux éthiques. Les bioéthiciens peuvent alors se tourner vers leurs outils traditionnels pour identifier les enjeux éthiques que soulèvent ces éléments. Notre proposition est un exemple parmi d’autres possibles de ce que cette approche peut accomplir : identifier d’une manière innovatrice des enjeux éthiques d’une nouvelle technologie.
Mots-clés :
- dépistage prénatal,
- recherche translationnelle,
- science de l’implantation,
- bioéthique,
- dépistage prénatal non invasif
Abstract
The implementation of a new technology is one step in the translation of a discovery into a clinical application. Numerous models have been proposed to study such translation; Goering, Holland and Kelley’s model puts forward priorities that resonate with bioethics. We propose the application of a tool from the implementation sciences, the Consolidated Framework for Implementation Research (CFIR), to identify the ethical issues of a new technology. This tool is designed to identify the barriers and facilitators to the implementation of a technology and is therefore part of the translational research model. An example is the non-invasive prenatal genomic test (NIPGT). This test is offered in some provinces in Canada as a second-line test for pregnant persons with a high probability of having a fetus with aneuploidy. Potential innovations of NIPGT are to offer it as a first-line test and to expand the number of genetic conditions screened. We thus propose to use CFIR to identify the ethical issues that arise from the barriers and facilitators to these innovations in NIPGT. By identifying barriers and facilitators to the implementation of a technology, this tool allows bioethicists to use a proven tool from another discipline to study ethical issues. Bioethicists can then turn to their traditional tools to identify the ethical issues raised by these elements. Our proposal is just one example of what this approach can accomplish: identifying ethical issues in a new technology in an innovative way.
Keywords:
- prenatal screening,
- translational research,
- implantation science,
- bioethics,
- non-invasive prenatal screening
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Appendices
Remerciements / Acknowledgements
Les auteurs aimeraient remercier l’équipe Pégase de l’Université de Montréal qui a participé aux échanges et aux réflexions : Marie-Christine Roy, Marie-François Malo, Stanislav Birko, Hortense Gallois, Charles Selva-Rivero, Cynthia Henriksen, Marie-Ève Lemoine, Jessica Leclerc-Blain, Stéphanie Cloutier.
The authors would like to thank the Pegasus team from the University of Montreal who participated in the discussions and reflections: Marie-Christine Roy, Marie-François Malo, Stanislav Birko, Hortense Gallois, Charles Selva-Rivero, Cynthia Henriksen, Marie-Ève Lemoine, Jessica Leclerc-Blain, Stéphanie Cloutier.
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