51
|
Freeley M. Current postgraduate training programs and online courses in precision medicine. Expert Rev Mol Diagn 2020; 20:569-574. [PMID: 31875486 DOI: 10.1080/14737159.2020.1709826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Freeley
- School of Biotechnology (Office X225), Dublin City University , Glasnevin, Ireland
| |
Collapse
|
52
|
Saleh M, Kerr R, Dunlop K. Scoping the Scene: What Do Nurses, Midwives, and Allied Health Professionals Need and Want to Know About Genomics? Front Genet 2019; 10:1066. [PMID: 31781159 PMCID: PMC6861370 DOI: 10.3389/fgene.2019.01066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Rapid changes in genomic technology are transforming healthcare delivery. Although it has been well established that many health professionals lack the adequate knowledge, skills, and confidence to adapt to these changes, the specific educational needs of Australian allied health professionals, nurses, and midwives are not well understood. This diverse group of health professionals is primarily involved in the management of symptoms and psychosocial care of patients with genetic conditions, rather than risk assessment and diagnosis. The relevance of genetics and genomics to their clinical practice may therefore differ from medical practitioners and specialists. Materials and Methods: This paper reports on a study undertaken to identify the perceived genetic knowledge and education needs for this group of health professionals. Allied health professionals, nurses, and midwives were recruited from throughout New South Wales (NSW) and invited to participate in semi-structured telephone or face to face interviews. Results: A total of 24 geographically and professionally diverse individuals (14 allied health, 6 nurses, and 4 midwives) were interviewed. Interview recordings were transcribed and using thematic qualitative analysis recurring themes were identified. The results show that this is a diverse group that is keen to know more about genomics and genetic services but unsure of reliable sources. Discussion: The need for a generic update from a trustworthy source was identified and suggested topics to be covered included genetic fundamentals, recognizing common genetic conditions, and psychosocial/ethical aspects of genetics/testing including informed consent. In addition, the challenge of incorporating education into highly clinical roles was identified as a key barrier and having a readily accessible, accredited learning resource would help overcome this. Findings from this study are informing the development of a targeted, interactive e-learning resource for allied health professionals, nurses, and midwives.
Collapse
Affiliation(s)
- Mona Saleh
- Centre for Genetics Education, New South Wales Health, Sydney, NSW, Australia
| | - Romy Kerr
- Centre for Genetics Education, New South Wales Health, Sydney, NSW, Australia.,New Zealand Genetic Health Service (Northern), Auckland, New Zealand
| | - Kate Dunlop
- Centre for Genetics Education, New South Wales Health, Sydney, NSW, Australia
| |
Collapse
|
53
|
Linderman MD, McElroy L, Chang L. MySeq: privacy-protecting browser-based personal Genome analysis for genomics education and exploration. BMC Med Genomics 2019; 12:172. [PMID: 31775760 PMCID: PMC6882182 DOI: 10.1186/s12920-019-0615-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/08/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The complexity of genome informatics is a recurring challenge for genome exploration and analysis by students and other non-experts. This complexity creates a barrier to wider implementation of experiential genomics education, even in settings with substantial computational resources and expertise. Reducing the need for specialized software tools will increase access to hands-on genomics pedagogy. RESULTS MySeq is a React.js single-page web application for privacy-protecting interactive personal genome analysis. All analyses are performed entirely in the user's web browser eliminating the need to install and use specialized software tools or to upload sensitive data to an external web service. MySeq leverages Tabix-indexing to efficiently query whole genome-scale variant call format (VCF) files stored locally or available remotely via HTTP(s) without loading the entire file. MySeq currently implements variant querying and annotation, physical trait prediction, pharmacogenomic, polygenic disease risk and ancestry analyses to provide representative pedagogical examples; and can be readily extended with new analysis or visualization components. CONCLUSIONS MySeq supports multiple pedagogical approaches including independent exploration and interactive online tutorials. MySeq has been successfully employed in an undergraduate human genome analysis course where it reduced the barriers-to-entry for hands-on human genome analysis.
Collapse
Affiliation(s)
| | - Leo McElroy
- Department of Computer Science, Middlebury College, Middlebury, VT USA
| | - Laura Chang
- Department of Computer Science, Middlebury College, Middlebury, VT USA
| |
Collapse
|
54
|
McGrath SP, Walton N, Williams MS, Kim KK, Bastola K. Are providers prepared for genomic medicine: interpretation of Direct-to-Consumer genetic testing (DTC-GT) results and genetic self-efficacy by medical professionals. BMC Health Serv Res 2019; 19:844. [PMID: 31760949 PMCID: PMC6876107 DOI: 10.1186/s12913-019-4679-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Precision medicine is set to deliver a rich new data set of genomic information. However, the number of certified specialists in the United States is small, with only 4244 genetic counselors and 1302 clinical geneticists. We conducted a national survey of 264 medical professionals to evaluate how they interpret genetic test results, determine their confidence and self-efficacy of interpreting genetic test results with patients, and capture their opinions and experiences with direct-to-consumer genetic tests (DTC-GT). Methods Participants were grouped into two categories, genetic specialists (genetic counselors and clinical geneticists) and medical providers (primary care, internists, physicians assistants, advanced nurse practitioners, etc.). The survey (full instrument can be found in the Additional file 1) presented three genetic test report scenarios for interpretation: a genetic risk for diabetes, genomic sequencing for symptoms report implicating a potential HMN7B: distal hereditary motor neuropathy VIIB diagnosis, and a statin-induced myopathy risk. Participants were also asked about their opinions on DTC-GT results and rank their own perceived level of preparedness to review genetic test results with patients. Results The rates of correctly interpreting results were relatively high (74.4% for the providers compared to the specialist’s 83.4%) and age, prior genetic test consultation experience, and level of trust assigned to the reports were associated with higher correct interpretation rates. The self-selected efficacy and the level of preparedness to consult on a patient’s genetic results were higher for the specialists than the provider group. Conclusion Specialists remain the best group to assist patients with DTC-GT, however, primary care providers may still provide accurate interpretation of test results when specialists are unavailable.
Collapse
Affiliation(s)
- Scott P McGrath
- School of Interdisciplinary Informatics, University of Nebraska at Omaha, 1110 S 67TH St., Omaha, 68182, NE, USA.
| | - Nephi Walton
- Genomic Medicine Institute, Geisinger, 100 N. Academy Ave., Danville, 17822, PA, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, 100 N. Academy Ave., Danville, 17822, PA, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, UC Davis, 2570 48th St., Sacramento, 95817, CA, USA
| | - Kiran Bastola
- School of Interdisciplinary Informatics, University of Nebraska at Omaha, 1110 S 67TH St., Omaha, 68182, NE, USA
| |
Collapse
|
55
|
Carroll JC, Allanson J, Morrison S, Miller FA, Wilson BJ, Permaul JA, Telner D. Informing Integration of Genomic Medicine Into Primary Care: An Assessment of Current Practice, Attitudes, and Desired Resources. Front Genet 2019; 10:1189. [PMID: 31824576 PMCID: PMC6882282 DOI: 10.3389/fgene.2019.01189] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction: Preparing primary care providers for genomic medicine (GM) first requires assessment of their educational needs in order to provide clear, purposeful direction and justify educational activities. More understanding is needed about primary care providers’ perspectives on their role in newer areas of GM and what resources would be helpful in practice. Our objective was to determine family physicians’ (FP) current involvement and confidence in GM, attitudes regarding its clinical value, suggestions for integration of GM into practice, and resources and education required. Methods: A self-complete anonymous questionnaire was mailed to a random sample of 2,000 FPs in Ontario, Canada in September 2012. Results: Adjusted response rate was 26% (361/1,365), mean age was 51, and 53% were male. FPs reported many aspects of traditional GM as part of current practice (eliciting family history: 93%; deciding who to refer to genetics: 94%; but few reported confidence (44%, 32% respectively). Newer areas of GM were not part of most FPs’ current practice and confidence was low (pharmacogenetics: 28% part of practice, 5% confident; direct-to-consumer genetic testing: 14%/2%; whole genome sequencing: 8%/2%). Attitudes were mixed with 59% agreeing that GM would improve patient health outcomes, 41% seeing benefits to genetic testing, but only 36% agreeing it was their responsibility to incorporate GM into practice. Few could identify useful sources of genetic information (22%) or find information about genetic tests (21%). Educational resources participants anticipated would be useful included contact information for local genetics clinics (89%), summaries of genetic disorders (86%), and genetic referral (85%) and testing (86%) criteria. About 58% were interested in learning about new genetic technologies. Most (76%) wanted to learn through in-person teaching (lectures, seminars etc.), 66% wanted contact with a local genetic counselor to answer questions, and 59% were interested in a genetics education website. Conclusion: FPs lack confidence in GM skills needed for practice, particularly in emerging areas of GM. They see their role as making appropriate referrals, are somewhat optimistic about the contribution GM may make to patient care, but express caution about its current clinical benefits. There is a need for evidence-based educational resources integrated into primary care and improved communication with genetic specialists.
Collapse
Affiliation(s)
- June C Carroll
- Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Shawna Morrison
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne A Permaul
- Sinai Health System, Ray D Wolfe Department of Family Medicine, Toronto, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
56
|
Al Bakir I, Sebepos-Rogers GM, Burton H, Monahan KJ. Mainstreaming of genomic medicine in gastroenterology, present and future: a nationwide survey of UK gastroenterology trainees. BMJ Open 2019; 9:e030505. [PMID: 31640999 PMCID: PMC6830597 DOI: 10.1136/bmjopen-2019-030505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Genomics and personalised medicine are increasingly relevant for patients with gastroenterological conditions. We aim to capture the current state of genomics training in gastroenterology to review current understanding, clinical experience and long-term educational needs of UK trainees. DESIGN AND SETTING A web-based nationwide survey of all UK gastroenterology specialty trainees was conducted in 2017. RESULTS 100 trainees (14% of UK gastroenterology trainees) completed this survey. Only 9% and 16% of respondents believe that their local training programme adequately prepares them for the future clinical practice using genomic medicine and personalised medicine, respectively. Barriers identified include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on the results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%).Survey respondents felt prepared to perform HFE genotyping (98%), assess TPMT status (97%) and interpret HLA subtyping for suspected coeliac disease (85%). However, only a minority felt prepared to perform the following investigations: polyposis screening (34%), hereditary pancreatitis screening (30%), testing for Lynch yndrome (33%) and KRAS testing for colorectal cancer (20%).Most respondents would support holding dedicated training days on genomic medicine (83%), formal training provisions for the mainstreaming of genomic testing (64%), an update to the UK gastroenterology specialty training curriculum and examinations (57%) and better-defined referral pathways for local genomic services (91%). CONCLUSION Most gastroenterology trainees in this survey feel ill equipped to practise genomic and personalised medicine as consultants. We propose specific revisions to the UK gastroenterology specialty curriculum that addresses trainees needs.
Collapse
Affiliation(s)
- Ibrahim Al Bakir
- Centre for Tumour Biology, Barts Cancer Institute, London, UK
- Department of Gastroenterology, St. Mark's Hospital, Harrow, UK
| | | | - Hilary Burton
- PHG Foundation, University of Cambridge, Cambridge, UK
| | - Kevin J Monahan
- Family Cancer Clinic, St. Mark's Hospital, Harrow, UK
- Genomic Medicine, Imperial College, London, United Kingdom
| |
Collapse
|
57
|
Abstract
With rapid advances in genetics and genomics, the commercialization and access to new applications has become more widespread and omnipresent throughout biomedical research. Thus, increasingly, more patients will have personal genomic information they may share with primary care providers (PCPs) to better understand the clinical significance of the data. To be able to respond to patient inquiries about genomic data, variant interpretation, disease risk, and other issues, PCPs will need to be able to increase or refresh their awareness about genetics and genomics, and identify reliable resources to use or refer patients. While provider educational efforts have increased, with the rapid advances in the field, ongoing efforts will be needed to prepare PCPs to manage patient needs, integrate results into care, and refer as indicated.
Collapse
Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA.
| |
Collapse
|
58
|
Vetsch J, Wakefield CE, Techakesari P, Warby M, Ziegler DS, O'Brien TA, Drinkwater C, Neeman N, Tucker K. Healthcare professionals' attitudes toward cancer precision medicine: A systematic review. Semin Oncol 2019; 46:291-303. [PMID: 31221444 DOI: 10.1053/j.seminoncol.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/30/2019] [Accepted: 05/22/2019] [Indexed: 02/05/2023]
Abstract
Use of precision medicine in oncology is burgeoning and can provide patients with new treatment options. However, it is not clear how precision medicine is impacting healthcare professionals (HCPs), particularly with regards to their concerns about this new approach. We therefore synthesized the existing literature on HCPs' attitudes toward cancer precision medicine. We searched four databases for relevant articles. Two reviewers screened eligible articles and extracted data. We assessed the quality of each article using the QualSyst tool. We found 22 articles, representing 4,321 HCPs (63.7% cancer specialists). HCPs held largely positive attitudes toward cancer precision medicine, including their capacity to facilitate treatment decisions and provide prognostic information. However, they also had concerns regarding costs, insurance coverage, limited HCP knowledge about precision medicine, potential misuse, difficulties accessing the tests, and delays in receiving test results. Most HCPs felt that test-related decisions should be shared between families and HCPs. HCPs intended to disclose actionable results but were less inclined to disclose negative/secondary findings. HCPs had a strong preference for genetic counselor involvement when disclosing germline findings. Most HCPs intended to use somatic and germline tests in their future practice but the extent to which pharmacogenomic tests will be used is uncertain. HCPs indicated that additional evidence supporting test utility and increased availability of treatment guidelines could facilitate the use of testing. HCPs held generally positive attitudes toward cancer precision medicine, however there were some key concerns. Addressing concerns early, devising educational support for HCPs and developing guidelines may facilitate the successful implementation of precision medicine trials in the future.
Collapse
Affiliation(s)
- J Vetsch
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
| | - P Techakesari
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - M Warby
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - D S Ziegler
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - T A O'Brien
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - C Drinkwater
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - N Neeman
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - K Tucker
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
59
|
GP attitudes to and expectations for providing personal genomic risk information to the public: a qualitative study. BJGP Open 2019; 3:bjgpopen18X101633. [PMID: 31049413 PMCID: PMC6480852 DOI: 10.3399/bjgpopen18x101633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/20/2018] [Indexed: 01/16/2023] Open
Abstract
Background As part of a pilot randomised controlled trial examining the impact of personal melanoma genomic risk information on behavioural and psychosocial outcomes, GPs were sent a booklet containing their patient’s genomic risk of melanoma. Aim Using this booklet as an example of genomic risk information that might be offered on a population-level in the future, this study explored GP attitudes towards communicating genomic risk information and resources needed to support this process. Design & setting Semi-structured interviews were conducted with 22 Australian GPs. Method The interviews were recorded and transcribed, and data were analysed thematically. Results GPs in this sample believed that communicating genomic risk may become a responsibility within primary care and they recommended a shared decisionmaking approach to guide the testing process. Factors were identified that may influence how and when GPs communicate genomic risk information. GPs view genomics-based risk as one of many disease risk factors and feel that this type of information could be applied in practice in the context of overall risk assessment for diseases for which prevention and early detection strategies are available. They believe it is important to ensure that patients understand their genomic risk and do not experience long-term adverse psychological responses. GPs desire clinical practice guidelines that specify recommendations for genomic risk assessment and patient management, point-of-care resources, and risk prediction tools that include genomic and traditional risk factors. Conclusion These findings will inform the development of resources for preparing GPs to manage and implement genomic risk information in practice.
Collapse
|
60
|
Rubanovich CK, Cheung C, Torkamani A, Bloss CS. Physician Communication of Genomic Results in a Diagnostic Odyssey Case Series. Pediatrics 2019; 143:S44-S53. [PMID: 30600271 DOI: 10.1542/peds.2018-1099i] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The availability of whole genome sequencing (WGS) is increasing in clinical care, and WGS is a promising tool in diagnostic odyssey cases. Physicians' ability to effectively communicate genomic information with patients, however, is unclear. In this multiperspective study, we assessed physicians' communication of patient genome sequencing information in a diagnostic odyssey case series. METHODS We evaluated physician communication of genome sequencing results in the context of an ongoing study of the utility of WGS for the diagnosis of rare and idiopathic diseases. A modified version of the Medical Communication Competence Scale was used to compare patients' ratings of their physicians' communication of general medical information to communication of genome sequencing information. Physician self-ratings were also compared with patient ratings. RESULTS A total of 47 patients, parents, and physicians across 11 diagnostic odyssey cases participated. In 6 of 11 cases (54%), the patient respondent rated the physician's communication of genome sequencing information as worse than that of general medical information. In 9 of 11 cases (82%), physician self-ratings of communication of genome sequencing information were worse than the patient respondent's rating. Identification of a diagnosis via WGS was positively associated with physician self-ratings (P = .021) but was not associated with patient respondent ratings (P = .959). CONCLUSIONS These findings reveal that even in diagnostic odyssey cases, in which genome sequencing may be clinically beneficial, physicians may not be well-equipped to communicate genomic information to patients. Future studies may benefit from multiperspective approaches to assessing and understanding physician-patient communication of genome-sequencing information.
Collapse
Affiliation(s)
- Caryn Kseniya Rubanovich
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | - Ali Torkamani
- Scripps Genomic Medicine Division, Scripps Translational Science Institute, Scripps Health, La Jolla, CA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA; and
| | - Cinnamon S Bloss
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| |
Collapse
|
61
|
Shaibi GQ, Kullo IJ, Singh DP, Sharp RR, De Filippis E, Cuellar I, Hernandez V, Levey S, Radecki Breitkopf C, Olson JE, Cerhan JR, Mandarino LJ, Thibodeau SN, Lindor NM. Developing a Process for Returning Medically Actionable Genomic Variants to Latino Patients in a Federally Qualified Health Center. Public Health Genomics 2018; 21:77-84. [PMID: 30522109 DOI: 10.1159/000494488] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022] Open
Abstract
AIM To develop a process for returning medically actionable genomic variants to Latino patients receiving care in a Federally Qualified Health Center. METHODS Prior to recruitment, researchers met with primary care providers to (1) orient clinicians to the project, (2) establish a process for returning actionable and nonactionable results to participants and providers through the electronic health record, and (3) develop a process for offering clinical decision support for follow-up education and care. A Community Advisory Board was engaged to provide input on recruitment strategies and materials for conveying results to participants. Participants in the Sangre Por Salud (Blood for Health) Biobank with hyperlipidemia or colon polyps represented the pool of potentially eligible participants. RESULTS A total of 1,621 individuals were invited to participate and 710 agreed to an in- person consenting visit (194 no-showed and 16 declined). Over 12-months, 500 participants were enrolled. Participants were primarily Spanish-speaking (81.6%), female (74.2%), and enrolled because of hyperlipidemia (95.4%). All but 2 participants opted to receive primary (i.e., related to enrollment phenotypes) as well as secondary actionable results. CONCLUSION Efforts to bring precision medicine to community-based health centers serving minority patients may require multilevel engagement activities to include individuals, providers, health systems, and the community.
Collapse
Affiliation(s)
- Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA,
| | - Iftikhar J Kullo
- Department of Cardiovascular Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Richard R Sharp
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Idali Cuellar
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sharon Levey
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence J Mandarino
- Division of Endocrinology, Department of Medicine, and Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona, Tucson, Arizona, USA
| | - Stephen N Thibodeau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|