Abstract

Objective

Develop a stakeholder-informed ethical framework to provide practical guidance to health systems considering implementation of suicide risk prediction models.

Methods

In this multi-method study, patients and family members participating in formative focus groups (n = 4 focus groups, 23 participants), patient advisors, and a bioethics consultant collectively informed the development of a web-based survey; survey results (n = 1,357 respondents) and themes from interviews with stakeholders (patients, health system administrators, clinicians, suicide risk model developers, and a bioethicist) were used to draft the ethical framework.

Results

Clinical, ethical, operational, and technical issues reiterated by multiple stakeholder groups and corresponding questions for risk prediction model adopters to consider prior to and during suicide risk model implementation are organized within six ethical principles in the resulting stakeholder-informed framework. Key themes include: patients’ rights to informed consent and choice to conceal or reveal risk (autonomy); appropriate application of risk models, data and model limitations and consequences including ambiguous risk predictors in opaque models (explainability); selecting actionable risk thresholds (beneficence, distributive justice); access to risk information and stigma (privacy); unanticipated harms (non-maleficence); and planning for expertise and resources to continuously audit models, monitor harms, and redress grievances (stewardship).

Conclusions

Enthusiasm for risk prediction in the context of suicide is understandable given the escalating suicide rate in the U.S. Attention to ethical and practical concerns in advance of automated suicide risk prediction model implementation may help avoid unnecessary harms that could thwart the promise of this innovation in suicide prevention.

• HIGHLIGHTS

• Patients’ desire to consent/opt out of suicide risk prediction models.

• Recursive ethical questioning should occur throughout risk model implementation.

• Risk modeling resources are needed to continuously audit models and monitor harms.

中文翻译：

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利益相关者知情的道德框架，用于指导基于电子健康记录的自杀风险预测模型的实施

 抽象的

 客观的

制定利益相关者知情的道德框架，为考虑实施自杀风险预测模型的卫生系统提供实用指导。

 方法

在这项多方法研究中，参与形成性焦点小组（ n = 4 个焦点小组，23 名参与者）的患者和家庭成员、患者顾问和生物伦理学顾问共同告知了一项基于网络的调查的制定；调查结果（ n = 1,357 名受访者）和利益相关者（患者、卫生系统管理员、临床医生、自杀风险模型开发人员和生物伦理学家）访谈主题用于起草道德框架。

 结果

多个利益相关者群体重申的临床、伦理、操作和技术问题，以及风险预测模型采用者在自杀风险模型实施之前和实施期间需要考虑的相应问题，均在最终的利益相关者知情框架中的六项伦理原则中进行了组织。关键主题包括：患者知情同意权以及选择隐瞒或披露风险的权利（自主权）；适当应用风险模型、数据和模型的局限性和后果，包括不透明模型中模糊的风险预测因素（可解释性）；选择可操作的风险阈值（仁慈、分配正义）；获取风险信息和耻辱（隐私）；意外伤害（非恶意）；规划专业知识和资源，以持续审核模型、监控危害和纠正申诉（管理）。

 结论

鉴于美国自杀率不断上升，对自杀风险预测的热情是可以理解的。在实施自动自杀风险预测模型之前关注道德和实际问题可能有助于避免不必要的伤害，从而阻碍这种自杀预防创新的承诺。

•  强调

• 
  患者同意/选择退出自杀风险预测模型的愿望。

• 
  在风险模型实施的整个过程中应该出现递归的道德质疑。

• 
  需要风险建模资源来持续审核模型和监控危害。