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Pearce A, Mitchell LA, Best S, Young MA, Terrill B. Publics' knowledge of, attitude to and motivation towards health-related genomics: a scoping review. Eur J Hum Genet 2024; 32:747-758. [PMID: 38316954 PMCID: PMC11220043 DOI: 10.1038/s41431-024-01547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/12/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
The use of genomic data in research and genomic information in clinical care is increasing as technologies advance and sequencing costs decrease. Using Rogers' Diffusion of Innovation (DOI) theory as a framework we reviewed recent literature examining publics' current knowledge of, attitude to, and motivation towards health-related genomics in clinical and research settings. The population of interest was described as 'publics' to denote the heterogeneity of 'the public'. Eligible studies were published in English between 2016-2022. We retrieved 1657 records, with 278 full-text reviewed against the eligibility criteria and concept definitions. In total, 99 articles were included in the review and descriptive numerical summaries were collated. Knowledge literature was categorized using deductive thematic analysis. For attitude and motivation, literature was coded using an analytic framework developed by the authors. There was wide variability in concept definition and measurement across studies. Overall, there was general positivity about genomics, with high awareness but little familiarity or factual knowledge. Publics had high expectations of genomics and perceived that it could provide them with information for their future. Only a few key attitudes were found to be important as motivators or barriers for participation in genomics; these were related to personal and clinical utility of the information. Context was often missing from studies, decreasing the utility of findings for implementation or public engagement. Future research would benefit by using theory-driven approaches to assess relevant publics' knowledge and attitudes of specific contexts or applications to support genomic implementation and informed decision-making.
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Affiliation(s)
- Angela Pearce
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia.
| | - Lucas A Mitchell
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
| | - Mary-Anne Young
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
| | - Bronwyn Terrill
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
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Floyd KJ, Wossenseged F, Buscetta AJ, Fasaye GA, Bonham VL. Views of adults living with sickle cell disease on the theoretical return of secondary genomic findings. Genet Med 2024; 26:100993. [PMID: 37811899 PMCID: PMC10859184 DOI: 10.1016/j.gim.2023.100993] [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: 06/29/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023] Open
Abstract
PURPOSE Although the body of research investigating research participants' opinions on the return of actionable secondary genomic findings grows, there has been limited study of individuals with genetic conditions, such as sickle cell disease (SCD). It is imperative that the views of diverse research participants on return of results (RoR) be investigated and rooted in the context of advancing health equity in genomics research. METHODS We conducted qualitative, semi-structured interviews with 30 adults living with SCD with differing insurance coverages and utilized a directed content analysis to derive themes. RESULTS Study findings show that living with SCD is a key influence on views of RoR. Participants were in favor of RoR while expressing concern regarding the burden RoR would place on their SCD management. Respondents also expressed an expectation for researchers to devote resources toward seeking ancillary care downstream and discussed how barriers faced when navigating SCD would inform their access to ancillary care. CONCLUSION Research participants living with chronic genetic conditions such as SCD are generally in favor of RoR but anticipate experiencing barriers to care similar to those faced navigating their SCD. Understanding the views of diverse cohorts on RoR will help researchers better understand downstream barriers participants may face.
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Affiliation(s)
- K Jameson Floyd
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Faeben Wossenseged
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Ashley J Buscetta
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Grace-Ann Fasaye
- Center for Cancer Research, Genetics Branch, National Cancer Institute. National Institutes of Health, Bethesda, MD
| | - Vence L Bonham
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.
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Meiser B, Butow P, Davies G, Napier CE, Schlub TE, Bartley N, Juraskova I, Ballinger ML, Thomas DM, Best MC. Psychological predictors of cancer patients' and their relatives' attitudes towards the return of genomic sequencing results. Eur J Med Genet 2022; 65:104516. [PMID: 35487418 DOI: 10.1016/j.ejmg.2022.104516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/02/2022] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
Abstract
This study assessed the psychological predictors of attitudes toward the return of germline genomic sequencing results in cancer patients and their biological relatives with a likely genetic basis for their cancer diagnosis, who completed a questionnaire prior to undergoing genomic sequencing. Of 602 probands and relatives, 94% of probands and 89% of relatives thought people would like to be informed about single-gene conditions for which there is prevention or treatment. Amongst relatives, this view was associated with higher perceived susceptibility and self-efficacy. Probands (66%) and relatives (59%) thought people would be interested in learning about single-gene conditions for which there is no prevention or treatment. Amongst probands, this view was associated with lower tolerance of uncertainty and amongst relatives with higher self-efficacy. Probands (92%) and relatives (90%) thought people would like to be informed about polygenic conditions that can have a major impact on health. Amongst probands this view was associated with lower perceived susceptibility of cancer recurrence, and amongst relatives, with higher perceived susceptibility and self-efficacy. Probands (86%) and relatives (86%) thought that people would like to be informed about polygenic conditions that can have a lower impact on health, and this view was associated with a lower perceived susceptibility of recurrence amongst probands. Inconclusion, these findings show that individuals' attitudes about the return of results depend on the perceived utility of different types of tests. Therefore, individuals need to gain a clear understanding of test utility, and appropriate consent processes are required to achieve informed choices.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Kensington, NSW, 2032, Australia.
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney NSW, 2006, Australia
| | - Grace Davies
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney NSW, 2006, Australia
| | - Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Nicci Bartley
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney NSW, 2006, Australia
| | - Ilona Juraskova
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney NSW, 2006, Australia
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, University of NSW, Kensington, NSW, 2032, Australia
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia; St Vincent's Clinical School, University of NSW, Kensington, NSW, 2032, Australia
| | - Megan C Best
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney NSW, 2006, Australia
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Return of individual research results from genomic research: A systematic review of stakeholder perspectives. PLoS One 2021; 16:e0258646. [PMID: 34748551 PMCID: PMC8575249 DOI: 10.1371/journal.pone.0258646] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.
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Beil A, Hornsby W, Uhlmann WR, Aatre R, Arscott P, Wolford B, Eagle KA, Yang B, McNamara J, Willer C, Roberts JS. Disclosure of clinically actionable genetic variants to thoracic aortic dissection biobank participants. BMC Med Genomics 2021; 14:66. [PMID: 33648514 PMCID: PMC7923508 DOI: 10.1186/s12920-021-00902-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Disclosure of pathogenic variants to thoracic aortic dissection biobank participants was implemented. The impact and costs, including confirmatory genetic testing in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory, were evaluated. METHODS We exome sequenced 240 cases with thoracic aortic dissection and 258 controls, then examined 11 aortopathy genes. Pathogenic variants in 6 aortopathy genes (COL3A1, FBN1, LOX, PRKG1, SMAD3, and TGFBR2) were identified in 26 participants, representing 10.8% of the cohort (26/240). A second research sample was used to validate the initial findings. Mailed letters to participants disclosed that a potentially disease causing DNA alteration had been identified (neither the gene nor variant was disclosed). Participants were offered clinical genetic counseling and confirmatory genetic testing in a CLIA laboratory. RESULTS Excluding 6 participants who were deceased or lost to follow-up, 20 participants received the disclosure letter, 10 of whom proceeded with genetic counseling, confirmatory genetic testing, and enrolled in a survey study. Participants reported satisfaction with the letter (4.2 ± 0.7) and genetic counseling (4.4 ± 0.4; [out of 5, respectively]). The psychosocial impact was characterized by low decisional regret (11.5 ± 11.6) and distress (16.0 ± 4.2, [out of 100, respectively]). The average cost for 26 participants was $400, including validation and sending letters. The average cost for those who received genetic counseling and CLIA laboratory confirmation was $605. CONCLUSIONS Participants were satisfied with the return of clinically significant biobank genetic results and CLIA laboratory testing; however, the process required significant time and resources. These findings illustrate the trade-offs involved for researchers considering returning research genetic results.
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Affiliation(s)
- Adelyn Beil
- Division of Pediatric Genetics, Metabolism, and Genomic Medicine, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Whitney Hornsby
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA
| | - Wendy R Uhlmann
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109-2029, USA
| | - Rajani Aatre
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA
| | - Patricia Arscott
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA
| | - Brooke Wolford
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Kim A Eagle
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Jennifer McNamara
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA
| | - Cristen Willer
- Department of Internal Medicine, Michigan Medicine, 5804 Medical Science II, 1241 E. Catherine Street, Ann Arbor, MI, 48109-5618, USA.
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
| | - J Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109-2029, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA.
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Wu KHH, Hornsby WE, Klunder B, Krause A, Driscoll A, Kulka J, Bickett-Hickok R, Fellows A, Graham S, Kaleba EO, Hayek SS, Shi X, Sutton NR, Douville N, Mukherjee B, Jamerson K, Brummett CM, Willer CJ. Exposure and risk factors for COVID-19 and the impact of staying home on Michigan residents. PLoS One 2021; 16:e0246447. [PMID: 33556117 PMCID: PMC7870003 DOI: 10.1371/journal.pone.0246447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/19/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has had a substantial impact on clinical care and lifestyles globally. The State of Michigan reports over 80,000 positive COVID-19 tests between March 1, 2020 and July 29, 2020. We surveyed 8,041 Michigan Medicine biorepository participants in late June 2020. We found that 55% of COVID-19 cases reported no known exposure to family members or to someone outside the house diagnosed with COVID-19. A significantly higher rate of COVID-19 cases were employed as essential workers (45% vs 19%, p = 9x10-12). COVID-19 cases reporting a fever were more likely to require hospitalization (categorized as severe; OR = 4.4 [95% CI: 1.6-12.5, p = 0.005]) whereas respondents reporting rhinorrhea was less likely to require hospitalization (categorized as mild-to-moderate; OR = 0.16 [95% CI: 0.04-0.73, p = 0.018]). African-Americans reported higher rates of being diagnosed with COVID-19 (OR = 4.0 [95% CI: 2.2-7.2, p = 5x10-6]), as well as higher rates of exposure to family or someone outside the household diagnosed with COVID-19, an annual household income < $40,000, living in rental housing, and chronic diseases. During the Executive Order in Michigan, African Americans, women, and the lowest income group reported worsening health behaviors and higher overall concern for the potential detrimental effects of the pandemic. The higher risk of contracting COVID-19 observed among African Americans may be due to the increased rates of working as essential employees, lower socioeconomic status, and exposure to known positive cases. Continued efforts should focus on COVID-19 prevention and mitigation strategies, as well as address the inequality gaps that result in higher risks for both short-term and long-term health outcomes.
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Affiliation(s)
- Kuan-Han H. Wu
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Whitney E. Hornsby
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Bethany Klunder
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Amelia Krause
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Anisa Driscoll
- Data Office for Clinical & Translational Research, Michigan Medicine Office of Research, Ann Arbor, MI, United States of America
- Precision Health Initiative, University of Michigan, Ann Arbor, MI, United States of America
| | - John Kulka
- Precision Health Initiative, University of Michigan, Ann Arbor, MI, United States of America
| | - Ryan Bickett-Hickok
- Precision Health Initiative, University of Michigan, Ann Arbor, MI, United States of America
| | - Austin Fellows
- Precision Health Initiative, University of Michigan, Ann Arbor, MI, United States of America
| | - Sarah Graham
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Erin O. Kaleba
- Data Office for Clinical & Translational Research, Michigan Medicine Office of Research, Ann Arbor, MI, United States of America
| | - Salim S. Hayek
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Nadia R. Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Nicholas Douville
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI, United States of America
| | - Kenneth Jamerson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Chad M. Brummett
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Cristen J. Willer
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, United States of America
- * E-mail:
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