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Johnson K, Erfani H, Maktabi MA, den Veyver IV, Nassef S. Lack of consensus among healthcare professionals at a large academic medical center on the use of exome sequencing for prenatal diagnosis. J Genet Couns 2022; 31:1330-1340. [PMID: 35799470 PMCID: PMC10022483 DOI: 10.1002/jgc4.1607] [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] [Received: 02/19/2021] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
Prenatal exome sequencing (ES) is increasingly used for prenatal diagnosis because emerging data indicate it has incremental diagnostic benefit in pregnancies with fetal anomalies without identified genetic abnormalities by karyotyping and chromosomal microarray analysis. The aim of this study was to evaluate the medical community's attitude toward the clinical utility and use of exome sequencing for prenatal diagnosis and to address differences in attitudes and responses by type of practitioner, level of training, and years passed since last full-time training. We analyzed the answers of 109 trainees and professionals in the fields of genetic counseling, laboratory science, and medicine to an online survey addressing these topics. Multiple-choice questions asked participants about their awareness of prenatal ES and what genetic test they would choose to order in certain scenarios. Likert-scale questions assessed participants' opinions of statements asserting when prenatal ES should be used for diagnostic testing. Attitude toward the use of prenatal ES statistically differed (p < 0.05) by type of participant and level of training. Practicing genetic counselors and physicians were more selective in their recommendations for prenatal ES than laboratory scientists. Genetic counseling students and practicing genetic counselors felt similarly about indications for the use of prenatal ES, whereas medical students were more liberal in their recommendations for prenatal ES than practicing physicians. This study shows a lack of consensus among the medical community regarding the clinical utility and indications for prenatal ES.
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Affiliation(s)
- Kylie Johnson
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Hadi Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Mohamad Ali Maktabi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Ignatia Van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
- Texas Children’s Hospital, Houston, TX
| | - Salma Nassef
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
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2
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Ong CSB, Fok RW, Tan RCA, Fung SM, Sun S, Ngeow JYY. General practitioners' (GPs) experience, attitudes and needs on clinical genetic services: a systematic review. Fam Med Community Health 2022; 10:fmch-2021-001515. [PMID: 36450397 PMCID: PMC9717000 DOI: 10.1136/fmch-2021-001515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The proliferation and growing demands of genetic testing are anticipated to revolutionise medical practice. As gatekeepers of healthcare systems, general practitioners (GPs) are expected to play a critical role in the provision of clinical genetic services. This paper aims to review existing literature on GPs' experience, attitudes and needs towards clinical genetic services. DESIGN A systematic mixed studies review of papers published between 2010 and 2022. ELIGIBILITY CRITERIA The inclusion criterion was peer-reviewed articles in English and related to GPs' experience, views and needs on any genetic testing. INFORMATION SOURCES The PubMed, PsycINFO, Cochrane, EMBASE databases were searched using Mesh terms, Boolean and wildcards combinations to identify peer-reviewed articles published from 2010 to 2022. Study quality was assessed using Mixed Methods Appraisal Tool. Only articles that fulfilled the inclusion criteria were selected. A thematic meta-synthesis was conducted on the final sample of selected articles to identify key themes. RESULTS A total of 62 articles were included in the review. Uncertainty over GPs' role in providing genetic services were attributed by the lack of confidence and time constraints and rarity of cases may further exacerbate their reluctance to shoulder an expanded role in clinical genetics. Although educational interventions were found to increasing GPs' knowledge and confidence to carry out genetic tasks, varied interest on genetic testing and preference for a shared care model with other genetic health professionals have resulted in minimal translation to clinical adoption. CONCLUSION This review highlights the need for deeper exploration of GPs' varied experience and attitudes towards clinical genetic services to better facilitate targeted intervention in the adoption of clinical genetics.
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Affiliation(s)
- Cheryl Siow Bin Ong
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Rose Wai‑Yee Fok
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ryo Chee Ann Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Shirley Sun
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Joanne Yuen Yie Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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3
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Blout Zawatsky CL, Leonhard JR, Bell M, Moore MM, Petry NJ, Platt DM, Green RC, Hajek C, Christensen KD. Workforce Considerations When Building a Precision Medicine Program. J Pers Med 2022; 12:jpm12111929. [PMID: 36422106 PMCID: PMC9692406 DOI: 10.3390/jpm12111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/11/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
This paper describes one healthcare system’s approach to strategically deploying genetic specialists and pharmacists to support the implementation of a precision medicine program. In 2013, Sanford Health initiated the development of a healthcare system-wide precision medicine program. Here, we report the necessary staffing including the genetic counselors, genetic counseling assistants, pharmacists, and geneticists. We examined the administrative and electronic medical records data to summarize genetic referrals over time as well as the uptake and results of an enterprise-wide genetic screening test. Between 2013 and 2020, the number of genetic specialists employed at Sanford Health increased by 190%, from 10.1 full-time equivalents (FTEs) to 29.3 FTEs. Over the same period, referrals from multiple provider types to genetic services increased by 423%, from 1438 referrals to 7517 referrals. Between 2018 and 2020, 11,771 patients received a genetic screening, with 4% identified with potential monogenic medically actionable predisposition (MAP) findings and 95% identified with at least one informative pharmacogenetic result. Of the MAP-positive patients, 85% had completed a session with a genetics provider. A strategic workforce staffing and deployment allowed Sanford Health to manage a new genetic screening program, which prompted a large increase in genetic referrals. This approach can be used as a template for other healthcare systems interested in the development of a precision medicine program.
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Affiliation(s)
- Carrie L. Blout Zawatsky
- Genomes2People, Department of Medicine (Genetics), Brigham and Women’s Hospital, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Precision Population Health, Ariadne Labs, Boston, MA 02115, USA
- The MGH Institute of Health Professions, Boston, MA 02115, USA
| | - Jennifer R. Leonhard
- Department of Genetics, Sanford Health, Bemidji, MN 56601, USA
- Correspondence: ; Tel.: +1-218-333-5068
| | - Megan Bell
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD 57117, USA
| | | | - Natasha J. Petry
- Department of Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58105, USA
| | - Dylan M. Platt
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD 57117, USA
| | - Robert C. Green
- Genomes2People, Department of Medicine (Genetics), Brigham and Women’s Hospital, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Precision Population Health, Ariadne Labs, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine Hajek
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57117, USA
- Helix, San Mateo, CA 94401, USA
| | - Kurt D. Christensen
- Broad Institute, Cambridge, MA 02142, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
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Wittowski CL, Clowes Candadai S, Perrone ME, Gallego DF, Conta JH, Dickerson JA. Evaluation of Exome Sequencing Criteria for Hospital Stewardship and Insurance Authorization at a Pediatric Hospital. Arch Pathol Lab Med 2022; 146:107-111. [DOI: 10.5858/arpa.2020-0572-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/06/2022]
Abstract
Context.—
Genomic molecular testing practices in a pediatric tertiary care institution can vary in utility by patient indication.
Objective.—
To evaluate exome sequencing (ES) ordering practices and the effects of applying criteria to support ES stewardship. Exome sequencing can provide molecular diagnostic information for patients with known or suspected genetic diseases, but it is relatively expensive, and the cost is often borne by patients, institutions, and payers.
Design.—
We examined ordering patterns of ES approved by board-certified geneticists at our tertiary pediatric care center, as well as preauthorization outcomes for ES requests. We compared positivity rates among patients by patient phenotype, composite insurance coverage criteria, and insurance preauthorization outcome.
Results.—
Patients who met composite coverage criteria were more likely to receive a positive result from ES compared to patients who did not meet composite coverage criteria, though this trend was not statistically significant. There was no significant difference in ES results between patients who were denied or not denied preauthorization by insurance payers.
Conclusions.—
Insurance payers should consider implementing and/or expanding coverage criteria for ES, and institutions should implement stewardship programs to support appropriate ES practices.
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Affiliation(s)
- Claire L. Wittowski
- From the Department of Laboratories (Wittowski, Clowes Candadai, Perrone, Gallego, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
| | - Sarah Clowes Candadai
- From the Department of Laboratories (Wittowski, Clowes Candadai, Perrone, Gallego, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
- Patient-Centered Laboratory Utilization Guidance Services (PLUGS) (Clowes Candadai, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
| | - Marie E. Perrone
- From the Department of Laboratories (Wittowski, Clowes Candadai, Perrone, Gallego, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
- The Department of Laboratory Medicine, University of Washington, Seattle (Perrone, Gallego, Dickerson)
| | - Daniel F. Gallego
- From the Department of Laboratories (Wittowski, Clowes Candadai, Perrone, Gallego, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
- The Department of Laboratory Medicine, University of Washington, Seattle (Perrone, Gallego, Dickerson)
| | - Jessie H. Conta
- From the Department of Laboratories (Wittowski, Clowes Candadai, Perrone, Gallego, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
- Patient-Centered Laboratory Utilization Guidance Services (PLUGS) (Clowes Candadai, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
| | - Jane A. Dickerson
- From the Department of Laboratories (Wittowski, Clowes Candadai, Perrone, Gallego, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
- Patient-Centered Laboratory Utilization Guidance Services (PLUGS) (Clowes Candadai, Conta, Dickerson), Seattle Children's Hospital, Seattle, Washington
- The Department of Laboratory Medicine, University of Washington, Seattle (Perrone, Gallego, Dickerson)
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Berrios C, Hurley EA, Willig L, Thiffault I, Saunders C, Pastinen T, Goggin K, Farrow E. Challenges in genetic testing: clinician variant interpretation processes and the impact on clinical care. Genet Med 2021; 23:2289-2299. [PMID: 34257423 DOI: 10.1038/s41436-021-01267-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Efforts have been made to standardize laboratory variant interpretation, but clinicians are ultimately tasked with clinical correlation and application of genetic test results in patient care. This study aimed to explore processes clinicians utilize when reviewing and returning genetic test results, and how they impact patient care. METHODS Medical geneticists, genetic counselors, and nongenetics clinicians from two Midwestern states completed surveys (n = 98) and in-depth interviews (n = 29) on practices of reviewing and returning genetic test results. Retrospective chart review (n = 130) examined discordant interpretations and the impact on care. RESULTS Participants reported variable behaviors in both reviewing and returning results based on factors such as confidence, view of role, practice setting, and relationship with the lab. Providers did not report requesting changes to variant classifications from laboratories, but indicated relaying conflicting classifications to patients in some cases. Chart reviews revealed medically impactful differences in interpretation between laboratories and clinicians in 18 (13.8%) records. CONCLUSION Clinician practices for reviewing and integrating genetic test results into patient care vary within and between specialties and impact patient care. Strategies to better incorporate both laboratory and clinician expertise into interpretation of genetic results could result in improved care across providers and settings.
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Affiliation(s)
- Courtney Berrios
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA. .,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
| | - Emily A Hurley
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, USA.,University of Kansas Medical Center, Kansas City, MO, USA
| | - Laurel Willig
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Isabelle Thiffault
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Carol Saunders
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tomi Pastinen
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kathy Goggin
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Emily Farrow
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
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