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Heath O, Hammerl E, Spitzinger A, Wortmann SB. Ending an Odyssey? The Psychosocial Experiences of Parents after the Genetic Diagnosis of a Mitochondrial Disease in Children. J Pers Med 2024; 14:523. [PMID: 38793105 PMCID: PMC11122152 DOI: 10.3390/jpm14050523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Obtaining a genetic diagnosis of a primary mitochondrial disease (PMD) is often framed as a diagnostic odyssey. Yet, even after receiving a diagnosis, parents of affected children experience ongoing therapeutic and prognostic uncertainty and considerable psychosocial challenges. Semi-structured interviews (N = 24) were conducted with parents of 13 children (aged 2-19 years) with a genetically confirmed PMD. Paternal (N = 11) and maternal (N = 13) perspectives were obtained, and thematic analysis was performed on all interviews. A genetic diagnosis was valuable and empowering for parents, despite eliciting varied emotional responses. While the diagnosis helped focus management decisions, families often felt overwhelmed and unsupported in navigating the healthcare system. Most parents reported a serious impact on their romantic relationship. The sources of social support varied, with a preference for established friendship and family support networks over disease-specific community support groups. Most parents favored prenatal genetic testing in the event of a future pregnancy. This study provides insight into the lived experiences of parents after a genetic diagnosis of PMD in their children. The findings draw awareness to supportive care needs and highlight important gaps that should be addressed to ensure that parents feel supported within a holistic framework of management for PMDs.
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Affiliation(s)
- Oliver Heath
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
| | - Emma Hammerl
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
| | - Anna Spitzinger
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
- Institut für Klinische Psychologie der UK für Psychiatrie, Psychotherapie und Psychosomatik der PMU, 5020 Salzburg, Austria
| | - Saskia B. Wortmann
- University Children’s Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (O.H.); (E.H.); (A.S.)
- Nijmegen Centre for Mitochondrial Disorders (NCMD), Amalia Children’s Hospital, Radboudumc, 6525 Nijmegen, The Netherlands
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Stafford-Smith B, Sullivan JA, McAlister M, Walley N, Shashi V, McConkie-Rosell A. The book is just being written: The enduring journey of parents of children with emerging- ultrarare disorders. J Genet Couns 2024. [PMID: 38562053 DOI: 10.1002/jgc4.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
Ultra rare disorders are being diagnosed at an unprecedented rate, due to genomic sequencing. These diagnoses are often a new gene association, for which little is known, and few share the diagnosis. For these diagnoses, we use the term emerging-ultrarare disorder (E-URD), defined as <100 diagnosed individuals. We contacted 20 parents of children diagnosed with an E-URD through the Duke University Research Sequencing Clinic. Seventeen completed semi-structured interviews exploring parental perspectives (7/17 had children in publications describing the phenotype; 4/17 had children in the first publication establishing a new disorder). Data were analyzed using a directed content approach informed by an empowerment framework. Parents reported a range of responses, including benefits of a diagnosis and challenges of facing the unknown, some described feeling lost and confused, while others expressed empowerment. Empowerment characteristics were hope for the future, positive emotions, engagement, and confidence/self-efficacy to connect with similar others, partner with healthcare providers, and seek new knowledge. We identified a subset of parents who proactively engaged researchers, supported research and publications, and created patient advocacy and support organizations to connect with and bolster similarly diagnosed families. Other parents reported challenges of low social support, low tolerance for uncertainty, limited knowledge about their child's disorder, as well as difficulty partnering with HCPs and connecting to an E-URD community. An overarching classification was developed to describe parental actions taken after an E-URD diagnosis: adjusting, managing, and pioneering. These classifications may help genetic counselors identify and facilitate positive steps with parents of a child with an E-URD.
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Affiliation(s)
- Bethany Stafford-Smith
- Centre for Medical Education, Cardiff University, Cardiff, UK
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, North Carolina, USA
| | - Jennifer A Sullivan
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, North Carolina, USA
| | | | - Nicole Walley
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, North Carolina, USA
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, North Carolina, USA
| | - Allyn McConkie-Rosell
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, North Carolina, USA
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Brothers KB, Cooper G, Mcnamara KC, Lemke AA, Timmons J, Rich CA, Cadigan RJ, Ponsaran RS, Goldenberg AJ. Moving to the Middle Ground: Redefining Genomic Utility to Expand Understanding of Familial Benefit. Ethics Hum Res 2024; 46:43-48. [PMID: 38240400 PMCID: PMC11173350 DOI: 10.1002/eahr.500199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Translational research has tended to ignore the question of whether receiving a genomic diagnosis provides utility in community care contexts outside of doctors' offices and hospitals. However, empirical research with parents has highlighted numerous ways that a genomic diagnosis might be of practical value in the care provided by teachers, physical or occupational therapists, speech-language pathologists, behavior analysts, and nonphysician mental health providers. In this essay, we propose a new conceptual model of genomic utility that offers the opportunity to better capture a broad range of potential implications of genomic technologies for families in various social and organizational systems. We explore crucial research directions to better understand how redefined utility might affect families and nonphysician professionals.
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Affiliation(s)
- Kyle B. Brothers
- Norton Children’s Research Institute Affiliated with the University of Louisville, Louisville, Kentucky
| | - Greg Cooper
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Katelyn C. Mcnamara
- Norton Children’s Research Institute Affiliated with the University of Louisville, Louisville, Kentucky
| | - Amy A. Lemke
- Norton Children’s Research Institute Affiliated with the University of Louisville, Louisville, Kentucky
| | - Josie Timmons
- Norton Children’s Research Institute Affiliated with the University of Louisville, Louisville, Kentucky
| | - Carla A. Rich
- Norton Children’s Research Institute Affiliated with the University of Louisville, Louisville, Kentucky
| | - R. Jean Cadigan
- Department of Social Medicine, University of Norton Carolina Chapel Hill School of Medicine, Chapel Hill, Norton Carolina
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Ackerman SL, Brown JEH, Zamora A, Outram S. "I Have Fought for so Many Things": Disadvantaged families' Efforts to Obtain Community-Based Services for Their Child after Genomic Sequencing. AJOB Empir Bioeth 2023; 14:208-217. [PMID: 37162201 PMCID: PMC10615790 DOI: 10.1080/23294515.2023.2209747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes. METHODS We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and thematic development were used to collaboratively interpret fieldnotes and transcripts. RESULTS Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child's day-to-day life. After sequencing, however, genetic information was not readily converted into improved access to services beyond the clinic, with families often struggling to use a genetic diagnosis to advocate for their child. CONCLUSION Families' ability to use a genetic diagnosis as an effective advocacy tool beyond the clinic was limited by the knowledge and resources available to them, and by the eligibility criteria used by therapeutic service providers' - which focused on clinical diagnosis and functional criteria more than etiologic information. All families undertaking genomic testing, particularly those who are disadvantaged, need additional support to understand the limits and potential benefits of genetic information beyond the clinic.
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Affiliation(s)
- Sara L Ackerman
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
- Department of Social & Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Julia E H Brown
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Astrid Zamora
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Outram
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
- Department of Social & Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
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Waltz M, Canter C, Bensen JT, Berg JS, Foreman AKM, Grant TL, Lich KH, Navas A, O’Daniel JM, Powell BC, Rini CM, Staley BS, Cadigan RJ. The Burden of COVID-19 on Caregivers of Children with Suspected Genetic Conditions: A Therapeutic Odyssey. Phys Occup Ther Pediatr 2022; 43:257-271. [PMID: 36310386 PMCID: PMC10079636 DOI: 10.1080/01942638.2022.2138734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
AIMS Children with disabilities and rare or undiagnosed conditions and their families have faced numerous hardships of living during the COVID-19 pandemic. For those with undiagnosed conditions, the diagnostic odyssey can be long, expensive, and marked by uncertainty. We, therefore, sought to understand whether and how COVID-19 impacted the trajectory of children's care. METHODS We conducted semi-structured qualitative interviews with 25 caregivers who, prior to the pandemic, were on a diagnostic odyssey for their children. RESULTS Most caregivers did not report any interruptions to their child's diagnostic odyssey. The greatest impact was access to therapy services, including the suspension or loss of their child's in-person therapeutic care and difficulties with virtual therapies. This therapy gap caused caregivers to fear that their children were not making progress. CONCLUSION Although much has been written about the challenges of diagnostic odysseys for children and their families, this study illustrates the importance of expanding the focus of these studies to include therapeutic odysseys. Because therapeutic odysseys continue regardless of whether diagnoses are made, future research should investigate how to support caregivers through children's therapies within and outside of the COVID-19 context.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Courtney Canter
- Department of Anthropology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Tracey L. Grant
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Angelo Navas
- Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Christine M. Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brooke S. Staley
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - R. Jean Cadigan
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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Childerhose JE, Rich CA, East KM, Kelley WV, Simmons S, Finnila CR, Bowling KM, Amaral MD, Hiatt SM, Thompson M, Gray DE, Lawlor JMJ, Myers RM, Barsh GS, Bebin EM, Cooper GM, Brothers KB, Brothers KB. The Therapeutic Odyssey: Positioning Genomic Sequencing in the Search for a Child's Best Possible Life. AJOB Empir Bioeth 2021; 12:179-189. [PMID: 33843487 PMCID: PMC9922533 DOI: 10.1080/23294515.2021.1907475] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The desire of parents to obtain a genetic diagnosis for their child with intellectual disability and associated symptoms has long been framed as a diagnostic odyssey, an arduous and sometimes perilous journey focused on the goal of identifying a cause for the child's condition.Methods: Semi-structured interviews (N = 60) were conducted with parents of children (N = 59, aged 2-24 years) with intellectual disability and/or developmental delay (IDD) who underwent genome sequencing at a single pediatric multispecialty clinic. Interviews were conducted after parents received their child's sequencing result (positive findings, negative findings, or variants of unknown significance). Thematic analysis was performed on all interviews.Results: Parents reported that obtaining a genetic diagnosis was one important step in their overall goal of helping their child live their best life possible life. They intended to use the result as a tool to help their child by seeking the correct school placement and obtaining benefits and therapeutic services.Conclusions: For the parents of children with IDD, the search for a genetic diagnosis is best conceptualized as a part of parents' ongoing efforts to leverage various diagnoses to obtain educational and therapeutic services for their children. Cleaving parents' search for a genetic diagnosis from these broader efforts obscures the value that some parents place on a sequencing result in finding and tailoring therapies and services beyond the clinic. Interviews with parents reveal, therefore, that genomic sequencing is best understood as one important stage of an ongoing therapeutic odyssey that largely takes place outside the clinic. Findings suggest the need to expand translational research efforts to contextualize a genetic diagnosis within parents' broader efforts to obtain educational and therapeutic services outside clinical contexts.
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Affiliation(s)
- Janet E. Childerhose
- Division of General Internal Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Pediatric Clinical and Translational Research, University of Louisville, Louisville, Kentucky, USA
| | - Carla A. Rich
- Division of Pediatric Clinical and Translational Research, University of Louisville, Louisville, Kentucky, USA
| | - Kelly M. East
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | | | - Shirley Simmons
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | | | - Kevin M. Bowling
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | | | - Susan M. Hiatt
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | | | - David E. Gray
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | | | - Richard M. Myers
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Gregory S. Barsh
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - E. Martina Bebin
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Greg M. Cooper
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Kyle B. Brothers
- Division of Pediatric Clinical and Translational Research, University of Louisville, Louisville, Kentucky, USA.,Correspondence to: Kyle B. Brothers, MD, PhD, University of Louisville School of Medicine, 231 E. Chestnut St., N-97, Louisville, KY 40202, Work Phone: 502-588-0797, Cell Phone: 502-762-8666, Fax: 502-629-5285,
| | - Kyle Bertram Brothers
- Division of Pediatric Clinical and Translational Research, University of Louisville, Louisville, Kentucky, USA
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Bilkey GA, Burns BL, Coles EP, Bowman FL, Beilby JP, Pachter NS, Baynam G, J. S. Dawkins H, Nowak KJ, Weeramanthri TS. Genomic Testing for Human Health and Disease Across the Life Cycle: Applications and Ethical, Legal, and Social Challenges. Front Public Health 2019; 7:40. [PMID: 30915323 PMCID: PMC6421958 DOI: 10.3389/fpubh.2019.00040] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/14/2019] [Indexed: 12/23/2022] Open
Abstract
The expanding use of genomic technologies encompasses all phases of life, from the embryo to the elderly, and even the posthumous phase. In this paper, we present the spectrum of genomic healthcare applications, and describe their scope and challenges at different stages of the life cycle. The integration of genomic technology into healthcare presents unique ethical issues that challenge traditional aspects of healthcare delivery. These challenges include the different definitions of utility as applied to genomic information; the particular characteristics of genetic data that influence how it might be protected, used and shared; and the difficulties applying existing models of informed consent, and how new consent models might be needed.
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Affiliation(s)
- Gemma A. Bilkey
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Belinda L. Burns
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Emily P. Coles
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Faye L. Bowman
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - John P. Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Nicholas S. Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Gareth Baynam
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Centre for Child Health Research, The University of Western Australia and Telethon Kids Institute, Perth, WA, Australia
| | - Hugh J. S. Dawkins
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Sir Walter Murdoch School of Policy and International Affairs, Murdoch University, Murdoch, WA, Australia
- School of Public Health, Curtin University of Technology, Bentley, WA, Australia
| | - Kristen J. Nowak
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia
| | - Tarun S. Weeramanthri
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
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Ayres S, Gallacher L, Stark Z, Brett GR. Genetic counseling in pediatric acute care: Reflections on ultra-rapid genomic diagnoses in neonates. J Genet Couns 2019; 28:273-282. [DOI: 10.1002/jgc4.1086] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/11/2018] [Accepted: 12/02/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Samantha Ayres
- Australian Genomics Health Alliance; Melbourne Australia
- Melbourne Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
| | - Lyndon Gallacher
- Australian Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
| | - Gemma R. Brett
- Australian Genomics Health Alliance; Melbourne Australia
- Melbourne Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
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Johnston J, Lantos JD, Goldenberg A, Chen F, Parens E, Koenig BA. Sequencing Newborns: A Call for Nuanced Use of Genomic Technologies. Hastings Cent Rep 2018; 48 Suppl 2:S2-S6. [PMID: 30133723 PMCID: PMC6901349 DOI: 10.1002/hast.874] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self-directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered. In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct-to-consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole-exome or whole-genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed. In a symptomatic newborn, targeted or genome-wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome-wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome-wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context.
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