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Garner M, Rajani B, Vaidya P, Dayeh SA, Cecchi AC, Miyake CC, Huff V, Wanat M, Wang E, Kurzlechner LM, Landstrom AP, An D, Liang Y, Moulik M, Wong TC, Cunha SR, Cannon A, Holt RL, Milewicz DM, Prakash SK. The UTHealth Houston Adult Cardiovascular Genomics Certificate Program: Efficacy and Impact on Healthcare Professionals. RESEARCH SQUARE 2024:rs.3.rs-4469272. [PMID: 38947076 PMCID: PMC11213163 DOI: 10.21203/rs.3.rs-4469272/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background The demand for genetic services has outpaced the availability of resources, challenging clinicians untrained in genetic integration into clinical decision-making. The UTHealth Adult Cardiovascular Genomics Certificate (CGC) program trains non-genetic healthcare professionals to recognize, assess, and refer patients with heritable cardiovascular diseases. This asynchronous online course includes 24 modules in three tiers of increasing complexity, using realistic clinical scenarios, interactive dialogues, quizzes, and tests to reinforce learning. We hypothesized that the CGC will increase genomic competencies in this underserved audience and encourage applying genomic concepts in clinical practice. Methods Required course evaluations include pre- and post-assessments, knowledge checks in each module, and surveys for module-specific feedback. After 6 months, longitudinal feedback surveys gathered data on the long-term impact of the course on clinical practice and conducted focused interviews with learners. Results The CGC was accredited in September 2022. Principal learners were nurses (24%), nurse practitioners (21%), physicians (16%), and physician assistants. Scores of 283 learners in paired pre- and post-assessments increased specific skills related to recognizing heritable diseases, understanding inheritance patterns, and interpreting genetic tests. Interviews highlighted the CGC's modular structure and linked resources as key strengths. Learners endorsed confidence to use genetic information in clinical practice, such as discussing genetic concepts and risks with patients and referring patients for genetic testing. Learners were highly likely to recommend the CGC to colleagues, citing its role in enhancing heritable disease awareness. Conclusions The CGC program effectively empowers non-genetic clinicians to master genomic competencies, fostering collaboration to prevent deaths from heritable cardiovascular diseases, and potentially transforming healthcare education and clinical practice.
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Affiliation(s)
| | | | | | | | | | | | - Vicki Huff
- University of Texas MD Anderson Cancer Center
| | | | | | | | | | - Daniel An
- University of Texas Health Science Center at Houston
| | - Yafen Liang
- University of Texas Health Science Center at Houston
| | | | | | - Shane R Cunha
- University of Texas Health Science Center at Houston
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Ogamba CF, Roberts AA, Ajudua SC, Akinwale MO, Jeje FM, Ibe FO, Afolayan MM, Kuyinu YA. Perceptions of Nigerian medical students regarding their preparedness for precision medicine: a cross-sectional survey in Lagos, Nigeria. BMC MEDICAL EDUCATION 2023; 23:879. [PMID: 37978519 PMCID: PMC10656926 DOI: 10.1186/s12909-023-04841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Advances in precision medicine in Nigeria suggest improving genomics education and competency among healthcare practitioners to facilitate clinical translation. Due to the scarcity of research in this area, this study aimed to assess Nigerian medical students' perceptions about their preparedness to integrate precision medicine into their future clinical practice. METHODS This was an institution-based cross-sectional study of medicine and surgery students in their clinical years attending the two fully accredited colleges of medicine in Lagos, Nigeria, between April and October 2022 using an adapted tool administered via Google Forms. The survey assessed their awareness, perceptions about knowledge, ability, and attitudes toward precision medicine, ethical concerns, and perceptions about their education in precision medicine. Multivariate linear regression models were used to assess factors associated with students' perceptions of their knowledge, ability, and attitudes. RESULTS A total of 300 students completed the questionnaires with a response rate of 40%. Awareness of genomic medicine terminology was high (92.0%). Responses to knowledge and ability questions revealed notable gaps, however, respondents had positive attitude scores overall. Higher medical school year was independently associated with lower knowledge (ptrend = 0.003) and ability (ptrend = 0.005) scores, and knowledge score was independently associated with a higher ability score (β: 0.76 95%CI: 0.67, 0.84; p < 0.001). Attitude scores significantly increased with increasing medical school year (ptrend = 0.04). The respondents mostly indicated concerns about government and corporate bodies' misuse of genomic data (35.7%) and the widening of socioeconomic disparities (34.0%). Although 65.0% of the respondents thought it important to learn about precision medicine, only 11.3% felt that their education had adequately prepared them for precision medicine, knew who to ask questions regarding genomic testing (10.7%), and felt their professors had encouraged the use of precision medicine (10.3%). CONCLUSION Despite high awareness of precision medicine terminology and overall positive attitudes, our findings highlight gaps in knowledge and ability to integrate genomics into the care of patients and a need to improve precision medicine education among Nigerian medical students.
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Affiliation(s)
- Chibuzor F Ogamba
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Alero A Roberts
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sharon C Ajudua
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Fuhad M Jeje
- Faculty of Clinical Sciences, Lagos State University College of Medicine, Lagos, Nigeria
| | - Festus O Ibe
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Moses M Afolayan
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yetunde A Kuyinu
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
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Kudron EL, Raghavan S, Lee YM, Lowery JT. Primary care providers' preferences for the communication and management of actionable genomic findings from a research biobank. GENETICS IN MEDICINE OPEN 2023; 1:100830. [PMID: 38287920 PMCID: PMC10824104 DOI: 10.1016/j.gimo.2023.100830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Purpose Little is known about non-genetics health care specialists' attitudes toward the return and utilization of actionable genomic results from a research biobank. We surveyed primary care providers (PCPs) to explore their perspectives on these results and their preferences for return. Methods We administered a paper and web-based 27-question survey to PCPs residing locally and caring for adult patients. Recruitment was conducted in person and by email, focusing on PCPs likely to interact with results generated by our institution's biobank. Results Of the ~482 PCPs contacted, 77 (16%) returned surveys. Although most respondents (90%) prefer that a genetics specialist be involved in communicating biobank-generated genomic results to patients, about 40% of respondents reported that a PCP shares the responsibility to discuss these results along with other specialists. A majority of respondents (74%) felt uncomfortable communicating these results to patients. However, respondents reported significantly greater comfort with this process when offered targeted educational resources (62% with vs 10% without resources; P < 10-5). Conclusion PCPs recognize the need to engage with their patients' biobank-generated genomic results but feel uncomfortable in doing so. Relevant resources are needed to improve PCPs' confidence in the use of these types of results to affect patient care.
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Affiliation(s)
- Elizabeth L. Kudron
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO
- Colorado Center for Personalized Medicine, University of Colorado, Aurora, CO
- Section of General Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Sridharan Raghavan
- Colorado Center for Personalized Medicine, University of Colorado, Aurora, CO
- VA Eastern Colorado Health Care System, Aurora, CO
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Yee Ming Lee
- Colorado Center for Personalized Medicine, University of Colorado, Aurora, CO
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Jan T. Lowery
- Colorado Center for Personalized Medicine, University of Colorado, Aurora, CO
- School of Public Health and Cancer Center, University of Colorado, Aurora, CO
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Preys CL, Blout Zawatsky CL, Massmann A, Heukelom JV, Green RC, Hajek C, Hickingbotham MR, Zoltick ES, Schultz A, Christensen KD. Attitudes about pharmacogenomic testing vary by healthcare specialty. Pharmacogenomics 2023; 24:539-549. [PMID: 37458095 PMCID: PMC10621761 DOI: 10.2217/pgs-2023-0039] [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: 03/06/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Aim: To understand how attitudes toward pharmacogenomic (PGx) testing among healthcare providers varies by specialty. Methods: Providers reported comfort ordering PGx testing and its perceived utility on web-based surveys before and after genetics education. Primary quantitative analyses compared primary care providers (PCPs) to specialty providers at both timepoints. Results: PCPs were more likely than specialty care providers to rate PGx testing as useful at both timepoints. Education increased comfort ordering PGx tests, with larger improvements among PCPs than specialty providers. Over 90% of cardiology and internal medicine providers rated PGx testing as useful at pre- and post-education. Conclusion: PCPs overwhelmingly perceive PGx to be useful, and provider education is particularly effective for improving PCPs' confidence. Education for all specialties will be essential to ensure appropriate integration into routine practice.
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Affiliation(s)
- Charlene L Preys
- MGH Institute of Health Professions, Charlestown, MA 02129, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Carrie L Blout Zawatsky
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Ariadne Labs, Boston, MA 02215, USA
| | - Amanda Massmann
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermilion, SD 57069, USA
| | - Joel Van Heukelom
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermilion, SD 57069, USA
| | - Robert C Green
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Ariadne Labs, Boston, MA 02215, USA
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Catherine Hajek
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Helix OpCo, LLC, San Diego, CA 92121, USA
| | - Madison R Hickingbotham
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Emilie S Zoltick
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - April Schultz
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermilion, SD 57069, USA
| | - Kurt D Christensen
- Ariadne Labs, Boston, MA 02215, USA
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA 02115, USA
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Shafqat S, Naseem M, Rana M, Naseem Z, Ahmed W, Musharraf MD, Zaheer A, Shaikh AS, Musharraf MB, Niaz M, Khan S, Irfan R, Imran A, Mehmood Z. Knowledge, attitude, and perceptions about cancer genetic testing in clinical practice in Karachi, Pakistan. J Community Genet 2023:10.1007/s12687-023-00650-2. [PMID: 37147454 DOI: 10.1007/s12687-023-00650-2] [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: 10/03/2022] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
Healthcare professionals (HCP) play an important role in the practical application of genetic screening tests but often feel inadequately prepared for cancer genetic testing (CGT) in clinical care. As the complexity of gene-related malignancies increases, it demands HCPs' preparedness to cater to patients' needs. Therefore, the aim of our study is to assess the knowledge, attitude, and practices of HCPs in Pakistan regarding the application of cancer genetics. Our cross-sectional survey was conducted from April 2022 to June 2022 amongst HCPs at a private and a governmental institution in Karachi, Pakistan. Non-probability random convenience sampling was used to select the population; however. non-clinical HCPs, as well as Interns, were excluded from our study. A total of 210 HCPs, 56.7% (119) bearing an experience of over 5 years of clinical experience, were included in this study. Most respondents from both hospitals deemed their knowledge inadequate, with only 2% (2) and 1.8% (2) being extremely knowledgeable, respectively. 68.6% (144) HCPs displayed a positive attitude towards CGT, with 55.2% (116) participants perceiving CGT in a positive light. As compared to the private sector, significantly more HCPs in the public sector dedicated ≥ 5 h/week for CME (P = 0.006), and were better prepared to counsel patients (P = 0.021) and interpret results concerning CGT (P = 0.020). Additionally, screening tests for specific cancer types were popularly considered a worthwhile avenue of investment to improve the current state of CGT in our healthcare system [47.6% (N = 100)]. Demonstrating a lack of knowledge among Pakistani doctors, our results call upon the need for additional training concerning CGT in both the public and private sectors alike. Understanding specific gaps in knowledge may further help enhance post-graduate training programs and eventually lead to effective incorporation of CGT into our healthcare setting.
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Affiliation(s)
| | | | - Masooma Rana
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Zehra Naseem
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Warda Ahmed
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | - Arisha Zaheer
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | | | - Mahnoor Niaz
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Saifullah Khan
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Rabiya Irfan
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Areeba Imran
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Zahid Mehmood
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
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Jia T, Wu C, Hu X, Li S, Zhang X, Cai Y, Chen J, Shi L, Lu CY, Nie X. Physicians' Knowledge, Attitude, and Experience of Pharmacogenomic Testing in China. J Pers Med 2022; 12:jpm12122021. [PMID: 36556242 PMCID: PMC9783535 DOI: 10.3390/jpm12122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: As prescribers, physicians play a decisive role in applying and promoting pharmacogenomic (PGx) testing in clinical practices. So far, little is known about physicians' perspectives on PGx testing in China. The aim of this study was to assess physicians' knowledge of, attitude towards, and experience of PGx testing in China. (2) Methods: A 39-question online survey was developed. Participants were physicians recruited through two platforms, MEDLINKER and "Dazhuanjia". (3) Results: A total of 450 respondents completed the survey and 366 questionnaires were eligible for analysis based on the inclusion criteria. Among all included physicians, 275 (75.1%) had heard of PGx testing before. More than half rated their knowledge of PGx testing as "Fair" (61.5%) while 20.0% chose "Excellent" or "Good" and 18.6% chose "Poor" or "Terrible". "Guidelines, consensus, and treatment paths for disease diagnosis and treatment" (72.7%) were the most preferred sources of information about PGx testing. Respondents were confident in their personal capacity to conduct PGx, with an average score of 3.30 ± 0.09 (out of 5.00). Most respondents (75.6%) believed that PGx could "help to improve efficacy and reduce the incidence of adverse reactions". Targeted cancer therapy (score 78.95 ± 1.26 out of 100) was considered the field where PGx testing had its highest value. Lack of professionals and knowledge (n = 186, 67.6%), high costs of testing (n = 170, 61.8%), and lack of hospitals to offer PGx testing (n = 166, 60.4%) were identified as the primary obstacles to increasing the uptake of PGx testing in China. Academic conference (n = 213, 72.4%) was considered the most efficient way for physicians to obtain information about PGx testing. (4) Conclusions: Physicians in China have poor knowledge about PGx testing; nonetheless, they generally had confidence in their capacity to order PGx testing and positive attitudes towards the use of PGx testing in routine clinical practices. Future efforts to promote the uptake of PGx testing should focus on foundational education and practical training.
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Affiliation(s)
- Tong Jia
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Caiying Wu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Xiaowen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Sicong Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Xinyi Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Yuchun Cai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Jing Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
- Correspondence: ; Tel.: +86-10-8280-5880
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7
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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; 12:1929. [PMID: 36422106 PMCID: PMC9692406 DOI: 10.3390/jpm12111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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
| | | | - 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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8
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McKnight D, Morales A, Hatchell KE, Bristow SL, Bonkowsky JL, Perry MS, Berg AT, Borlot F, Esplin ED, Moretz C, Angione K, Ríos-Pohl L, Nussbaum RL, Aradhya S, Levy RJ, Parachuri VG, Lay-Son G, de Montellano DJDO, Ramirez-Garcia MA, Benítez Alonso EO, Ziobro J, Chirita-Emandi A, Felix TM, Kulasa-Luke D, Megarbane A, Karkare S, Chagnon SL, Humberson JB, Assaf MJ, Silva S, Zarroli K, Boyarchuk O, Nelson GR, Palmquist R, Hammond KC, Hwang ST, Boutlier SB, Nolan M, Batley KY, Chavda D, Reyes-Silva CA, Miroshnikov O, Zuccarelli B, Amlie-Wolf L, Wheless JW, Seinfeld S, Kanhangad M, Freeman JL, Monroy-Santoyo S, Rodriguez-Vazquez N, Ryan MM, Machie M, Guerra P, Hassan MJ, Candee MS, Bupp CP, Park KL, Muller E, Lupo P, Pedersen RC, Arain AM, Murphy A, Schatz K, Mu W, Kalika PM, Plaza L, Kellogg MA, Lora EG, Carson RP, Svystilnyk V, Venegas V, Luke RR, Jiang H, Stetsenko T, Dueñas-Roque MM, Trasmonte J, Burke RJ, Hurst AC, Smith DM, Massingham LJ, Pisani L, Costin CE, Ostrander B, Filloux FM, Ananth AL, Mohamed IS, Nechai A, Dao JM, Fahey MC, Aliu E, Falchek S, Press CA, Treat L, Eschbach K, Starks A, Kammeyer R, Bear JJ, Jacobson M, Chernuha V, Meibos B, Wong K, Sweney MT, Espinoza AC, Van Orman CB, Weinstock A, Kumar A, Soler-Alfonso C, Nolan DA, Raza M, Rojas Carrion MD, Chari G, Marsh ED, Shiloh-Malawsky Y, Parikh S, Gonzalez-Giraldo E, Fulton S, Sogawa Y, Burns K, Malets M, Montiel Blanco JD, Habela CW, Wilson CA, Guzmán GG, Pavliuk M. Genetic Testing to Inform Epilepsy Treatment Management From an International Study of Clinical Practice. JAMA Neurol 2022; 79:1267-1276. [PMID: 36315135 PMCID: PMC9623482 DOI: 10.1001/jamaneurol.2022.3651] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Importance It is currently unknown how often and in which ways a genetic diagnosis given to a patient with epilepsy is associated with clinical management and outcomes. Objective To evaluate how genetic diagnoses in patients with epilepsy are associated with clinical management and outcomes. Design, Setting, and Participants This was a retrospective cross-sectional study of patients referred for multigene panel testing between March 18, 2016, and August 3, 2020, with outcomes reported between May and November 2020. The study setting included a commercial genetic testing laboratory and multicenter clinical practices. Patients with epilepsy, regardless of sociodemographic features, who received a pathogenic/likely pathogenic (P/LP) variant were included in the study. Case report forms were completed by all health care professionals. Exposures Genetic test results. Main Outcomes and Measures Clinical management changes after a genetic diagnosis (ie, 1 P/LP variant in autosomal dominant and X-linked diseases; 2 P/LP variants in autosomal recessive diseases) and subsequent patient outcomes as reported by health care professionals on case report forms. Results Among 418 patients, median (IQR) age at the time of testing was 4 (1-10) years, with an age range of 0 to 52 years, and 53.8% (n = 225) were female individuals. The mean (SD) time from a genetic test order to case report form completion was 595 (368) days (range, 27-1673 days). A genetic diagnosis was associated with changes in clinical management for 208 patients (49.8%) and usually (81.7% of the time) within 3 months of receiving the result. The most common clinical management changes were the addition of a new medication (78 [21.7%]), the initiation of medication (51 [14.2%]), the referral of a patient to a specialist (48 [13.4%]), vigilance for subclinical or extraneurological disease features (46 [12.8%]), and the cessation of a medication (42 [11.7%]). Among 167 patients with follow-up clinical information available (mean [SD] time, 584 [365] days), 125 (74.9%) reported positive outcomes, 108 (64.7%) reported reduction or elimination of seizures, 37 (22.2%) had decreases in the severity of other clinical signs, and 11 (6.6%) had reduced medication adverse effects. A few patients reported worsening of outcomes, including a decline in their condition (20 [12.0%]), increased seizure frequency (6 [3.6%]), and adverse medication effects (3 [1.8%]). No clinical management changes were reported for 178 patients (42.6%). Conclusions and Relevance Results of this cross-sectional study suggest that genetic testing of individuals with epilepsy may be materially associated with clinical decision-making and improved patient outcomes.
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Affiliation(s)
| | | | | | | | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City,Center for Personalized Medicine, Primary Children’s Hospital, Salt Lake City, Utah
| | - Michael Scott Perry
- Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | - Anne T. Berg
- Department of Neurology, Northwestern University—Feinberg School of Medicine, Chicago, Illinois,COMBINEDBrain, Brentwood, Tennessee
| | - Felippe Borlot
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Katie Angione
- Children’s Hospital Colorado, Aurora,Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Loreto Ríos-Pohl
- Clinical Integral de Epilepsia, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | | | | | | | - Rebecca J. Levy
- Division of Medical Genetics, Lucile Packard Children’s Hospital at Stanford University, Stanford, California
- Division of Child Neurology, Lucile Packard Children’s Hospital at Stanford University, Stanford, California
| | | | - Guillermo Lay-Son
- Genetic Unit, Pediatrics Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Miguel Angel Ramirez-Garcia
- Genetics Department, National Institute of Neurology and Neurosurgery, “Manuel Velasco Suárez,” Mexico City, Mexico
| | - Edmar O. Benítez Alonso
- Genetics Department, National Institute of Neurology and Neurosurgery, “Manuel Velasco Suárez,” Mexico City, Mexico
| | - Julie Ziobro
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Adela Chirita-Emandi
- Genetic Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timis, Romania
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu” Timisoara, Timis, Romania
| | - Temis M. Felix
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dianne Kulasa-Luke
- NeuroDevelopmental Science Center, Akron Children’s Hospital, Akron, Ohio
| | - Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut Jerome Lejeune, Paris, France
| | | | | | | | | | - Sebastian Silva
- Child Neurology Service, Hospital de Puerto Montt, Puerto Montt, Chile
| | | | - Oksana Boyarchuk
- I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Gary R. Nelson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Rachel Palmquist
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Katherine C. Hammond
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Sean T. Hwang
- Zucker School of Medicine, Hofstra Northwell, Hempstead, New York
| | - Susan B. Boutlier
- ECU Physician Internal Medicine Pediatric Neurology, Greenville, North Carolina
| | | | - Kaitlin Y. Batley
- Department of Pediatrics and Neurology, UT Southwestern, Dallas, Texas
| | - Devraj Chavda
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | - James W. Wheless
- Pediatric Neurology, University of Tennessee Health Science Center, Memphis
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
| | | | - Manoj Kanhangad
- Department of Paediatrics, Monash University, Clayton, Australia
| | | | | | | | - Monique M. Ryan
- The Royal Children’s Hospital Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Michelle Machie
- Department of Pediatrics and Neurology, UT Southwestern, Dallas, Texas
| | - Patricio Guerra
- Universidad San Sebastián, Department of Pediatrics, Medicine School, Patagonia Campus, Puerto Montt, Chile
| | - Muhammad Jawad Hassan
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Meghan S. Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Caleb P. Bupp
- Spectrum Health, West Michigan Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Kristen L. Park
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Eric Muller
- Clinical Genetics, Stanford Children’s Health Specialty Services, San Francisco, California
| | - Pamela Lupo
- Division of Neurology, Department of Pediatrics, University of Texas Medical Branch, League City
| | | | - Amir M. Arain
- Division of Epilepsy, Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Andrea Murphy
- Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
| | | | - Weiyi Mu
- Johns Hopkins University, Baltimore, Maryland
| | | | - Lautaro Plaza
- Hospital Materno Perinatal “Mónica Pretelini Sáenz,” Toluca, México
| | | | - Evelyn G. Lora
- Dominican Neurological and Neurosurgical Society, Santo Domingo, Dominican Republic
| | | | | | - Viviana Venegas
- Clínica Alemana de Santiago, Universidad del Desarrollo, Pediatric Neurology Unit, Santiago, Chile
| | - Rebecca R. Luke
- Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | | | | | | | | | - Rebecca J. Burke
- Division of Medical Genetics, Department of Pediatrics, West Virginia University School of Medicine, Morgantown
- Division of Neonatology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown
| | - Anna C.E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham
| | | | - Lauren J. Massingham
- Hasbro Children’s Hospital, Providence, Rhode Island
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Laura Pisani
- Zucker School of Medicine, Hofstra Northwell, Hempstead, New York
- Northwell Health, Medical Genetics, Great Neck, New York
| | | | - Betsy Ostrander
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Francis M. Filloux
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Amitha L. Ananth
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Ismail S. Mohamed
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Alla Nechai
- Neurology Department, Kiev City Children Clinical Hospital No. 1, Kyiv City, Ukraine
| | - Jasmin M. Dao
- Adult and Child Neurology Medical Associates, Long Beach, California
- Miller Children’s Hospital, Long Beach, California
| | - Michael C. Fahey
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Ermal Aliu
- Department of Genetics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephen Falchek
- Nemours Children’s Hospital, Wilmington, Delaware
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Craig A. Press
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Lauren Treat
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Krista Eschbach
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Angela Starks
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Ryan Kammeyer
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Joshua J. Bear
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Mona Jacobson
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Veronika Chernuha
- Pediatric Neurology Institute, “Dana-Dwek” Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Kristen Wong
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Matthew T. Sweney
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - A. Chris Espinoza
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Colin B. Van Orman
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Arie Weinstock
- Division of Child Neurology, Department of Neurology, University at Buffalo, Buffalo, New York
- Oishei Children’s Hospital, Buffalo, New York
| | - Ashutosh Kumar
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Muhammad Raza
- Nishtar Medical University, Multan, Punjab, Pakistan
| | | | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York
- Kings County Hospital Center, Brooklyn, New York
| | - Eric D. Marsh
- Division of Child Neurology, Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Sumit Parikh
- Neurogenetics, Cleveland Clinic, Cleveland, Ohio
| | | | - Stephen Fulton
- Pediatric Neurology, University of Tennessee Health Science Center, Memphis
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Yoshimi Sogawa
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Carey A. Wilson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Guillermo G. Guzmán
- Servicio Neuropsiquiatria Infantil, Hospital San Borja Arriarán, Santiago, Chile
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9
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Mighton C, Shickh S, Aguda V, Krishnapillai S, Adi-Wauran E, Bombard Y. From the patient to the population: Use of genomics for population screening. Front Genet 2022; 13:893832. [PMID: 36353115 PMCID: PMC9637971 DOI: 10.3389/fgene.2022.893832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/26/2022] [Indexed: 10/22/2023] Open
Abstract
Genomic medicine is expanding from a focus on diagnosis at the patient level to prevention at the population level given the ongoing under-ascertainment of high-risk and actionable genetic conditions using current strategies, particularly hereditary breast and ovarian cancer (HBOC), Lynch Syndrome (LS) and familial hypercholesterolemia (FH). The availability of large-scale next-generation sequencing strategies and preventive options for these conditions makes it increasingly feasible to screen pre-symptomatic individuals through public health-based approaches, rather than restricting testing to high-risk groups. This raises anew, and with urgency, questions about the limits of screening as well as the moral authority and capacity to screen for genetic conditions at a population level. We aimed to answer some of these critical questions by using the WHO Wilson and Jungner criteria to guide a synthesis of current evidence on population genomic screening for HBOC, LS, and FH.
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Affiliation(s)
- Chloe Mighton
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Salma Shickh
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vernie Aguda
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Suvetha Krishnapillai
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ella Adi-Wauran
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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10
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Charron M, Kaiser B, Dauge A, Gallois H, Lapointe J, Dorval M, Nabi H, Joly Y. Integrating hereditary breast and ovarian cancer genetic counselling and testing into mainstream clinical practice: Legal and ethical challenges. Crit Rev Oncol Hematol 2022; 178:103797. [PMID: 36031172 DOI: 10.1016/j.critrevonc.2022.103797] [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: 04/25/2022] [Revised: 07/07/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
Health professionals not specialized in genetics are expected to take an increasing role in genetic services delivery. This article aims to identify legal and ethical challenges related to a collaborative oncogenetics service model, where non-genetic health professionals provide genetic services to patients. Through a scoping literature review, we identified issues to the provision of hereditary breast and ovarian cancer, or other hereditary adult cancers, genetic testing under this model. Concerns that arose in the literature were informed consent, lack of adherence to best practice guidelines, lack of education of non-genetic health professionals on the provision of genetic services, psychological impacts of genetic testing, continuity of care, the complexity of genetic test results, confidentiality, risks of medical mismanagement, and the associated medical responsibility liabilities. Despite these challenges, there is a growing consensus towards the feasibility of cancer genetic testing being undertaken by non-genetic healthcare professionals in a collaborative oncogenetics service model.
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Affiliation(s)
- Marilou Charron
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada.
| | - Beatrice Kaiser
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
| | - Aurélie Dauge
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
| | - Hortense Gallois
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
| | - Julie Lapointe
- Oncology Division, CHU de Québec - Université Laval Research Center, Québec, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Université Laval, Researcher Oncology Division, CHU de Québec - Université Laval Research Center, Canada
| | - Hermann Nabi
- Faculty of Medicine, Université Laval, Researcher Oncology Division, CHU de Québec - Université Laval Research Center, Canada
| | - Yann Joly
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
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11
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Arcila ME, Snow AN, Akkari YMN, Chabot-Richards D, Pancholi P, Tafe LJ. Molecular Pathology Education: A Suggested Framework for Primary Care Resident Training in Genomic Medicine: A Report of the Association for Molecular Pathology Training and Education Committee. J Mol Diagn 2022; 24:430-441. [PMID: 35304347 DOI: 10.1016/j.jmoldx.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/17/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
Developments in genomics are profoundly influencing medical practice. With increasing use of genetic and genomic testing across every aspect of the health care continuum, patients and their families are increasingly turning to primary care physicians (PCPs) for discussion and advice regarding tests, implications, and results. Yet, with the rapid growth of information, technology, and applications, PCPs are finding it challenging to fill the gaps in knowledge and support the growing needs of their patients. A critical component in expanding PCP genomic literacy lies in the education of physicians in training and in practice. Although a framework for developing physician competencies in genomics has already been developed, the Association for Molecular Pathology is uniquely situated to actively utilize the skills of its members to engage and support PCPs in this effort. This report provides an overview and a suggested basic teaching framework, which can be used by molecular professionals in their individual institutions as a starting point for educational outreach.
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Affiliation(s)
- Maria E Arcila
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony N Snow
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Yassmine M N Akkari
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Cytogenetics and Molecular Pathology, Legacy Health, Portland, Oregon
| | - Devon Chabot-Richards
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Preeti Pancholi
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura J Tafe
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
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12
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Scherr CL, Kalke K, Ramesh S, Fakhari H, Dellefave-Castillo LM, Smith ME, Kalny C, McNally EM, Rasmussen-Torvik LJ. Integrating clinical genetics in cardiology: Current practices and recommendations for education. Genet Med 2022; 24:1054-1061. [PMID: 35339388 PMCID: PMC9991006 DOI: 10.1016/j.gim.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Recent advances in genetics can facilitate the identification of at-risk individuals and diagnosis of cardiovascular disorders. As a nascent field, more research is needed to optimize the clinical practice of cardiovascular genetics, including the assessment of educational needs to promote appropriate use of genetic testing. METHODS Qualitative interviews conducted with cardiovascular specialists (N = 43) were audiotaped. Thematic analysis was conducted on professional transcripts. RESULTS Participants recognized the value of genetics in identifying and diagnosing at-risk individuals. However, organizational systems, cost, and feeling of unpreparedness were identified as barriers. Participants felt that the rapid pace of genetic science resulted in further challenges to maintaining an adequate knowledge base and highlighted genetics experts' importance. Even when a genetics expert was available, participants wanted to know more about which patients benefit most from genetic testing and expressed a desire to better understand management recommendations associated with a positive test result. CONCLUSION Participants recognized the benefit but felt underprepared to provide recommendations for genetic testing and, in some cases, lacked organizational resources to refer patients to a genetics expert. Additional training in genetics for cardiology practitioners and ensuring availability of a genetics expert can improve the use of genetics in cardiology settings.
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Affiliation(s)
- Courtney L Scherr
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL.
| | - Kerstin Kalke
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Sanjana Ramesh
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Hoda Fakhari
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Lisa M Dellefave-Castillo
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Callie Kalny
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura J Rasmussen-Torvik
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
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13
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Artificial Intelligence and Cardiovascular Genetics. Life (Basel) 2022; 12:life12020279. [PMID: 35207566 PMCID: PMC8875522 DOI: 10.3390/life12020279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/26/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
Polygenic diseases, which are genetic disorders caused by the combined action of multiple genes, pose unique and significant challenges for the diagnosis and management of affected patients. A major goal of cardiovascular medicine has been to understand how genetic variation leads to the clinical heterogeneity seen in polygenic cardiovascular diseases (CVDs). Recent advances and emerging technologies in artificial intelligence (AI), coupled with the ever-increasing availability of next generation sequencing (NGS) technologies, now provide researchers with unprecedented possibilities for dynamic and complex biological genomic analyses. Combining these technologies may lead to a deeper understanding of heterogeneous polygenic CVDs, better prognostic guidance, and, ultimately, greater personalized medicine. Advances will likely be achieved through increasingly frequent and robust genomic characterization of patients, as well the integration of genomic data with other clinical data, such as cardiac imaging, coronary angiography, and clinical biomarkers. This review discusses the current opportunities and limitations of genomics; provides a brief overview of AI; and identifies the current applications, limitations, and future directions of AI in genomics.
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14
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Bajguz D, Danylchuk NR, Czarniecki M, Selig JP, Sutphen R, Kaylor J. Utilization of genetic testing: Analysis of 4,499 prior authorization requests for molecular genetic tests at four US regional health plans. J Genet Couns 2021; 31:771-780. [PMID: 34939253 DOI: 10.1002/jgc4.1543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/11/2022]
Abstract
Continuous advances in genetic testing methodologies and an increased understanding of the genetic mechanisms of diseases have fueled genetic testing utilization across health care specialties. To our knowledge, national trends in the ordering of genetic testing have not been studied broadly across clinical indications, testing methodologies, and ordering provider specialties. We performed a retrospective analysis of 4,499 complete prior authorization requests for molecular genetic testing submitted to four regional health plans' commercial lines of business between May 1, 2019 and May 31, 2019. Ordering providers were characterized by their certification(s) and specialty of practice. Among 4,499 genetic testing requests, 92% were ordered by non-genetics providers. Obstetrician/gynecology (OBGYN) (63%), oncology (15%), and genetics (8%) providers ordered genetic testing most frequently. Reproductive, hereditary cancer, and tumor testing were the most frequently ordered genetic tests. Seventy-nine percent of all prior authorization requests were approved. When analyzing complex genetic testing requests, we found that testing ordered by genetics providers was more likely to be approved based on health plan policy than testing ordered by non-genetics providers. Our results suggest that health care providers across multiple medical specialties may benefit from involvement of genetics specialists in decision-making regarding molecular tests.
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Affiliation(s)
- Dominika Bajguz
- Genetic Counseling Department, College for Health Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Noelle R Danylchuk
- Genetic Counseling Department, College for Health Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - James P Selig
- Biostatistics Department, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Julie Kaylor
- Genetic Counseling Department, College for Health Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,InformedDNA, Inc., St. Petersburg, Florida, USA
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15
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Decisional needs of patients considering preimplantation genetic testing: a systematic review. Reprod Biomed Online 2021; 44:839-852. [DOI: 10.1016/j.rbmo.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
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16
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Truong TK, Kenneson A, Rosen AR, Singh RH. Genetic Referral Patterns and Responses to Clinical Scenarios: A Survey of Primary Care Providers and Clinical Geneticists. J Prim Care Community Health 2021; 12:21501327211046734. [PMID: 34583568 PMCID: PMC8485275 DOI: 10.1177/21501327211046734] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary care physicians (PCPs) are considered the gatekeepers of genetic services, but they often underutilize or inappropriately utilize such services, leading to lack of early treatment, incorrect diagnoses, and unnecessary procedures. This study aims to delineate PCP referral patterns, including the frequency of, motivators for, and barriers to genetic referrals and testing in the present landscape of genomics. Methods: A 34-item online survey was distributed to PCPs in the United States (US). PCP demographics, practice characteristics, and referral patterns, motivators, and barriers were analyzed. Six hypothetical clinical scenarios included in the survey also were presented to a cohort of clinical geneticists. We calculated PCPs’ rates of ordering genetic tests and of referral to genetics services in the past year. Rates and responses to clinical scenarios were compared based on respondents’ personal and practice characteristics. Results: A total of 95 PCPs and 25 clinical geneticists participated. Among the PCPs, 79% reported referring and 50% reported ordering genetic testing in the last year. PCPs with genetic counselors (GCs) in their clinic referred at significantly higher rates than those without (P = .008). White PCPs referred at significantly higher rates compared to Black or African American PCPs (P = .009). The most commonly reported motivators for referring patients to genetic services were preference for specialist coordination, lack of knowledge, and family’s desire for risk information. The most commonly reported barriers were patient refusal, provider concerns about costs to patients, and uncertainty of when a genetic referral is appropriate. In response to clinical scenarios, clinical geneticists were in agreement about the need for genetic testing or referral for 2 of the scenarios. For these 2 scenarios, only 48% and 71% of PCPs indicated that they would offer genetic testing or referral, respectively. Conclusions: Responses to clinical scenarios suggest that it is not clear to PCPs when referrals or testing are needed. Collaboration with GCs is one approach to reducing barriers to and improving PCPs’ utilization of genetic services. Clear guidelines from clinical geneticists may help facilitate appropriate use of genetics services by PCPs. Additional research is needed to further describe barriers that PCPs face in genetic testing/referrals.
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Affiliation(s)
- Tina K Truong
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ami R Rosen
- Emory University School of Medicine, Atlanta, GA, USA
| | - Rani H Singh
- Emory University School of Medicine, Atlanta, GA, USA
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17
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McGrath SP, Peabody AE, Walton D, Walton N. Legal Challenges in Precision Medicine: What Duties Arising From Genetic and Genomic Testing Does a Physician Owe to Patients? Front Med (Lausanne) 2021; 8:663014. [PMID: 34381794 PMCID: PMC8349980 DOI: 10.3389/fmed.2021.663014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
Precision medicine is increasingly incorporated into clinical practice via three primary data conduits: environmental, lifestyle, and genetic data. In this manuscript we take a closer look at the genetic tier of precision medicine. The volume and variety of data provides a more robust picture of health for individual patients and patient populations. However, this increased data may also have an adverse effect by muddling our understanding without the proper pedagogical tools. Patient genomic data can be challenging to work with. Physicians may encounter genetic results which are not fully understood. Genetic tests may also lead to the quandary of linking patients with diseases or disorders where there are no known treatments. Thus, physicians face a unique challenge of establishing the proper scope of their duty to patients when dealing with genomic data. Some of those scope of practice boundaries have been established as a result of litigation, while others remain an open question. In this paper, we map out some of the legal challenges facing the genomic component of precision medicine, both established and some questions requiring additional guidance. If physicians begin to perceive genomic data as falling short in overall benefit to their patients, it may detrimentally impact precision medicine as a whole. Helping to develop guidance for physicians working with patient genomic data can help avoid this fate of faltering confidence.
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Affiliation(s)
- Scott P McGrath
- CITRIS and the Banatao Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Arthur E Peabody
- Hooper, Lundy & Bookman, Professional Corporation, Washington, DC, United States
| | - Derek Walton
- Walton Legal Professional Limited Liability Company, Salt Lake City, UT, United States
| | - Nephi Walton
- Intermountain Healthcare, Salt Lake City, UT, United States
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18
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Galbraith LN, Preys CL, Rehm HL, Scheuner MT, Hajek C, Green RC, Christensen KD. Primary care providers' responses to unsolicited Lynch syndrome secondary findings of varying clinical significance. Genet Med 2021; 23:1977-1983. [PMID: 34113000 PMCID: PMC8487923 DOI: 10.1038/s41436-021-01225-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: How primary care providers (PCPs) respond to genomic secondary findings (SFs) of varying clinical significance (pathogenic, uncertain significance (VUS), or benign) is unknown. Methods: We randomized 148 American Academy of Family Physicians members to review three reports with varying significance for Lynch syndrome. Participants provided open-ended responses about the follow-up they would address and organized the SF reports and five other topics in the order they would prioritize responding to them (1=highest priority, 6=lowest priority). Results: PCPs suggested referrals more often for pathogenic variants or VUSs than benign variants (72% vs 16%, p<0.001). PCPs were also more likely to address further workup, like a colonoscopy or EGD, in response to pathogenic variants or VUSs than benign variants (43% vs 4%, p<0.001). The likelihoods of addressing referrals or further workup were similar when PCPs reviewed pathogenic variants and VUSs (both p>0.46). SF reports were prioritized highest for pathogenic variants (2.7 for pathogenic variants, 3.6 for VUSs, 4.3 for benign variants, all p≤0.014). Conclusions: Results suggest that while PCPs appreciated the differences in clinical significance, disclosure of VUSs as SFs would substantially increase downstream health care utilization.
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Affiliation(s)
- Lauren N Galbraith
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Charlene L Preys
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Heidi L Rehm
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Maren T Scheuner
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Division of Medical Genetics, Department of Pediatrics, and Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Catherine Hajek
- Sanford Health Imagenetics, Sioux Falls, SD, USA.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Ariadne Labs, Boston, MA, USA
| | - Kurt D Christensen
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA. .,Broad Institute of Harvard and MIT, Cambridge, MA, USA. .,Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
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19
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Muflih S, Alshogran OY, Al-Azzam S, Al-Taani G, Khader YS. Physicians' Knowledge and Attitudes Regarding Point-of-Care Pharmacogenetic Testing: A Hospital-Based Cross-Sectional Study. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:655-665. [PMID: 34103970 PMCID: PMC8179816 DOI: 10.2147/pgpm.s307694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
Introduction Pharmacogenetic testing (PGx) is a diagnostic technique used by physicians to determine the possible reactions of patients to drug treatment on the basis of their genetic makeup. The aim of this study was to determine the impact of physicians’ awareness, attitudes, and sociodemographics on the adoption of point-of-care (POC) PGx testing as a diagnostic method, as well as the impact of their knowledge, attitudes, and sociodemographics on its adoption. Methods A cross-sectional survey of 200 physicians and medical trainees working at the Clinics of King Abdullah University Hospital in Jordan was performed. Data on sociodemographics, knowledge and attitudes concerning PGx testing, genetic information sources, and barriers to POC-PGx testing adoption were gathered. Results Participants’ perceived knowledge of the role of PGx testing in therapeutic decision-making was rated as “Excellent” (1.9%), “Very Good” (19.4%), “Good” (34.4%), “Fair” (32.5%), and “Poor” (11.9%). Physicians’ actual knowledge of PGx testing was adequate (mean=3.56 out of 7, SD=1.2), but their attitudes were generally favorable (mean=3.64 out of 5.00, SD=0.52). According to Rogers’ theory, many variables (eg, perceived need, relative advantage, compatibility) had a significant impact on physicians’ willingness to endorse POC-PGx testing. Discussion The majority of physicians stated that they were unaware of PGx testing. Physicians’ perceived knowledge of POC-PGx testing, however, was higher than those who participated in other studies. Participants were optimistic about the future benefits of PGx testing in prescribing effective medications and reducing potential side effects, which were consistent with previous studies. Physicians’ willingness to accept and implement POC-PGx testing was hampered by a lack of PGx expertise, as well as concerns about patient confidentiality, employability, and insurability. More training and genetic courses are needed, according to the majority of participants.
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Affiliation(s)
- Suhaib Muflih
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Osama Y Alshogran
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ghaith Al-Taani
- Department of Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Yousef S Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, 22110, Jordan
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20
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Thom J, Haw T. Awareness of genetic counseling services among allied healthcare professionals in South Africa. J Genet Couns 2021; 30:1649-1657. [PMID: 33934426 DOI: 10.1002/jgc4.1431] [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: 12/15/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/05/2022]
Abstract
Genetic counseling has been shown to increase patient empowerment leading to positive outcomes. However, in the Johannesburg state healthcare system, the genetic counseling service is underutilized. Individuals with genetic disorders present with a variety of symptoms and are frequently referred to allied healthcare professionals for management; therefore, these professionals are in a unique position to identify appropriate patients and refer them for genetic counseling. This study aimed to determine whether allied health professionals, including physiotherapists, occupational therapists, and speech and language therapists, were aware of genetic counseling services in Johannesburg, South Africa, and whether they had previously referred patients to these services. The study also aimed to identify barriers and facilitators to referral. An adapted paper-copy questionnaire was administered to allied health professionals working at one of three state hospitals in Johannesburg. A total of 57 participants were included in this study. Results indicated that 29/57 (50.9%) of allied health professionals knew that genetic counseling services were available but only 15/29 (51.7%) of those who knew of the service had referred patients to these services in the last year. Barriers to referral included misconceptions about the role of genetic counselors, insufficient knowledge of which patients would benefit from genetic counseling, and being unable to obtain appropriate information from the Genetics Clinic for patient referral. However, allied health professionals recognized the benefit of genetic counseling and 53/57 (93%) wanted to increase their genetics knowledge. Therefore, genetics education of allied health professionals, and improved information regarding the referral procedure for genetic counseling, may improve the number of patients referred.
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Affiliation(s)
- Jamey Thom
- Division of Human Genetics, National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tabitha Haw
- Division of Human Genetics, National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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How do non-geneticist physicians deal with genetic tests? A qualitative analysis. Eur J Hum Genet 2021; 30:320-331. [PMID: 33907318 PMCID: PMC8904857 DOI: 10.1038/s41431-021-00884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022] Open
Abstract
Genetic testing is accepted to be a common practice in many medical specialties. These genetic tests raise issues such as respect for basic rights, how to handle results and uncertainty and how to balance concerns for medical confidentiality with the rights of third parties. Physicians need help to deal with the rapid development of genomic medicine as most of them have received no specific training on the medical, ethical, and social issues involved. Analyzing how these professionals integrate genetic testing into the patient-provider relationship is essential to paving the way for a better use of genomics by all. We conducted a qualitative study comprising a series of focus groups with 21 neurologists and endocrinologists about their genetic testing practices in the western part of France. The interviews were transcribed and analyzed for major themes. We identified an automated care management procedure of genetic testing that affects patient autonomy. The simple fact of having a written consent cannot justify a genetic test given the stakes associated with the results. We also suggest orienting practices toward a systemic approach using a multidisciplinary team or network to provide resources for dealing with uncertainties in interpreting results or situations that require additional technical or clinical skills and, if necessary, to allow for joint consultations with both a geneticist and a non-geneticist medical specialist.
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22
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Srinivasan T, Sutton EJ, Beck AT, Cuellar I, Hernandez V, Pacyna JE, Shaibi GQ, Kullo IJ, Lindor NM, Singh D, Sharp RR. Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center. J Prim Care Community Health 2021; 12:21501327211000242. [PMID: 33729042 PMCID: PMC7975483 DOI: 10.1177/21501327211000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Minority communities have had limited access to advances in genomic medicine.
Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health
Center in Phoenix, Arizona, partnered to assess the feasibility of offering
genomic screening to Latino patients receiving care at a community-based
health center. We examined primary care provider (PCP) experiences reporting
genomic screening results and integrating those results into patient
care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other
members of the health care team charged with supporting patients who
received positive genomic screening results. Interviews were recorded,
transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results
indicating a genetic variant that warranted clinical management. PCPs felt
genomic screening was valuable to patients and their families, and that
genomic research should strive to include underrepresented minorities.
Providers identified multiple challenges integrating genomic sequencing into
patient care, including difficulties maintaining patient contact over time;
arranging follow-up medical care; and managing results in an environment
with limited genetics expertise. Providers also reflected on the ethics of
offering genomic sequencing to patients who may not be able to pursue
diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing
advances in precision medicine to community-based health centers serving
under-resourced populations. By proactively considering patient support
needs, and identifying financial assistance programs and patient-referral
mechanisms to support patients who may need specialized medical care, PCPs
and other health care providers can help to ensure that precision medicine
lives up to its full potential as a tool for improving patient care.
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23
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Abstract
Neurodevelopmental disorders are the most prevalent chronic medical conditions encountered in pediatric primary care. In addition to identifying appropriate descriptive diagnoses and guiding families to evidence-based treatments and supports, comprehensive care for individuals with neurodevelopmental disorders includes a search for an underlying etiologic diagnosis, primarily through a genetic evaluation. Identification of an underlying genetic etiology can inform prognosis, clarify recurrence risk, shape clinical management, and direct patients and families to condition-specific resources and supports. Here we review the utility of genetic testing in patients with neurodevelopmental disorders and describe the three major testing modalities and their yields - chromosomal microarray, exome sequencing (with/without copy number variant calling), and FMR1 CGG repeat analysis for fragile X syndrome. Given the diagnostic yield of genetic testing and the potential for clinical and personal utility, there is consensus that genetic testing should be offered to all patients with global developmental delay, intellectual disability, and/or autism spectrum disorder. Despite this recommendation, data suggest that a minority of children with autism spectrum disorder and intellectual disability have undergone genetic testing. To address this gap in care, we describe a structured but flexible approach to facilitate integration of genetic testing into clinical practice across pediatric specialties and discuss future considerations for genetic testing in neurodevelopmental disorders to prepare pediatric providers to care for patients with such diagnoses today and tomorrow.
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Affiliation(s)
- Juliann M. Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
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24
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Afolaranmi O, Salako O, Okunade K, James A, Fagbenro G. Integrating genomics education into Nigerian undergraduate medical training - A narrative review. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Lemke AA, Amendola LM, Kuchta K, Dunnenberger HM, Thompson J, Johnson C, Ilbawi N, Oshman L, Hulick PJ. Primary Care Physician Experiences with Integrated Population-Scale Genetic Testing: A Mixed-Methods Assessment. J Pers Med 2020; 10:E165. [PMID: 33066060 PMCID: PMC7720124 DOI: 10.3390/jpm10040165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
The scalable delivery of genomic medicine requires collaboration between genetics and non-genetics providers. Thus, it is essential to investigate and address the perceived value of and barriers to incorporating genetic testing into the clinical practice of primary care providers (PCPs). We used a mixed-methods approach of qualitative interviews and surveys to explore the experience of PCPs involved in the pilot DNA-10K population genetic testing program. Similar to previous research, PCPs reported low confidence with tasks related to ordering, interpreting and managing the results of genetic tests, and identified the need for additional education. PCPs endorsed high levels of utility for patients and their families but noted logistical challenges to incorporating genetic testing into their practice. Overall PCPs were not familiar with the United States' Genetic Information Nondiscrimination Act and they expressed high levels of concern for patient data privacy and potential insurance discrimination. This PCP feedback led to the development and implementation of several processes to improve the PCP experience with the DNA-10K program. These results contribute to the knowledge base regarding genomic implementation using a mixed provider model and may be beneficial for institutions developing similar clinical programs.
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Affiliation(s)
- Amy A. Lemke
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (H.M.D.); (J.T.); (C.J.); (P.J.H.)
| | - Laura M. Amendola
- Division of Medical Genetics, University of Washington, Seattle, WA 98115, USA;
| | - Kristine Kuchta
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL 60201, USA;
| | - Henry M. Dunnenberger
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (H.M.D.); (J.T.); (C.J.); (P.J.H.)
| | - Jennifer Thompson
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (H.M.D.); (J.T.); (C.J.); (P.J.H.)
| | - Christian Johnson
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (H.M.D.); (J.T.); (C.J.); (P.J.H.)
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Nadim Ilbawi
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (N.I.); (L.O.)
| | - Lauren Oshman
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (N.I.); (L.O.)
| | - Peter J. Hulick
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; (H.M.D.); (J.T.); (C.J.); (P.J.H.)
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26
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Makhnoon S, Corredor J, Arun B, Bell D, Yarbrough A, Livingston JA, Peterson SK, Roth M. Impact of a Genetic Evaluation Initiative to Increase Access to Genetic Services for Adolescent and Young Adults at a Tertiary Cancer Hospital. J Adolesc Young Adult Oncol 2020; 10:296-302. [PMID: 32830989 DOI: 10.1089/jayao.2020.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer are at increased risk for inherited cancer predisposition syndromes. Genetic counseling (GC) is important for accurate risk assessment, diagnosis, and management of inherited cancers. Numerous barriers prevent AYA access to genetic services. This study describes outcomes of a genetic evaluation initiative (GEI) regarding utilization of genetic services among AYAs. Methods: To improve AYA access to GC, the AYA program at UT MD Anderson Cancer Center implemented GEI, a process for identifying and referring eligible patients for GC. We collected retrospective electronic medical record data between July 12, 2018 and July 12, 2019 to capture AYA's clinical characteristics, genetic referral, scheduled appointments, counseling, testing, and results. Results: In total, 516 AYAs were referred to the AYA clinic during the study period with a median age of first cancer diagnosis of 17 years. One hundred sixty-six AYAs were identified who would benefit from genetic evaluation, 57 (34.3%) of whom had previously undergone counseling. One hundred nine patients were recommended for referral to GC, and 64.2% (70/109) were referred by the AYA team. To date, 58.6% (41/70) met with a genetic counselor and 75.6% (31/41) completed genetic testing, which yielded 1 pathogenic, 2 uncertain, and 29 benign results. Conclusion: The GEI resulted in a 72.0% relative increase in the rate of GC utilization and represents a novel approach to increasing AYA patient access to cancer genetic services in this population.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica Corredor
- Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Banu Arun
- Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donna Bell
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angela Yarbrough
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Andrew Livingston
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Roth
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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27
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Almomani BA, Al-Sawalha NA, Al-Keilani MS, Aman HA. The difference in knowledge and concerns between healthcare professionals and patients about genetic-related issues: A questionnaire-based study. PLoS One 2020; 15:e0235001. [PMID: 32559245 PMCID: PMC7304621 DOI: 10.1371/journal.pone.0235001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022] Open
Abstract
Effective adoption of genetics in clinical practice requires the support of and interaction between the different partners of healthcare system; healthcare professionals (HCPs) and patients. The study aimed to assess and compare the knowledge, factors affecting the knowledge, and concerns of HCPs and patients regarding genetic-related issues such as lack of knowledge about genetics and genetic conditions, awareness of the importance of genetics in clinical practice and genetic services and resources deficits. A cross sectional study was conducted in different areas of Jordan using a convenient sampling approach. An English questionnaire was self-administered to HCPs. Face-to-face interviews were conducted with patients in Arabic by trained researcher. A total of 1000 HCPs and 1448 patients were recruited. There was a significant difference (p<0.001) in the knowledge between HCPs and patients. Among HCPs, physicians (OR = 2.278, 95%CI = 1.410–3.680, p = 0.001) and pharmacists (OR = 2.163, 95%CI = 1.362–3.436, p = 0.001) were more knowledgeable than nurses. In addition, females were more knowledgeable than males (OR = 1.717, 95%CI = 1.203–2.451, p = 0.003). Among patients, participants who had a bachelor degree (OR = 1.579, 95%CI = 1.231–2.025, p<0.001) were more knowledgeable compared to those who only had school education. HCPs appeared to have more concerns than patients (p<0.001) regarding all genetic-related issues. These findings suggested a positive association between education and genetic knowledge as well as concerns; as HCPs were more knowledgeable and concerned than patients. Appropriate integration and expansion of basic genetic knowledge courses and clinical genetic training in the curriculum should be adopted to prepare HCPs to enhance the integration of genetic information in clinical settings.
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Affiliation(s)
- Basima A. Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Nour A. Al-Sawalha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Maha S. Al-Keilani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hatem A. Aman
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
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28
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Conway ME, Kalejta CD, Sternen DL, Singh IR. The Importance of Genetics Experts in Optimizing Genetic Test Orders Through Prospective and Retrospective Reviews. Am J Clin Pathol 2020; 153:537-547. [PMID: 31802100 DOI: 10.1093/ajcp/aqz188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To demonstrate the impact of genetics specialists on identifying test order errors and improving reimbursement for genetic testing. METHODS Forty-four cases in which whole exome sequencing (WES) was performed but not reimbursed were reviewed by a genetic counselor through simulated prospective and retrospective reviews. RESULTS Fifty-two percent of WES requests were ordered by nongenetics providers. Retrospective review revealed that 50% of cases were denied because of contractual constraints on billing. If review by a genetic counselor had occurred in real time, modifications or cancellations would have been recommended in 82% of the cases. CONCLUSIONS A laboratory stewardship program involving genetics experts identified test order errors and opportunities for improved reimbursement and cost savings. Significant variables affected reimbursement, including inpatient status, payer criteria, and ordering provider specialty.
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Affiliation(s)
| | | | - Darci L Sternen
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
| | - Ila R Singh
- Department of Pathology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
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29
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McGill BC, Wakefield CE, Hetherington K, Munro LJ, Warby M, Lau L, Tyrrell V, Ziegler DS, O’Brien TA, Marshall GM, Malkin D, Hansford JR, Tucker KM, Vetsch J. "Balancing Expectations with Actual Realities": Conversations with Clinicians and Scientists in the First Year of a High-Risk Childhood Cancer Precision Medicine Trial. J Pers Med 2020; 10:E9. [PMID: 32075154 PMCID: PMC7151613 DOI: 10.3390/jpm10010009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Precision medicine is changing cancer care and placing new demands on oncology professionals. Precision medicine trials for high-risk childhood cancer exemplify these complexities. We assessed clinicians' (n = 39) and scientists' (n = 15) experiences in the first year of the PRecISion Medicine for Children with Cancer (PRISM) trial for children and adolescents with high-risk cancers, through an in-depth semi-structured interview. We thematically analysed participants' responses regarding their professional challenges, and measured oncologists' knowledge of genetics and confidence with somatic and germline molecular test results. Both groups described positive early experiences with PRISM but were cognisant of managing parents' expectations. Key challenges for clinicians included understanding and communicating genomic results, balancing biopsy risks, and drug access. Most oncologists rated 'good' knowledge of genetics, but a minority were 'very confident' in interpreting (25%), explaining (34.4%) and making treatment recommendations (18.8%) based on somatic genetic test results. Challenges for scientists included greater emotional impact of their work and balancing translational outputs with academic productivity. Continued tracking of these challenges across the course of the trial, while assessing the perspectives of a wider range of stakeholders, is critical to drive the ongoing development of a workforce equipped to manage the demands of paediatric precision medicine.
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Affiliation(s)
- Brittany C. McGill
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Kate Hetherington
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Lachlan J. Munro
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Meera Warby
- Hereditary Cancer Centre, Department of Medical Oncology, Prince of Wales Hospital, Randwick 2031, Australia; (M.W.); (K.M.T.)
- Prince of Wales Clinical School, UNSW Sydney, Sydney 2052, Australia
| | - Loretta Lau
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - Vanessa Tyrrell
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - David S. Ziegler
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - Tracey A. O’Brien
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
| | - Glenn M. Marshall
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - David Malkin
- Division of Haematology/Oncology, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Jordan R. Hansford
- Children’s Cancer Centre, Royal Children’s Hospital, Melbourne 3052, Australia;
- Division of Cancer, Murdoch Children’s Research Institute, Melbourne 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne 3010, Australia
- Department of Paediatrics, Monash University, Melbourne 3800, Australia
| | - Katherine M. Tucker
- Hereditary Cancer Centre, Department of Medical Oncology, Prince of Wales Hospital, Randwick 2031, Australia; (M.W.); (K.M.T.)
- Prince of Wales Clinical School, UNSW Sydney, Sydney 2052, Australia
| | - Janine Vetsch
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
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Clinical application of genomic high-throughput data: Infrastructural, ethical, legal and psychosocial aspects. Eur Neuropsychopharmacol 2020; 31:1-15. [PMID: 31866110 DOI: 10.1016/j.euroneuro.2019.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 11/03/2018] [Accepted: 09/20/2019] [Indexed: 12/28/2022]
Abstract
Genomic high-throughput technologies (GHTT) such as next-generation sequencing represent a fast and cost-effective tool toward a more comprehensive understanding of the molecular background of complex diseases. However, technological advances contrast with insufficient application in clinical practice. Thus, patients, physicians, and other professionals are faced with tough challenges that forestall the efficient and effective implementation. With the increasing application of genetic testing, it is of paramount importance that physicians and other professionals in healthcare recognize the restrictions and potential of GHTT, in order to understand and interpret the complex data in the context of health and disease. At the same time, the growing volume and complexity of data is forever increasing the need for sustainable infrastructure and state-of-the-art tools for efficient data management, including their analysis and integration. The large pool of sensitive information remains difficult to interpret and fundamental questions spanning from billing to legal, social, and ethical issues have still not been resolved. Here we summarize and discuss these obstacles in an interdisciplinary context and suggest ways to overcome them. Continuous discussion with clinicians, data managers, biostatisticians, systems medicine experts, ethicists, legal scholars, and patients illuminates the strengths, weakness, and current practices in the pipeline from biomaterial to sequencing and data management. This discussion also highlights the new, cross-disciplinary working collaborations to realize the wide-ranging challenges in clinical genomics including the exceptional demands placed on the staff preparing and presenting the data, as well as the question as to how to report the data and results to patients.
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Abstract
Direct to consumer laboratory testing is a rapidly growing industry. However, the idea of consumers ordering their own laboratory tests has raised ethical concerns. Respect for autonomy, beneficence, nonmaleficence, and justice are core principles of biomedical ethics. Although direct to consumer testing would seem to offer autonomy to consumers, autonomy is only maintained if certain criteria are met, including intentionality, understanding, and noncontrol. There is little published evidence to support either beneficence or maleficence of direct to consumer testing. Finally, there are conflicting opinions about the justice of direct to consumer testing and whether it increases or decreases health disparities.
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Affiliation(s)
- Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, Box 8118, 660 South Euclid, St Louis, MO 63110, USA.
| | - Melissa M Budelier
- Department of Pathology and Immunology, Washington University School of Medicine, Box 8118, 660 South Euclid, St Louis, MO 63110, USA
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Abstract
Medical teaching must include new knowledge and technologies and how these affect patient care. The Medical Humanities can contribute to a more holistic and caring view of health and disease.
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Affiliation(s)
- Maurizio Bifulco
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Simona Pisanti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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33
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Heck PR, Meyer MN. Population Whole Exome Screening: Primary Care Provider Attitudes About Preparedness, Information Avoidance, and Nudging. Med Clin North Am 2019; 103:1077-1092. [PMID: 31582005 DOI: 10.1016/j.mcna.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Compared to clinicians previously surveyed, primary care providers employed in a health system known for clinical genomics were more likely to have ordered or referred a patient for genetic testing, but had only modestly more genetics training and reported similarly low levels of comfort answering patient questions about genetic risk. Most supported population genomic screening, reported willingness to get screened themselves, and judged a hypothetical patient's decision to be screened favorably relative to a similar patient's decision to decline screening. Stakeholder perceptions of the ethical appropriateness of nudging at-risk patients to discuss testing with counselors were mixed.
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Affiliation(s)
- Patrick R Heck
- Autism & Developmental Medicine Institute, Geisinger, 120 Hamm Drive, M-C 60-36, Lewisburg, PA 17827, USA; Center for Translational Bioethics and Health Care Policy, Geisinger, Danville, PA 17822, USA. https://twitter.com/P_HECK
| | - Michelle N Meyer
- Center for Translational Bioethics and Health Care Policy, Geisinger, Danville, PA 17822, USA; Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger, 100 North Academy Avenue, M-C 30-57, Danville, PA 17822, USA.
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34
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Crellin E, McClaren B, Nisselle A, Best S, Gaff C, Metcalfe S. Preparing Medical Specialists to Practice Genomic Medicine: Education an Essential Part of a Broader Strategy. Front Genet 2019; 10:789. [PMID: 31572433 PMCID: PMC6749815 DOI: 10.3389/fgene.2019.00789] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Abstract
Developing a competent workforce will be crucial to realizing the promise of genomic medicine. The preparedness of medical specialists without specific genetic qualifications to play a role in this workforce has long been questioned, prompting widespread calls for education across the spectrum of medical training. Adult learning theory indicates that for education to be effective, a perceived need to learn must first be established. Medical specialists have to perceive genomic medicine as relevant to their clinical practice. Here, we review what is currently known about medical specialists’ perceptions of genomics, compare these findings to those from the genetics era, and identify areas for future research. Previous studies reveal that medical specialists’ views on the clinical utility of genomic medicine are mixed and are often tempered by several concerns. Specialists generally perceive their confidence and understanding to be lacking; subsequently, they welcome additional educational support, although specific needs are rarely detailed. Similar findings from the genetics era suggest that these challenges are not necessarily new but on a different scale and relevant to more specialties as genomic applications expand. While existing strategies developed for genetic education and training may be suitable for genomic education and training, investigating the educational needs of a wider range of specialties is critically necessary to determine if tailored approaches are needed and, if so, to facilitate these. Other interventions are also required to address some of the additional challenges identified in this review, and we encourage readers to see education as part of a broader implementation strategy.
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Affiliation(s)
- Erin Crellin
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Belinda McClaren
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Gronowski AM, Budelier MM, Campbell SM. Ethics for Laboratory Medicine. Clin Chem 2019; 65:1497-1507. [PMID: 31434657 DOI: 10.1373/clinchem.2019.306670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laboratory medicine, like other areas of medicine, is obliged to adhere to high ethical standards. There are particular ethical issues that are unique to laboratory medicine and other areas in which ethical issues uniquely impact laboratory practice. Despite this, there is variability in ethics education within the profession. This review provides a foundation for the study of ethics within laboratory medicine. CONTENT The Belmont Report identifies 3 core principles in biomedical ethics: respect for persons (including autonomy), beneficence (and its corollary nonmalfeasance), and justice. These core principles must be adhered to in laboratory medicine. Informed consent is vital to maintain patient autonomy. However, balancing patient autonomy with the desire for beneficence can sometimes be difficult when patients refuse testing or treatment. The use of leftover or banked samples is fundamental to the ability to do research, create reference intervals, and develop new tests, but it creates problems with consent. Advances in genetic testing have created unique ethical issues regarding privacy, incidental findings, and informed consent. As in other professions, the emergence of highly contagious and deadly infectious diseases poses a difficult ethical dilemma of helping patients while protecting healthcare workers. CONCLUSIONS Although many clinical laboratorians do not see or treat patients, they must be held accountable to the highest ethical and professional behavior. Recognition and understanding of ethical issues are essential to ethical practice of laboratory medicine.
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Affiliation(s)
- Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO;
| | - Melissa M Budelier
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Sheldon M Campbell
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
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36
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Qian E, Thong MK, Flodman P, Gargus J. A comparative study of patients' perceptions of genetic and genomic medicine services in California and Malaysia. J Community Genet 2019; 10:351-361. [PMID: 30506521 PMCID: PMC6591353 DOI: 10.1007/s12687-018-0399-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/18/2018] [Indexed: 11/29/2022] Open
Abstract
In the era of personalized and genomic medicine, awareness of patients with rare diseases is increasing as new approaches to diagnosis and treatment are developed. This study examined perceived barriers experienced by families with rare diseases and explored possible differences between participants in Malaysia and California, USA. The study involved N = 108 participants recruited in genetics clinic appointments at the University of Malaya Medical Center and three sites in Southern California. Participants completed a survey involving multiple choice and Likert scale items pertaining to perceived barriers to access genetics-related healthcare. Results from this study provide evidence of similar perceived barriers, despite differences in the two populations. Participants selected the expansion of healthcare provider knowledge of rare diseases to be the most beneficial approach to overcome perceived barriers. In both locations, it was also noted that travel distance to clinic was not perceived as a large stress factor. Taking these observations together, a healthcare model with a central location of providers well-versed in medical genetics may be considered if further data support our findings. The data from this study support a need for improving healthcare provider knowledge of genetics. Future studies exploring how these perceived stress factors are impacting families as well as different methods of educating providers are suggested by findings from the study, as well as studies querying the opinions of those who are unable to access genetics services.
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Affiliation(s)
- Emily Qian
- Department of Genetic and Genomic Medicine, University of California Irvine, Irvine, CA, 92697, USA.
| | - Meow-Keong Thong
- Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Pamela Flodman
- Department of Genetic and Genomic Medicine, University of California Irvine, Irvine, CA, 92697, USA
| | - Jay Gargus
- Department of Genetic and Genomic Medicine, University of California Irvine, Irvine, CA, 92697, USA
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37
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Primary Care Physicians' Knowledge, Attitudes, and Experience with Personal Genetic Testing. J Pers Med 2019; 9:jpm9020029. [PMID: 31137623 PMCID: PMC6617198 DOI: 10.3390/jpm9020029] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023] Open
Abstract
Primary care providers (PCPs) will play an important role in precision medicine. However, their lack of training and knowledge about genetics and genomics may limit their ability to advise patients or interpret or utilize test results. We evaluated PCPs’ awareness of the role of genetics/genomics in health, knowledge about key concepts in genomic medicine, perception/attitudes towards direct-to-consumer (DTC) genetic testing, and their level of confidence/comfort in discussing testing with patients prior to and after undergoing DTC testing through the 23andMe Health + Ancestry Service. A total of 130 PCPs completed the study. Sixty-three percent were board-certified in family practice, 32% graduated between 1991 and 2000, and 88% had heard of 23andMe prior to the study. Seventy-two percent decided to participate in the study to gain a better understanding about testing. At baseline, 23% of respondents indicated comfort discussing genetics as a risk factor for common diseases, increasing to 59% after undergoing personal genetic testing (PGT) (p < 0.01). In summary, we find that undergoing PGT augments physicians’ confidence, comfort, and interest in DTC testing.
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38
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Stiles D, Appelbaum PS. Cases in Precision Medicine: Concerns About Privacy and Discrimination After Genomic Sequencing. Ann Intern Med 2019; 170:717-721. [PMID: 31060048 PMCID: PMC6715527 DOI: 10.7326/m18-2666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients and research participants have indicated that privacy of their genetic test results is an important concern, particularly with respect to insurance coverage. Internists and other physicians whose patients ask about legal protections for information generated by genome sequencing for clinical purposes can provide both reassurance and caution. Protections for medical information in general, as well as laws in some states that provide additional safeguards for genetic data, should reassure patients that this information will remain private. Patients themselves will need to weigh the risks versus the benefits of generating genomic data in deciding whether to undergo exome sequencing.
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Affiliation(s)
| | - Paul S Appelbaum
- Columbia University and New York State Psychiatric Institute, New York, New York (P.S.A.)
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39
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Farrow E, Rengasamy Venugopalan S, Thiffault I, Saunders C. Examination of rare genetic variants in dental enamel genes: The potential role of next-generation sequencing in primary dental care. Orthod Craniofac Res 2019; 22 Suppl 1:49-55. [PMID: 31074140 DOI: 10.1111/ocr.12266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the potential role of next-generation sequencing (NGS) and genetic testing to guide preventive care in dental enamel disorders using publicly available databases to access the frequency of deleterious alleles in AMTN, AMLEX and ENAM, associated with amelogenesis imperfecta (AI). SETTING AND SAMPLE POPULATION Public resources, including gnomAD (The Broad Institute) and the Center for Pediatric Genomic Medicine's warehouse, which together contain variants from nearly 145 000 exomes and genomes. MATERIAL & METHODS Public resources, including sequencing data from ~145 000 exomes and genomes were queried for predicted loss of function variants with a minor allele frequency <1% in AMTN, AMLEX and ENAM. RESULTS A total of 95 variants were identified in the combined dataset. If confirmed, this could be diagnostic for autosomal dominant AI. CONCLUSIONS The rapid integration of NGS into clinical care allows for the expansion of genetic testing for disorders that are not currently tested routinely, including non-syndromic dental enamel disorders. A genotypic-driven diagnosis of a disorder of enamel development could impact dental care, especially in young children, including early and more frequent monitoring to prevent complications. As new gene-disease associations continue to emerge, including those for common and non-syndromic craniofacial disorders, the possibility of genomic-guided precision medicine and dentistry and the development of targeted, individualized therapeutics into standard clinical care will increase substantially.
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Affiliation(s)
- Emily Farrow
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Isabelle Thiffault
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.,Department of Pathology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Carol Saunders
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.,Department of Pathology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
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40
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Muflih S, Bleidt BA, Lafferty L, Shawaqfeh MS, Alvarez G. Measuring knowledge and attitudes towards the utilization of pharmacogenetic testing among physicians. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Suhaib Muflih
- College of Pharmacy Nova Southeastern UniversityDavie Florida USA
| | - Barry A. Bleidt
- College of Pharmacy Nova Southeastern UniversityDavie Florida USA
| | - Lynn Lafferty
- Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University Fort Lauderdale Florida USA
| | - Mohammad S. Shawaqfeh
- College of Pharmacy King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS) Riyadh Saudi Arabia
| | - Goar Alvarez
- College of Pharmacy Nova Southeastern UniversityDavie Florida USA
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41
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Arjunan A, Ben-Shachar R, Kostialik J, Johansen Taber K, Lazarin GA, Denne E, Muzzey D, Haverty C. Technology-Driven Noninvasive Prenatal Screening Results Disclosure and Management. Telemed J E Health 2019; 26:8-17. [PMID: 30807262 PMCID: PMC6948005 DOI: 10.1089/tmj.2018.0253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Noninvasive prenatal screening (NIPS) utilization has grown dramatically and is increasingly offered to the general population by nongenetic specialists. Web-based technologies and telegenetic services offer potential solutions for efficient results delivery and genetic counseling. Introduction: All major guidelines recommend patients with both negative and positive results be counseled. The main objective of this study was to quantify patient utilization, motivation for posttest counseling, and satisfaction of a technology platform designed for large-scale dissemination of NIPS results. Methods: The technology platform provided general education videos to patients, results delivery through a secure portal, and access to telegenetic counseling through phone. Automatic results delivery to patients was sent only to patients with screen-negative results. For patients with screen-positive results, either the ordering provider or a board-certified genetic counselor contacted the patient directly through phone to communicate the test results and provide counseling. Results: Over a 39-month period, 67,122 NIPS results were issued through the platform, and 4,673 patients elected genetic counseling consultations; 95.2% (n = 4,450) of consultations were for patients receiving negative results. More than 70% (n = 3,370) of consultations were on-demand rather than scheduled. A positive screen, advanced maternal age, family history, previous history of a pregnancy with a chromosomal abnormality, and other high-risk pregnancy were associated with the greatest odds of electing genetic counseling. By combining web education, automated notifications, and telegenetic counseling, we implemented a service that facilitates results disclosure for ordering providers. Discussion: This automated results delivery platform illustrates the use of technology in managing large-scale disclosure of NIPS results. Further studies should address effectiveness and satisfaction among patients and providers in greater detail. Conclusions: These data demonstrate the capability to deliver NIPS results, education, and counseling-congruent with professional society management guidelines-to a large population.
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Affiliation(s)
- Aishwarya Arjunan
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Rotem Ben-Shachar
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Jamie Kostialik
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | | | - Gabriel A Lazarin
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Elizabeth Denne
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Dale Muzzey
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Carrie Haverty
- Division of Medical Affairs, Counsyl, South San Francisco, California
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42
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Affiliation(s)
- Aaron W Aday
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Calum A MacRae
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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43
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Hauser D, Obeng AO, Fei K, Ramos MA, Horowitz CR. Views Of Primary Care Providers On Testing Patients For Genetic Risks For Common Chronic Diseases. Health Aff (Millwood) 2019; 37:793-800. [PMID: 29733703 DOI: 10.1377/hlthaff.2017.1548] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We surveyed 488 primary care providers in community and academic practices in New York City in the period 2014-16 about their views on genetic testing for chronic diseases. The majority of the providers, most of whom were current or recent physicians in training, had had formal genetics education and had positive views of the utility of genetic testing. However, they felt unprepared to work with patients at high risk for genetic conditions and were not confident about interpreting test results. Many were concerned that genetic testing might lead to insurance discrimination and lacked trust in companies that offer genetic tests. These findings point to some of the attitudes and knowledge gaps among the providers that should be considered in the clinical implementation of genomic medicine for chronic conditions. Enhanced training, guidelines, clinical tools, and awareness of patient protections might support the effective adoption of genomic medicine by primary care providers.
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Affiliation(s)
- Diane Hauser
- Diane Hauser ( ) is a senior associate in the Institute for Family Health and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, both in New York City
| | - Aniwaa Owusu Obeng
- Aniwaa Owusu Obeng is an assistant professor in the Charles Bronfman Institute for Personalized Medicine and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, and the clinical pharmacogenomics coordinator in the Pharmacy Department at Mount Sinai Hospital
| | - Kezhen Fei
- Kezhen Fei is a biostatistician in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
| | - Michelle A Ramos
- Michelle A. Ramos is a program manager in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
| | - Carol R Horowitz
- Carol R. Horowitz is a professor in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
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44
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Kopel J. Clinical genetic testing in medical education. Proc (Bayl Univ Med Cent) 2019; 32:165-166. [DOI: 10.1080/08998280.2018.1528937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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45
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Aartsma-Rus A, Hegde M, Ben-Omran T, Buccella F, Ferlini A, Gallano P, Howell RR, Leturcq F, Martin AS, Potulska-Chromik A, Saute JA, Schmidt WM, Sejersen T, Tuffery-Giraud S, Uyguner ZO, Witcomb LA, Yau S, Nelson SF. Evidence-Based Consensus and Systematic Review on Reducing the Time to Diagnosis of Duchenne Muscular Dystrophy. J Pediatr 2019; 204:305-313.e14. [PMID: 30579468 DOI: 10.1016/j.jpeds.2018.10.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Madhuri Hegde
- Department of Human Genetics, Emory University School of Medicine/School of Biological Sciences, Georgia Institute of Technology/Perkin Elmer Genetics, Atlanta, GA
| | - Tawfeg Ben-Omran
- Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Pia Gallano
- U705 CIBERER, Servei de Genetica, Hospital de Sant Pau, Barcelona, Spain
| | | | - France Leturcq
- Department of Genetics and Molecular Biology, Hospitalier Universitaire Paris Centre, Cochin Hospital, Paris, France
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Hackensack, NJ
| | | | - Jonas A Saute
- Medical Genetics and Neurology Services, Hospital de Clinicas de Porto Alegre/Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Wolfgang M Schmidt
- Neuromuscular Research Department, Medical University of Vienna, Vienna, Austria
| | - Thomas Sejersen
- Department of Women's and Children's Health, Karolinska Institute/Astrid Lindgrens Barnsjukhus, Karolinska University Hospital, Stockholm, Sweden
| | - Sylvie Tuffery-Giraud
- Laboratory of Rare Genetic Diseases (LGMR), University of Montpellier, Montpellier, France
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Shu Yau
- Viapath Analytics, Guy's Hospital, London, United Kingdom
| | - Stanley F Nelson
- Department of Human Genetics, University of California, Los Angeles, CA.
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46
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Greenberg S, Yashar BM, Pearlman M, Duquette D, Milliron K, Marvin M. Evaluating and improving the implementation of a community-based hereditary cancer screening program. J Community Genet 2019; 10:51-60. [PMID: 29508367 PMCID: PMC6325040 DOI: 10.1007/s12687-018-0357-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022] Open
Abstract
Healthcare disparities exist in the provision of cancer genetic services including genetic counseling and testing related to BRCA1/2 mutations. To address this in a community health setting a screening tool was created to identify high-risk women. This study evaluates the implementation of the tool and identifies opportunities for improved cancer genetic screening, including regular clinician education. A mixed-method approach was used to evaluate clinician utilization of the screening tool at Planned Parenthood affiliates. Novel surveys that evaluated acceptance and implementation were administered to clinicians (n = 14) and semi-structured interviews (n = 6) were used to explore clinicians' perspectives and identify gaps in its utilization. Educational modules that addressed gaps were developed, implemented, and evaluated using a post-education survey (n = 8). Clinicians reported confidence in administering and interpreting the screening tool, but reported less confidence in their knowledge of cancer genetics and ability to connect clients with genetic counseling and testing (p = .003). Educational modules resulted in significant gains in clinician knowledge on genetic topics (p < .05) and increased self-reported confidence in connecting clients with genetic services. The modules reinforced the belief that genetic testing is beneficial for patients at increased risk (p = .001) and is important to inform subsequent medical management (p = .027). While building community clinicians' capacity to connect clients with genetic services is crucial, it is challenged by knowledge and confidence gaps in discussions of genetic services with clients. Consistent genetic-focused education with non-genetic clinicians can improve confidence and knowledge, enabling a more effective screening program in community health settings.
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Affiliation(s)
- Samantha Greenberg
- Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI, 48109-5618, USA.
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI, 48109-5618, USA
| | - Mark Pearlman
- University of Michigan Obstetrics and Gynecology, 1540 E Hospital DR SPC 4276, Ann Arbor, MI, 48109-4276, USA
| | - Deb Duquette
- Feinberg School of Medicine, 645 North Michigan Avenue, Suite 630, Chicago, IL, 60611, USA
| | - Kara Milliron
- University of Michigan Comprehensive Cancer Center, 300 N Ingalls- 3A12, Ann Arbor, MI, 48109-5471, USA
| | - Monica Marvin
- Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI, 48109-5618, USA
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47
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Krishnamachari B, Rehman M, Cohn JE, Chan V, Modi N, Leitner O, Tangney K, O'Connor A, Blazey W, Koehler S, Tegay D. Video Education on Hereditary Breast and Ovarian Cancer (HBOC) for Physicians: an Interventional Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1213-1221. [PMID: 28573517 DOI: 10.1007/s13187-017-1233-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The National Comprehensive Cancer Network (NCCN) guidelines are the gold standard in hereditary cancer risk assessment, screening, and treatment. A minority of physicians follow NCCN guidelines for BRCA1 or BRCA2 mutations. This study assesses the impact of an interventional educational program on HBOC in terms of knowledge. Physicians were sent an invite to join either an intervention survey (web-training offered prior to the knowledge survey) or control survey (web-training offered after the knowledge survey). Sixty-nine physicians in the intervention arm and 67 physicians in the control arm completed the survey. The interventional group regularly answered items correctly at a higher frequency than the control group. For example, 64.71% (n = 44) of physicians in the intervention group knew that multi-gene testing does not have to include only highly penetrant genes compared to 32.84% (n = 22) of the control group (p < 0.01). Similar results were seen with other specific survey items. The current study is important in that it shows web-based education to be a feasible and effective modality for training on hereditary breast cancer. This type of education may be incorporated into CME programs and can be used as a foundation for further studies as well.
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Affiliation(s)
- Bhuma Krishnamachari
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine, 20 Riland PO Box 8000, Northern Boulevard, Old Westbury, NY, 11568, USA.
| | - Mahin Rehman
- Academic Medicine Scholars Program, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Jason E Cohn
- Department of Otolaryngology-Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Vivian Chan
- Academic Medicine Scholars Program, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Neil Modi
- Division of Research, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | | | | | | | - William Blazey
- Department of Family Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Sharon Koehler
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine, 20 Riland PO Box 8000, Northern Boulevard, Old Westbury, NY, 11568, USA
| | - David Tegay
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine, 20 Riland PO Box 8000, Northern Boulevard, Old Westbury, NY, 11568, USA
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48
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Gay EA, Byers PH, Bennett RL, Bird TD, Hisama FM. Trends over 42 years in the Adult Medical Genetics Clinic at the University of Washington. Genet Med 2018; 21:1457-1461. [DOI: 10.1038/s41436-018-0329-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/24/2018] [Indexed: 11/09/2022] Open
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49
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Douma KFL, Bleeker FE, Medendorp NM, Croes EAJ, Smets EMA. Information exchange between patients with Lynch syndrome and their genetic and non-genetic health professionals: whose responsibility? J Community Genet 2018; 10:237-247. [PMID: 30209752 PMCID: PMC6435774 DOI: 10.1007/s12687-018-0381-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/23/2018] [Indexed: 01/24/2023] Open
Abstract
Individuals at high risk for Lynch syndrome (LS) should be offered genetic counselling, since preventive options are available. However, uptake of genetic services and follow-up care are currently suboptimal, possibly caused by inadequate exchange of information. Therefore, this qualitative study aims to gain insight in the process of information exchange between patients diagnosed with LS and their non-genetic (i.e., general practitioner, gastroenterologist, gynaecologist) and genetic (i.e., clinical geneticist or genetic counsellor) health professionals concerning referral for genetic counselling and follow-up care. Participants comprised 13 patients diagnosed with LS (8 index patients and 5 of their affected relatives) and 24 health professionals (6 general practitioners, 8 gastroenterologists, 6 gynaecologists and 4 genetic health professionals). Analysis of the interview transcripts was performed in parallel and again after the interviews, following guidelines for qualitative research and using MAXQDA software. The main finding is that patients may ‘get lost’ between health professionals who lack a clear overview of their own and each other’s role and responsibilities in the referral and follow-up care for patients with possible LS. Education of non-genetic health professionals and optimisation of communication between health professionals might help to enable more timely diagnosis of LS and allow patients to address their doubts and questions to the most appropriate healthcare professional.
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Affiliation(s)
- Kirsten F L Douma
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Fonnet E Bleeker
- Department of Clinical Genetics, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.,Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Niki M Medendorp
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Emmelyn A J Croes
- Department Communication and Information Sciences, Tilburg University School of Humanities, Tilburg, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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50
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Albassam A, Alshammari S, Ouda G, Koshy S, Awad A. Knowledge, perceptions and confidence of physicians and pharmacists towards pharmacogenetics practice in Kuwait. PLoS One 2018; 13:e0203033. [PMID: 30183746 PMCID: PMC6124749 DOI: 10.1371/journal.pone.0203033] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/14/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pharmacogenetics practice has been successfully implemented in many developed countries to enhance personalized medicine and improve clinical and economic outcomes. An understanding of healthcare providers' knowledge, perceptions, confidence towards pharmacogenetics, and their active enrollment with pharmacogenetic testing is essential for test acceptance and utilization. This study was designed to assess physicians' and pharmacists' knowledge, perceptions, and confidence towards pharmacogenetics, determine the preferred learning format for their future education in pharmacogenetics, and identify the barriers to its application in their practice settings. METHODS A cross-sectional survey was conducted using a pretested self-administered questionnaire on a sample of 629 randomly selected physicians and pharmacists. Descriptive and comparative analyses were used in data analysis. RESULTS The response rate was 98.1%. Less than one-tenth of respondents were exposed to pharmacogenetics education or training (8.9%), applied pharmacogenetics testing in their practice (9.4%), or provided patient counselling on the results of the pharmacogenetic testing (9.1%), and over 90% of them were physicians. The overall respondents' mean (SD) total knowledge score percentage was low [45.0% (24)] and there was no significant difference between the physicians and pharmacists scores (p>0.05). Only 16.0% of participants indicated that they felt confident in applying pharmacogenetics in their practice settings. Despite these low levels of knowledge and self-confidence, 70.2% of participants expressed overall positive perceptions towards pharmacogenetics and its clinical implications. These positive overall perceptions were found to be significantly more common among pharmacists compared to physicians (p<0.05). The top two perceived barriers facing the implementation of pharmacogenetics in Kuwait were lack of education or training and clinical guidelines. CONCLUSIONS These findings highlight important concerns and will aid in the assessment of current pharmacogenetics practice. Also, they will provide further insight in designing future targeted multifaceted interventions to promote the adoption and utilization of pharmacogenetics testing in Kuwait.
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Affiliation(s)
- Abdullah Albassam
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Shahad Alshammari
- Department of Pharmacy, Jahra Hospital, Ministry of Health, Jahra City, Kuwait
| | - Ghadeer Ouda
- Drug Inspection Administration, Ministry of Health, Kuwait City, Kuwait
| | - Samuel Koshy
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Abdelmoneim Awad
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
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