Challenges facing the clinical adoption of a new prognostic biomarker: a case study.

IF 1.3 4区 医学 Q4 SOCIAL SCIENCES, BIOMEDICAL Biosocieties Pub Date : 2023-01-21 DOI:10.1057/s41292-022-00296-2
Trine Schifter Larsen, Jesper Eugen-Olsen, Ove Andersen, Jeanette Wassar Kirk
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Abstract

In this article, we show how a particular biomarker comes into being in an emergency department in a hospital in Copenhagen, Denmark. We explore the contextual becoming of this biomarker, suPAR, through interviews with nurses and physicians and through relational ontology. We find that as a prognostic biomarker suPAR is challenged in it becoming as an object for clinical practice in the emergency department by the power of diagnostic practices and the desire for experience-based scripts that quickly enable the clinician to reach the right diagnosis. Although suPAR is enacted as a promising triage strategy suggesting a low or high risk of disease, the inability to rule out specific diagnoses and producing the notion of secure clinical actions make its non-specificity and prognostic character problematic in clinical practices. Specific diagnostic criteria versus prognostic interpretation and non-specificity risk profiling challenges the way healthcare workers in an emergency department understand the tasks they are set to solve and how to solve them. We discuss how the becoming of suPAR is strengthened through enactments of specificity and engagement in triage strategies and we reflect on it's becoming through new diagnostic practices with the need to accommodate diagnostic ambiguity.

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临床采用新预后生物标志物面临的挑战:案例研究。
在本文中,我们展示了丹麦哥本哈根一家医院的急诊科是如何产生一种特殊的生物标志物的。我们通过对护士和医生的访谈,并通过关系本体论,探讨了这一生物标记物 suPAR 的产生背景。我们发现,作为一种预后生物标志物,suPAR 在成为急诊科临床实践对象的过程中,受到了诊断实践力量的挑战,也受到了对基于经验的脚本的渴望的挑战,这种脚本能让临床医生快速得出正确的诊断。虽然 suPAR 是一种很有前途的分诊策略,能提示疾病的低风险或高风险,但由于无法排除特定的诊断并产生安全临床行动的概念,其非特异性和预后性在临床实践中很成问题。具体的诊断标准与预后解释以及非特异性风险分析对急诊科医护人员理解他们要解决的任务以及如何解决这些任务的方式提出了挑战。我们讨论了如何通过制定特异性和参与分诊策略来加强 suPAR 的形成,并反思了通过新的诊断实践来适应诊断模糊性的必要性。
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来源期刊
Biosocieties
Biosocieties SOCIAL SCIENCES, BIOMEDICAL-
CiteScore
3.40
自引率
6.20%
发文量
23
期刊介绍: BioSocieties is committed to the scholarly exploration of the crucial social, ethical and policy implications of developments in the life sciences and biomedicine. These developments are increasing our ability to control our own biology; enabling us to create novel life forms; changing our ideas of ‘normality’ and ‘abnormality’; transforming our understanding of personal identity, family relations, ancestry and ‘race’; altering our social and personal expectations and responsibilities; reshaping global economic opportunities and inequalities; creating new global security challenges; and generating new social, ethical, legal and regulatory dilemmas. To address these dilemmas requires us to break out from narrow disciplinary boundaries within the social sciences and humanities, and between these disciplines and the natural sciences, and to develop new ways of thinking about the relations between biology and sociality and between the life sciences and society. BioSocieties provides a crucial forum where the most rigorous social research and critical analysis of these issues can intersect with the work of leading scientists, social researchers, clinicians, regulators and other stakeholders. BioSocieties defines the key intellectual issues at the science-society interface, and offers pathways to the resolution of the critical local, national and global socio-political challenges that arise from scientific and biomedical advances. As the first journal of its kind, BioSocieties publishes scholarship across the social science disciplines, and represents a lively and balanced array of perspectives on controversial issues. In its inaugural year BioSocieties demonstrated the constructive potential of interdisciplinary dialogue and debate across the social and natural sciences. We are becoming the journal of choice not only for social scientists, but also for life scientists interested in the larger social, ethical and policy implications of their work. The journal is international in scope, spanning research and developments in all corners of the globe. BioSocieties is published quarterly, with occasional themed issues that highlight some of the critical questions and problematics of modern biotechnologies. Articles, response pieces, review essays, and self-standing editorial pieces by social and life scientists form a regular part of the journal.
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