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Canadian Perspectives on the Clinical Actionability of Neuroimaging in Disorders of Consciousness

  • Grace Lee (a1), Adrian C. Byram (a1), Adrian M. Owen (a2), Urs Ribary (a3), A. Jon Stoessl (a1) (a4), Andrea Townson (a5), Christine Stables (a4) and Judy Illes (a1)...

Abstract

Background: Acquired brain injury is a critical public health and socioeconomic problem in Canada, leaving many patients in vegetative, minimally conscious, or locked-in states, unresponsive and unable to communicate. Recent advances in neuroimaging research have demonstrated residual consciousness in a few exemplary patients with acquired brain injury, suggesting potential misdiagnosis and changes in prognosis. Such progress, in parallel with research using multimodal brain imaging technologies in recent years, has promising implications for clinical translation, notwithstanding the many challenges that impact health care and policy development. This study explored the perspectives of Canadian professionals with expertise either in neuroimaging research, disorders of consciousness, or both, on the potential clinical applications and implications of imaging technology. Methods: Twenty-two professionals from designated communities of neuroimaging researchers, ethicists, lawyers, and practitioners participated in semistructured interviews. Data were analyzed for emergent themes. Results: The five most dominant themes were: (1) validation and calibration of the methods; (2) informed consent; (3) burdens on the health care system; (4) implications for the Canadian health care system; and (5) possibilities for improved prognosis. Conclusions: Movement of neuroimaging from research into clinical care for acquired brain injury will require careful consideration of legal and ethical issues alongside research reliability, responsible distribution of health care resources, and the interaction of technological capabilities with patient outcome.

Perspectives canadiennes à propos de l’ « actionnabilité » clinique de la neuroimagerie dans les troubles de la conscience. Contexte: Une lésion cérébrale acquise est un problème de santé publique et un problème socioéconomique important au Canada et ce type de lésions laisse plusieurs patients dans un état végétatif, de conscience minimale ou de verrouillage avec absence de réponse et incapacité à communiquer. Des progrès récents de la recherche en neuroimagerie ont montré la présence d’un état de conscience résiduel chez quelques patients particuliers ayant subi une lésion cérébrale, ce qui suggère la possibilité qu’un diagnostic erroné ait été posé et donc modifie le pronostic. De tels progrès, en parallèle avec la recherche utilisant des technologies d’imagerie multimodales du cerveau dans les dernières années, comportent des implications prometteuses en clinique malgré les nombreux défis qui ont des incidences sur les soins de santé et l’élaboration de politiques. Cette étude a exploré les perspectives des professionnels Canadiens qui possèdent une expertise, soit dans la recherche en neuroimagerie, dans les troubles de la conscience ou dans ces deux domaines, concernant les applications et les implications cliniques potentielles de la technologie d’imagerie. Méthode: Vingt-deux professionnels de milieux désignés de neuroimagerie, soit des chercheurs, des éthiciens, des avocats et des praticiens ont participé à des entrevues semi-structurées. Les données ont été analysées pour déceler des thèmes émergents. Résultats: Les 5 principaux thèmes émergents étaient les suivants: (1) la validation et la calibration des méthodes; (2) le consentement éclairé; (3) le fardeau pour le système de santé; (4) les implications pour le système de santé canadien; et (5) les possibilités d’améliorer le pronostic. Conclusions: Le transfert de la neuroimagerie des lésions traumatiques cérébrales de la recherche à la clinique requerra qu’on effectue un examen approfondi tant des aspects légaux et éthiques que de la fiabilité de la recherche, de la distribution responsable des ressources en santé et de l’interaction entre les ressources technologiques et les résultats chez les patients.

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Copyright

Corresponding author

Correspondence to: Judy Illes, Canada Research Chair in Neuroethics, Professor of Neurology, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC, Canada V6T 2B5. Email: jilles@mail.ubc.ca

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Canadian Perspectives on the Clinical Actionability of Neuroimaging in Disorders of Consciousness

  • Grace Lee (a1), Adrian C. Byram (a1), Adrian M. Owen (a2), Urs Ribary (a3), A. Jon Stoessl (a1) (a4), Andrea Townson (a5), Christine Stables (a4) and Judy Illes (a1)...

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