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Fehlberg Z, Best S, Long JC, Theodorou T, Pope C, Hibbert P, Williams S, Freeman L, Righetti S, Archibald AD, Braithwaite J. Scaling-up and future sustainability of a national reproductive genetic carrier screening program. NPJ Genom Med 2023; 8:18. [PMID: 37524740 PMCID: PMC10390466 DOI: 10.1038/s41525-023-00357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/01/2023] [Indexed: 08/02/2023] Open
Abstract
An understanding of factors influencing implementation is essential to realise the benefits of population-based reproductive genetic carrier screening programs. The aim of this study was to synthesise data collected during the Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission) to track how priorities shifted over time and identify important factors during scaling-up and for sustainment. We used a multi-method qualitative approach to integrate longitudinal project data collected from 10 project committees with 16 semi-structured interviews conducted with study team members. Both datasets were analysed using the Consolidated Framework for Implementation Research (CFIR) to identify constructs of interest within early, mid-point, and future implementation phases. Several CFIR constructs were present across implementation. The complexity of implementation presented challenges that were overcome through a quality-designed and packaged product, formal and informal networks and communication, and access to knowledge and information. Addressing the diverse consumer needs through resources and increasing community and non-genetic speciality engagement remained a priority throughout and for future sustainment. Going forward, further addressing program complexities and securing funding were emphasised. By applying an implementation framework, findings from this study may be useful for future effort towards building and/or sustaining reproductive genetic carrier screening programs.
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Affiliation(s)
- Zoe Fehlberg
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- Australian Genomics Health Alliance, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephanie Best
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia.
- Australian Genomics Health Alliance, Melbourne, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Cancer Centre Dept of Oncology, University of Melbourne, Melbourne, Australia.
| | - Janet C Long
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
| | - Tahlia Theodorou
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hibbert
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sharon Williams
- School of Health & Social Care, Swansea University, Swansea, Wales, UK
| | - Lucinda Freeman
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Sarah Righetti
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Network, Sydney, Australia
| | - Alison D Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- Australian Genomics Health Alliance, Melbourne, Australia
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9
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Archibald AD, McClaren BJ, Caruana J, Tutty E, King EA, Halliday JL, Best S, Kanga-Parabia A, Bennetts BH, Cliffe CC, Madelli EO, Ho G, Liebelt J, Long JC, Braithwaite J, Kennedy J, Massie J, Emery JD, McGaughran J, Marum JE, Boggs K, Barlow-Stewart K, Burnett L, Dive L, Freeman L, Davis MR, Downes MJ, Wallis M, Ferrie MM, Pachter N, Scuffham PA, Casella R, Allcock RJN, Ong R, Edwards S, Righetti S, Lunke S, Lewis S, Walker SP, Boughtwood TF, Hardy T, Newson AJ, Kirk EP, Laing NG, Delatycki MB. The Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission): Design and Implementation. J Pers Med 2022; 12:1781. [PMID: 36579509 PMCID: PMC9698511 DOI: 10.3390/jpm12111781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 01/01/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) provides people with information about their chance of having children with autosomal recessive or X-linked genetic conditions, enabling informed reproductive decision-making. RGCS is recommended to be offered to all couples during preconception or in early pregnancy. However, cost and a lack of awareness may prevent access. To address this, the Australian Government funded Mackenzie’s Mission—the Australian Reproductive Genetic Carrier Screening Project. Mackenzie’s Mission aims to assess the acceptability and feasibility of an easily accessible RGCS program, provided free of charge to the participant. In study Phase 1, implementation needs were mapped, and key study elements were developed. In Phase 2, RGCS is being offered by healthcare providers educated by the study team. Reproductive couples who provide consent are screened for over 1200 genes associated with >750 serious, childhood-onset genetic conditions. Those with an increased chance result are provided comprehensive genetic counseling support. Reproductive couples, recruiting healthcare providers, and study team members are also invited to complete surveys and/or interviews. In Phase 3, a mixed-methods analysis will be undertaken to assess the program outcomes, psychosocial implications and implementation considerations alongside an ongoing bioethical analysis and a health economic evaluation. Findings will inform the implementation of an ethically robust RGCS program.
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Affiliation(s)
- Alison D. Archibald
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Belinda J. McClaren
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jade Caruana
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Australian Genomics, Parkville, VIC 3052, Australia
| | - Erin Tutty
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Emily A. King
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- Bruce Lefroy Centre, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Jane L. Halliday
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Stephanie Best
- Australian Genomics, Parkville, VIC 3052, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Anaita Kanga-Parabia
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Bruce H. Bennetts
- Sydney Genome Diagnostics, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Specialty of Genomic Medicine, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Corrina C. Cliffe
- NSW Health Pathology Randwick Genomics Laboratory, Randwick, NSW 2031, Australia
| | - Evanthia O. Madelli
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Australian Genomics, Parkville, VIC 3052, Australia
| | - Gladys Ho
- Sydney Genome Diagnostics, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Specialty of Genomic Medicine, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Jan Liebelt
- South Australian Clinical Genetics Service, North Adelaide, SA 5006, Australia
- Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
- Repromed, Dulwich, SA 5065, Australia
| | - Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Genomics, Parkville, VIC 3052, Australia
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
- International Society for Quality in Health Care, D02 YY23 Dublin, Ireland
| | - Jillian Kennedy
- Genetic Services of Western Australia, Subiaco, WA 6008, Australia
| | - John Massie
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- Department of Respiratory Medicine, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
- School of Medicine, University of Queensland, St Lucia, QLD 4072, Australia
| | - Justine E. Marum
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
| | - Kirsten Boggs
- Australian Genomics, Parkville, VIC 3052, Australia
- Centre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Department of Clinical Genetics, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Leslie Burnett
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- St Vincent’s Clinical School, University of New South Wales, Darlinghurst, NSW 2010, Australia
- Invitae Australia, Alexandria, NSW 2015, Australia
| | - Lisa Dive
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Lucinda Freeman
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Mark R. Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Nedlands, WA 6009, Australia
- Centre for Medical Research, University of Western Australia, Nedlands, WA 6009, Australia
| | - Martin J. Downes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD 4111, Australia
| | - Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, Hobart, TAS 7000, Australia
- School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Monica M. Ferrie
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Genetic Support Network of Victoria, Parkville, VIC 3052, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Subiaco, WA 6008, Australia
- King Edward Memorial Hospital, Subiaco, WA 6008, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Paul A. Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD 4111, Australia
| | | | - Richard J. N. Allcock
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Nedlands, WA 6009, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Royston Ong
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Samantha Edwards
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Sarah Righetti
- Centre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Department of Pathology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Sharon Lewis
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Tiffany F. Boughtwood
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Australian Genomics, Parkville, VIC 3052, Australia
| | - Tristan Hardy
- Monash IVF Group, Richmond, VIC 3121, Australia
- SA Pathology, Adelaide, SA 5000, Australia
| | - Ainsley J. Newson
- Australian Genomics, Parkville, VIC 3052, Australia
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Edwin P. Kirk
- NSW Health Pathology Randwick Genomics Laboratory, Randwick, NSW 2031, Australia
- Centre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Nigel G. Laing
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Nedlands, WA 6009, Australia
- Centre for Medical Research, University of Western Australia, Nedlands, WA 6009, Australia
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Martin B. Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- Bruce Lefroy Centre, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
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11
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Righetti S, Dive L, Archibald AD, Freeman L, McClaren B, Kanga-Parabia A, Delatycki MB, Laing NG, Kirk EP, Newson AJ. Correspondence on "Screening for autosomal recessive and X-linked conditions during pregnancy and preconception: a practice resource of the American College of Medical Genetics and Genomics (ACMG)" by Gregg et al. Genet Med 2022; 24:1158-1161. [PMID: 35168887 DOI: 10.1016/j.gim.2022.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Sarah Righetti
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Lisa Dive
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.
| | - Alison D Archibald
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lucinda Freeman
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Belinda McClaren
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anaita Kanga-Parabia
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nigel G Laing
- UWA Centre for Medical Research, University of Western Australia, Nedlands, Western Australia, Australia; Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
| | - Edwin P Kirk
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia; NSW Health Pathology East Genomics Laboratory, Randwick, New South Wales, Australia
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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