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131 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 and how having the option to participate in research gives a sense of control and be beneficial. Could you also talk a little bit about what are the concerns that women with breast cancer have about these sorts of archival projects? The second question has to do with the consent process. To amplify some themes that Alex raised, are there barriers to a layered consent process from the point of view of the woman at different stages of breast cancer so that we had heard some anecdotal information that, you know, you have so much on your mind at the time of diagnosis, definitive treatment, that really is not the optimal time from the woman's point of view to enter into the kind of nuance layered discussion that Dr. Old was talking about. So again most of the barriers you were talking about were barriers from the clinician side or from the cost side. Are there also barriers to a layered approach to consent from a woman's point of view? Finally, if you could -- MS. BARR: Okay. DR. LO: We all try and get three questions under the guise of one. So part 2B or part 3 is could you address the issue of being recontacted? MS. BARR: Yes.

132 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 DR. LO: You said that your group was very much against having recontact to provide research information back to women and yet other advocacy groups have said, "Give us the information and let us decide, do not tell us it is still experimental, it is our body, let us decide." Apparently you wanted an exception when there was clinical information that would make a difference to the woman, like a misdiagnosis, in either direction, more serious or less serious. How about being recontacted to be invited to participate in a research study in which it would be an identifiable link study? Is there -- is that a benefit? Is it a harm? It obviously is going to be different for different women but what should the policy be? MS. BARR: Let me tell you about the policy and the evolving policy. The policy of the Action Plan Working Group was that recontact for additional research was enough of an invasion that an individual should, indeed, agree to it at the time they donate tissue. I am going in for clinical work and one of the decisions I have to make is do I want to be part of this ongoing or not. The IRB community said that to promise that you would not be recontacted unless you gave your permission, which is what it is to ask that question, is misleading

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DR. LO: You said that your group was very much<br />

aga<strong>in</strong>st hav<strong>in</strong>g recontact to provide research <strong>in</strong>formation<br />

back to women and yet other advocacy groups have said,<br />

"Give us the <strong>in</strong>formation and let us decide, do not tell us<br />

it is still experimental, it is our body, let us decide."<br />

Apparently you wanted an exception when there<br />

was cl<strong>in</strong>ical <strong>in</strong>formation that would make a difference to<br />

the woman, like a misdiagnosis, <strong>in</strong> either direction, more<br />

serious or less serious. How about be<strong>in</strong>g recontacted to be<br />

<strong>in</strong>vited to participate <strong>in</strong> a research study <strong>in</strong> which it<br />

would be an identifiable l<strong>in</strong>k study? Is there -- is that a<br />

benefit? Is it a harm? It obviously is go<strong>in</strong>g to be<br />

different for different women but what should the policy<br />

be?<br />

MS. BARR: Let me tell you about the policy and<br />

the evolv<strong>in</strong>g policy. The policy of the Action Plan Work<strong>in</strong>g<br />

Group was that recontact for additional research was enough<br />

of an <strong>in</strong>vasion that an <strong>in</strong>dividual should, <strong>in</strong>deed, agree to<br />

it at the time they donate tissue. I am go<strong>in</strong>g <strong>in</strong> for<br />

cl<strong>in</strong>ical work and one of the decisions I have to make is do<br />

I want to be part of this ongo<strong>in</strong>g or not.<br />

The IRB community said that to promise that you<br />

would not be recontacted unless you gave your permission,<br />

which is what it is to ask that question, is mislead<strong>in</strong>g

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