Biomarkers as Common Data Elements for Symptom and Self-Management Science

Gayle G Page; Elizabeth J Corwin; Susan G Dorsey; Nancy S Redeker; Donna Jo McCloskey; Joan K Austin; Barbara J Guthrie; Shirley M Moore; Debra Barton; Miyong T Kim; Sharron L Docherty; Drenna Waldrop-Valverde; Donald E Bailey Jr; Rachel F Schiffman; Angela Starkweather; Teresa M Ward; Suzanne Bakken; Kathleen T Hickey; Cynthia L Renn; Patricia Grady

doi:10.1111/jnu.12378

Biomarkers as Common Data Elements for Symptom and Self-Management Science

J Nurs Scholarsh. 2018 May;50(3):276-286. doi: 10.1111/jnu.12378. Epub 2018 Mar 25.

Authors

Gayle G Page¹, Elizabeth J Corwin², Susan G Dorsey³, Nancy S Redeker⁴, Donna Jo McCloskey⁵, Joan K Austin⁶, Barbara J Guthrie⁷, Shirley M Moore⁸, Debra Barton⁹, Miyong T Kim¹⁰, Sharron L Docherty¹¹, Drenna Waldrop-Valverde¹², Donald E Bailey Jr¹³, Rachel F Schiffman¹⁴, Angela Starkweather¹⁵, Teresa M Ward¹⁶, Suzanne Bakken¹⁷, Kathleen T Hickey¹⁸, Cynthia L Renn¹⁹, Patricia Grady²⁰

Affiliations

¹ Nu Beta, Professor and Independence Foundation Chair in Nursing Education, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
² Alpha Epsilon, Professor and Associate Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
³ Pi, Professor and Chair, Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA.
⁴ Delta Mu, Beatrice Renfield Term Professor of Nursing, Professor, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT.
⁵ Clinical Advisor, Contractor, National Institute of Nursing Research, NIH, Bethesda, MD, USA.
⁶ Alpha, Distinguished Professor Emerita, Indiana University School of Nursing, Indianapolis, IN and National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
⁷ Professor, Director of the PhD Program, Northeastern University, Boston, MA, USA.
⁸ Delta Xi, Edward J. and Louise Mellen Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
⁹ Mary Lou Willard French Professor of Oncology Nursing, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Epsilon Theta, Professor, Associate Vice President for Community Health Engagement, University of Texas at Austin, Austin, TX, USA.
¹¹ Iota Omicron, Associate Professor, School of Nursing; Associate Professor, Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA.
¹² Associate Professor and Assistant Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
¹³ Beta Epsilon and Theta Iota, Associate Professor, Duke University, Durham, NC, USA.
¹⁴ Alpha Chi and Eta Nu, Professor and Associate Dean for Research, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
¹⁵ Mu, Professor, University of Connecticut School of Nursing, Storrs, CT, USA.
¹⁶ Psi-at-Large, Associate Professor, University of Washington School of Nursing, Seattle, WA, USA.
¹⁷ Alpha Eta, The Alumni Professor of Nursing and Professor of Biomedical Informatics Director, Columbia University, New York, NY, USA.
¹⁸ Alpha Eta, Professor of Nursing at Columbia University Medical Center, Columbia University, New York, NY, USA.
¹⁹ Pi, Associate Professor Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA.
²⁰ Tau, Director, National Institute of Nursing Research, National Institutes or Health, Bethesda, MD, USA.

Abstract

Purpose: Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance.

Design and methods: From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas.

Findings: The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms.

Conclusions: It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science.

Clinical relevance: The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.

Keywords: Biomarker; common data elements; self-management; symptoms.

MeSH terms

Biomarkers / analysis*
Cognition Disorders / diagnosis
Common Data Elements*
Depression / diagnosis
Fatigue / diagnosis
Humans
Pain / diagnosis
Reproducibility of Results
Self-Management / methods*
Sleep Wake Disorders
United States

Substances

Biomarkers

Abstract

MeSH terms

Substances

Grants and funding