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Swietlik EM, Fay M, Morrell NW. Understanding what drives genetic study participation: Perspectives of patients, carers, and relatives. Pulm Circ 2024; 14:e12346. [PMID: 38361979 PMCID: PMC10867872 DOI: 10.1002/pul2.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/17/2024] Open
Abstract
Genetic research's growing importance in understanding pulmonary arterial hypertension (PAH) and developing effective treatments prompted the RAPID-PAH study. This study sought feedback from stakeholders who participated in two genomic studies to enhance genetic study delivery and clinical integration. Stakeholders from nine UK PH centres, representing various roles, ages, genders, and mutation statuses, took part in 53 semi-structured interviews and focus groups. Transcripts were thematically coded using inductive analysis. Clustering analysis was conducted to identify patient groups that shared attitudes. In this paper, we focus on patients', carers', and relatives' perspectives. The key interview themes revealed insights into participants' attitudes toward genetic research and testing more generally, expertise and knowledge of the disease itself, motivations and barriers to participating in genetic research, awareness of and interest in consent procedures and the use of personal and genetic data, as well as the process of communicating individual genetic results. Factors influencing genetic research participation included altruistic motives, personal diagnostic experiences, and family-related hopes. Clustering analysis produced distinct clusters based on the presence of barriers and motivators for research participation; however, hardly any patients shared identical sets of attitudes, emphasising the need for personalised approaches to recruitment. Most patients reported poor engagement with study-related materials. Patients who received individual genetic results expressed satisfaction with the process, whereas those who did not were disappointed with the lack of feedback. Reflecting on patient perspectives, we offer recommendations to improve the genetic study delivery process. Enhancing genetic research integration into clinical practice requires tailored engagement, clear communication, and support from healthcare stakeholders.
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Affiliation(s)
- Emilia M. Swietlik
- Department of Medicine, The Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- Department of Pulmonology, Collegium MedicumUniversity of Warmia and Mazury in OlsztynOlsztynPoland
| | | | - Nicholas W. Morrell
- Department of Medicine, The Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
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Hirschi OR, Felker SA, Rednam SP, Vallance KL, Parsons DW, Roy A, Cooper GM, Plon SE. Combined Bioinformatic and Splicing Analysis of Likely Benign Intronic and Synonymous Variants Reveals Evidence for Pathogenicity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.30.23297632. [PMID: 37961416 PMCID: PMC10635218 DOI: 10.1101/2023.10.30.23297632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Current clinical variant analysis pipelines focus on coding variants and intronic variants within 10-20 bases of an exon-intron boundary that may affect splicing. The impact of newer splicing prediction algorithms combined with in vitro splicing assays on rare variants currently considered Benign/Likely Benign (B/LB) is unknown. Methods Exome sequencing data from 576 pediatric cancer patients enrolled in the Texas KidsCanSeq study were filtered for intronic or synonymous variants absent from population databases, predicted to alter splicing via SpliceAI (>0.20), and scored as potentially deleterious by CADD (>10.0). Total cellular RNA was extracted from monocytes and RT-PCR products analyzed. Subsequently, rare synonymous or intronic B/LB variants in a subset of genes submitted to ClinVar were similarly evaluated. Variants predicted to lead to a frameshifted splicing product were functionally assessed using an in vitro splicing reporter assay in HEK-293T cells. Results KidsCanSeq exome data analysis revealed a rare, heterozygous, intronic variant (NM_177438.3(DICER1):c.574-26A>G) predicted by SpliceAI to result in gain of a secondary splice acceptor site. The proband had a personal and family history of pleuropulmonary blastoma consistent with DICER1 syndrome but negative clinical sequencing reports. Proband RNA analysis revealed alternative DICER1 transcripts including the SpliceAI-predicted transcript.Similar bioinformatic analysis of synonymous or intronic B/LB variants (n=31,715) in ClinVar from 61 Mendelian disease genes yielded 18 variants, none of which could be scored by MaxEntScan. Eight of these variants were assessed (DICER1 n=4, CDH1 n=2, PALB2 n=2) using in vitro splice reporter assay and demonstrated abnormal splice products (mean 66%; range 6% to 100%). Available phenotypic information from submitting laboratories demonstrated DICER1 phenotypes in 2 families (1 variant) and breast cancer phenotypes for PALB2 in 3 families (2 variants). Conclusions Our results demonstrate the power of newer predictive splicing algorithms to highlight rare variants previously considered B/LB in patients with features of hereditary conditions. Incorporation of SpliceAI annotation of existing variant data combined with either direct RNA analysis or in vitro assays has the potential to identify disease-associated variants in patients without a molecular diagnosis.
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Affiliation(s)
- Owen R Hirschi
- Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | | | - Surya P Rednam
- Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | | | - D Williams Parsons
- Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | | | | | - Sharon E Plon
- Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
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McConkie-Rosell A, Spillmann RC, Schoch K, Sullivan JA, Walley N, McDonald M, Hooper SR, Shashi V. Unraveling non-participation in genomic research: A complex interplay of barriers, facilitators, and sociocultural factors. J Genet Couns 2023; 32:993-1008. [PMID: 37005744 PMCID: PMC10542653 DOI: 10.1002/jgc4.1707] [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: 11/28/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/04/2023]
Abstract
Although genomic research offering next-generation sequencing (NGS) has increased the diagnoses of rare/ultra-rare disorders, populations experiencing health disparities infrequently participate in these studies. The factors underlying non-participation would most reliably be ascertained from individuals who have had the opportunity to participate, but decline. We thus enrolled parents of children and adult probands with undiagnosed disorders who had declined genomic research offering NGS with return of results with undiagnosed disorders (Decliners, n = 21) and compared their data to those who participated (Participants, n = 31). We assessed: (1) practical barriers and facilitators, (2) sociocultural factors-genomic knowledge and distrust, and (3) the value placed upon a diagnosis by those who declined participation. The primary findings were that residence in rural and medically underserved areas (MUA) and higher number of barriers were significantly associated with declining participation in the study. Exploratory analyses revealed multiple co-occurring practical barriers, greater emotional exhaustion and research hesitancy in the parents in the Decliner group compared to the Participants, with both groups identifying a similar number of facilitators. The parents in the Decliner group also had lower genomic knowledge, but distrust of clinical research was not different between the groups. Importantly, despite their non-participation, those in the Decliner group indicated an interest in obtaining a diagnosis and expressed confidence in being able to emotionally manage the ensuing results. Study findings support the concept that some families who decline participation in diagnostic genomic research may be experiencing pile-up with exhaustion of family resources - making participation in the genomic research difficult. This study highlights the complexity of the factors that underlie non-participation in clinically relevant NGS research. Thus, approaches to mitigating barriers to NGS research participation by populations experiencing health disparities need to be multi-pronged and tailored so that they can benefit from state-of -the art genomic technologies.
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Affiliation(s)
- Allyn McConkie-Rosell
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
| | - Rebecca C. Spillmann
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
| | - Kelly Schoch
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
| | - Jennifer A. Sullivan
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
| | - Nicole Walley
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
| | - Marie McDonald
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
| | | | - Stephen R. Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine and Duke Health System, Durham, NC, USA
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Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
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Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
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Rao ND, Kaganovsky J, Fullerton SM, Chen AT, Shirts BH. Factors Influencing Genetic Screening Enrollment among a Diverse, Community-Ascertained Cohort. Public Health Genomics 2023; 26:113-122. [PMID: 37604133 PMCID: PMC10614558 DOI: 10.1159/000531989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Genetic screening for preventable adult-onset hereditary conditions has been proposed as a mechanism to reduce health disparities. Analysis of how race and ethnicity influence decision-making to receive screening can inform recruitment efforts and more equitable population screening design. A study at the University of Washington Medicine that invited unselected patients to participate in genetic screening for pathogenic variation in medically important genes provided an opportunity to evaluate these factors. METHODS We analyzed screening enrollee survey data to understand factors most important and least important in decision-making about screening overall and across different race and ethnicity groups. Electronic health record race and ethnicity and survey-reported race and ethnicity were compared to assist with interpretation. Comments provided about reasons for not enrolling in screening were analyzed using content analysis. RESULTS Overall, learning about disease risk and identifying risk early for prevention purposes were important factors in decision-making to receive screening, and regrets about screening and screening being against one's moral code were not viewed as important. Although racial identity was challenging to assign in all cases, compared to other enrollees, African-American and Asian enrollees considered test accuracy and knowing more about the test to be of greater importance. Three themes emerged related to nonparticipation: benefits do not outweigh risks, don't want to know, and challenges with study logistics. CONCLUSION Our results highlight important motivators for receiving screening and areas that can be addressed to increase screening interest and accessibility. This knowledge can inform future population screening program design including recruitment and education approaches.
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Affiliation(s)
- Nandana D Rao
- Institute for Public Health Genetics, University of Washington, Seattle, Washington, USA,
| | - Jailanie Kaganovsky
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian H Shirts
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Miller EG, Young JL, Rao A, Ward-Lev E, Halley MC. Demographic Characteristics Associated With Perceptions of Personal Utility in Genetic and Genomic Testing: A Systematic Review. JAMA Netw Open 2023; 6:e2310367. [PMID: 37145601 PMCID: PMC10163389 DOI: 10.1001/jamanetworkopen.2023.10367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 05/06/2023] Open
Abstract
Importance The expansion of genetic and genomic testing in health care has led to recognition that these tests provide personal as well as clinical utility to patients and families. However, available systematic reviews on this topic have not reported the demographic backgrounds of participants in studies of personal utility, leaving generalizability unclear. Objective To determine the demographic characteristics of participants in studies examining the personal utility of genetic and genomic testing in health care. Evidence Review For this systematic review, we utilized and updated the results of a highly cited 2017 systematic review on the personal utility of genetics and genomics, which identified relevant articles published between January 1, 2003, and August 4, 2016. We also used the original methods to update this bibliography with literature published subsequently up to January 1, 2022. Studies were screened for eligibility by 2 independent reviewers. Eligible studies reported empirical data on the perspectives of patients, family members, and/or the general public in the US on the personal utility of any type of health-related genetic or genomic test. We utilized a standardized codebook to extract study and participant characteristics. We summarized demographic characteristics descriptively across all studies and by subgroup based on study and participant characteristics. Findings We included 52 studies with 13 251 eligible participants. Sex or gender was the most frequently reported demographic characteristic (48 studies [92.3%]), followed by race and ethnicity (40 studies [76.9%]), education (38 studies [73.1%]), and income (26 studies [50.0%]). Across studies, participants disproportionately were women or female (mean [SD], 70.8% [20.5%]), were White (mean [SD], 76.1% [22.0%]), had a college degree or higher (mean [SD], 64.5% [19.9%]), and reported income above the US median (mean [SD], 67.4% [19.2%]). Examination of subgroups of results by study and participant characteristics evidenced only small shifts in demographic characteristics. Conclusions and Relevance This systematic review examined the demographic characteristics of individual participants in studies of the personal utility of health-related genetic and genomic testing in the US. The results suggest that participants in these studies were disproportionately White, college-educated women with above-average income. Understanding the perspectives of more diverse individuals regarding the personal utility of genetic and genomic testing may inform barriers to research recruitment and uptake of clinical testing in currently underrepresented populations.
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Affiliation(s)
- Emily G. Miller
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Jennifer L. Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anoushka Rao
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Eliana Ward-Lev
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Meghan C. Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
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7
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Prince AE, Suter SM, Uhlmann WR, Scherer AM. The goldilocks conundrum: Disclosing discrimination risks in informed consent. J Genet Couns 2022; 31:1383-1393. [PMID: 35930740 PMCID: PMC9722586 DOI: 10.1002/jgc4.1613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Informed consent is a foundational ethical and legal principle in human subjects research and clinical care. Yet, there is extensive debate over how much information must be disclosed to meet ethical goals and legal requirements, especially about non-medical risks. In this online, survey-based experiment of a diverse sample of the US general population, we explored one aspect of this debate by testing whether the level of detail included in informed consent regarding genetic anti-discrimination protections alters individuals' willingness to participate in a hypothetical research study and their concerns regarding genetic discrimination. Participants were randomized to receive sample informed consent language with one of three levels of disclosure regarding the protections and limitations of the Genetic Information Nondiscrimination Act (GINA). Our sample (n = 1,195) had a mean age of 45.9 (SD = 17.9) years and 40% with ≤high school education. Participants were 51.3% female and 36.7% non-Hispanic White. On average, those who received consent language with none of GINA's limitations highlighted were more willing to participate than those who were warned about various gaps in GINA. They also had significantly lower perceived risk of discrimination than those presented with the most information about limitations. Our study found that providing more comprehensive information about GINA notably lessened willingness to participate in the hypothetical studies, highlighting the need for clinicians and researchers to thoughtfully consider how to disclose anti-discrimination risks in informed consent.
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Affiliation(s)
| | - Sonia M. Suter
- GW Law, The George Washington University, Washington, DC, 20052, USA
| | - Wendy R. Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine, Department of Human Genetics, University of Michigan School of Medicine, Ann Arbor, Michigan, 48109, USA, Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, 48109, USA
| | - Aaron M. Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, 52242, USA
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Mandrell BN, Johnson LM, Caples M, Gattuso J, Maciaszek JL, Mostafavi R, Sharp KMH, Nichols KE. Parental Preferences Surrounding Timing and Content of Consent Conversations for Clinical Germline Genetic Testing Following a Child's New Cancer Diagnosis. JCO Precis Oncol 2022; 6:e2200323. [PMID: 36265116 PMCID: PMC9848596 DOI: 10.1200/po.22.00323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Clinical genomic testing is increasingly being used to direct pediatric cancer care. Many centers are interested in offering testing of tumors and paired germline tissues at or near the time of cancer diagnosis. We conducted this study to better understand parent preferences surrounding timing and content of consent conversations for clinical germline genetic testing of their children with cancer as a part of real-time cancer care. PATIENTS AND METHODS A seven-question survey developed by the Division of Cancer Predisposition and collaborators at St Jude Children's Research Hospital (St Jude) was distributed to members of the St Jude Patient Family Advisory Council, which included parents of childhood cancer survivors and bereaved parents whose children with cancer had died. Parents were asked to provide free text comments after each question. Qualitative methods were used to derive codes from parent comments, and survey results were depicted using descriptive statistics. RESULTS The survey was completed by 172 parents. Ninety-three (54%) endorsed an approach for consent conversations ≥ 1 month after cancer diagnosis, whereas 58 (34%) endorsed an approach at 1-2 weeks and 21 (12%) at 1-2 days. Needing time to adjust to a new or relapsed cancer diagnosis and feeling overwhelmed were frequent themes; however, parents acknowledged the urgency and importance of testing. Parents desired testing of as many cancer-related genes as possible, with clinical utility the most important factor for proceeding with testing. Most parents (75%) desired germline results to be disclosed in person, preferably by a genetic counselor. CONCLUSION Parents described urgency and benefits associated with germline testing, but desired flexibility in timing to allow for initial adjustment after their child's cancer diagnosis.
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Affiliation(s)
- Belinda N. Mandrell
- Division of Nursing Research, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN
| | - Liza Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Mary Caples
- Division of Nursing Research, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN
| | - Jami Gattuso
- Division of Nursing Research, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN
| | - Jamie L. Maciaszek
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Roya Mostafavi
- Division of Cancer Predisposition, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Kim E. Nichols
- Division of Cancer Predisposition, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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Young JL, Halley MC, Anguiano B, Fernandez L, Bernstein JA, Wheeler MT, Tabor HK. Beyond race: Recruitment of diverse participants in clinical genomics research for rare disease. Front Genet 2022; 13:949422. [PMID: 36072659 PMCID: PMC9441547 DOI: 10.3389/fgene.2022.949422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Despite recent attention to increasing diversity in clinical genomics research, researchers still struggle to recruit participants from varied sociodemographic backgrounds. We examined the experiences of parents from diverse backgrounds with enrolling their children in clinical genomics research on rare diseases. We explored the barriers and facilitators parents encountered and possible impacts of sociodemographic factors on their access to research.Methods: We utilized semi-structured interviews with parents of children participating in the Undiagnosed Diseases Network. Interview data were analyzed using comparative content analysis.Results: We interviewed 13 Hispanic, 11 non-Hispanic White, four Asian, and two biracial parents. Participants discussed different pathways to clinical genomics research for rare disease as well as how sociodemographic factors shaped families’ access. Themes focused on variation in: 1) reliance on providers to access research; 2) cultural norms around health communication; 3) the role of social capital in streamlining access; and 4) the importance of language-concordant research engagement.Conclusion: Our findings suggest that variables beyond race/ethnicity may influence access in clinical genomics research. Future efforts to diversify research participation should consider utilizing varied recruitment strategies to reach participants with diverse sociodemographic characteristics.
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Affiliation(s)
- Jennifer L. Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States
- Center for Genetic Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Jennifer L. Young,
| | - Meghan C. Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States
| | - Beatriz Anguiano
- Human Genetics and Genetic Counseling, Stanford University School of Medicine, Stanford, CA, United States
| | - Liliana Fernandez
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, CA, United States
| | - Jonathan A. Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Holly K. Tabor
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States
- Department of Medicine, Stanford University, Stanford, CA, United States
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Duenas DM, Shipman KJ, Porter KM, Shuster E, Guerra C, Reyes A, Kauffman TL, Hunter JE, Goddard KAB, Wilfond BS, Kraft SA. Motivations and concerns of patients considering participation in an implementation study of a hereditary cancer risk assessment program in diverse primary care settings. Genet Med 2022; 24:610-621. [PMID: 34906471 PMCID: PMC8939763 DOI: 10.1016/j.gim.2021.11.017] [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: 08/25/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Understanding the motivations and concerns of patients from diverse populations regarding participation in implementation research provides the needed evidence about how to design and conduct studies for facilitating access to genetics services. Within a hereditary cancer screening study assessing a multifaceted intervention, we examined primary care patients' motivations and concerns about participation. METHODS We surveyed and interviewed study participants after they enrolled, surveyed those who did not complete enrollment, and used descriptive qualitative and quantitative methods to identify motivations and concerns regarding participation. RESULTS Survey respondents' most common motivations included a desire to learn about their future risk (81%), receiving information that may help family (58%), and a desire to advance research (34%). Interviews revealed 3 additional important factors: affordability of testing, convenience of participation, and clinical relationships supporting research decision-making. Survey data of those who declined enrollment showed that the reasons for declining included concerns about privacy (38%), burdens of the research (19%), and their fear of not being able to cope with the genetic information (19%). CONCLUSION Understanding the facilitating factors and concerns that contribute to decisions about research may reveal ways to improve equity in access to care and research that could lead to greater uptake of genomic medicine across diverse primary care patient populations.
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Affiliation(s)
- Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA.
| | - Kelly J Shipman
- Palliative Care and Resilience Research Program, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, CA
| | - Ana Reyes
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
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Kelada L, Wakefield C, Vidic N, Armstrong DS, Bennetts B, Boggs K, Christodoulou J, Harrison J, Ho G, Kapur N, Lindsey-Temple S, McDonald T, Mowat D, Schultz A, Selvadurai H, Tai A, Jaffe A. Genomic testing for children with interstitial and diffuse lung disease (chILD): parent satisfaction, understanding and health-related quality of life. BMJ Open Respir Res 2022; 9:e001139. [PMID: 35190460 PMCID: PMC8862491 DOI: 10.1136/bmjresp-2021-001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Research is needed to determine best practice for genomic testing in the context of child interstitial or diffuse lung disease (chILD). We explored parent's and child's health-related quality of life (HRQoL), parents' perceived understanding of a genomic testing study, satisfaction with information and the study and decisional regret to undertake genomic testing. METHODS Parents of children with diagnosed or suspected chILD who were enrolled in a genomic sequencing study were invited to complete questionnaires pretesting (T1) and after receiving the result (T2). RESULTS Parents' (T1, n=19; T2, n=17) HRQoL was lower than population norms. Study satisfaction (T1) and perceived understanding (T2) were positively correlated (rs=0.68, p=0.014). Satisfaction with information (T1 and T2) and decisional regret (T2) were negatively correlated (T1 rs=-0.71, p=0.01; T2 rs=-0.56, p=0.03). Parents reported wanting more frequent communication with staff throughout the genomic sequencing study, and greater information about the confidentiality of test results. CONCLUSIONS Understanding of genomic testing, satisfaction with information and participation and decisional regret are inter-related. Pretest consultations are important and can allow researchers to explain confidentiality of data and the variable turnaround times for receiving a test result. Staff can also update parents when there will be delays to receiving a result.
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Affiliation(s)
- Lauren Kelada
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, New South Wales, Australia
| | - Claire Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, New South Wales, Australia
| | - Nada Vidic
- School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, New South Wales, Australia
| | - David S Armstrong
- Department of Respiratory Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Bruce Bennetts
- Discipline of Genetic Medicine and Discipline of Child & Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, Victoria, Australia
| | - Kirsten Boggs
- Department of Clinical Genetics, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
- Mackenzie's Mission, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - John Christodoulou
- Discipline of Genetic Medicine and Discipline of Child & Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mitochondrial, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne Harrison
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Division of Infection and Immunity, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Gladys Ho
- Discipline of Genetic Medicine and Discipline of Child & Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Suzanna Lindsey-Temple
- School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, New South Wales, Australia
- Department of Clinical Genetics, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Tim McDonald
- Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - David Mowat
- School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - André Schultz
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Tai
- Respiratory and Sleep Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Adam Jaffe
- School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, New South Wales, Australia
- Respiratory Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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12
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Krantz ID, Medne L, Weatherly JM, Wild KT, Biswas S, Devkota B, Hartman T, Brunelli L, Fishler KP, Abdul-Rahman O, Euteneuer JC, Hoover D, Dimmock D, Cleary J, Farnaes L, Knight J, Schwarz AJ, Vargas-Shiraishi OM, Wigby K, Zadeh N, Shinawi M, Wambach JA, Baldridge D, Cole FS, Wegner DJ, Urraca N, Holtrop S, Mostafavi R, Mroczkowski HJ, Pivnick EK, Ward JC, Talati A, Brown CW, Belmont JW, Ortega JL, Robinson KD, Brocklehurst WT, Perry DL, Ajay SS, Hagelstrom RT, Bennett M, Rajan V, Taft RJ. Effect of Whole-Genome Sequencing on the Clinical Management of Acutely Ill Infants With Suspected Genetic Disease: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:1218-1226. [PMID: 34570182 PMCID: PMC8477301 DOI: 10.1001/jamapediatrics.2021.3496] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Whole-genome sequencing (WGS) shows promise as a first-line genetic test for acutely ill infants, but widespread adoption and implementation requires evidence of an effect on clinical management. OBJECTIVE To determine the effect of WGS on clinical management in a racially and ethnically diverse and geographically distributed population of acutely ill infants in the US. DESIGN, SETTING, AND PARTICIPANTS This randomized, time-delayed clinical trial enrolled participants from September 11, 2017, to April 30, 2019, with an observation period extending to July 2, 2019. The study was conducted at 5 US academic medical centers and affiliated children's hospitals. Participants included infants aged between 0 and 120 days who were admitted to an intensive care unit with a suspected genetic disease. Data were analyzed from January 14 to August 20, 2020. INTERVENTIONS Patients were randomized to receive clinical WGS results 15 days (early) or 60 days (delayed) after enrollment, with the observation period extending to 90 days. Usual care was continued throughout the study. MAIN OUTCOMES AND MEASURES The main outcome was the difference in the proportion of infants in the early and delayed groups who received a change of management (COM) 60 days after enrollment. Additional outcome measures included WGS diagnostic efficacy, within-group COM at 90 days, length of hospital stay, and mortality. RESULTS A total of 354 infants were randomized to the early (n = 176) or delayed (n = 178) arms. The mean participant age was 15 days (IQR, 7-32 days); 201 participants (56.8%) were boys; 19 (5.4%) were Asian; 47 (13.3%) were Black; 250 (70.6%) were White; and 38 (10.7%) were of other race. At 60 days, twice as many infants in the early group vs the delayed group received a COM (34 of 161 [21.1%; 95% CI, 15.1%-28.2%] vs 17 of 165 [10.3%; 95% CI, 6.1%-16.0%]; P = .009; odds ratio, 2.3; 95% CI, 1.22-4.32) and a molecular diagnosis (55 of 176 [31.0%; 95% CI, 24.5%-38.7%] vs 27 of 178 [15.0%; 95% CI, 10.2%-21.3%]; P < .001). At 90 days, the delayed group showed a doubling of COM (to 45 of 161 [28.0%; 95% CI, 21.2%-35.6%]) and diagnostic efficacy (to 56 of 178 [31.0%; 95% CI, 24.7%-38.8%]). The most frequent COMs across the observation window were subspecialty referrals (39 of 354; 11%), surgery or other invasive procedures (17 of 354; 4%), condition-specific medications (9 of 354; 2%), or other supportive alterations in medication (12 of 354; 3%). No differences in length of stay or survival were observed. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, for acutely ill infants in an intensive care unit, introduction of WGS was associated with a significant increase in focused clinical management compared with usual care. Access to first-line WGS may reduce health care disparities by enabling diagnostic equity. These data support WGS adoption and implementation in this population. TRAIL REGISTRATION ClinicalTrials.gov Identifier: NCT03290469.
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Affiliation(s)
| | - Ian D. Krantz
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Livija Medne
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jamila M. Weatherly
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - K. Taylor Wild
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sawona Biswas
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of California, San Francisco
| | - Batsal Devkota
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tiffiney Hartman
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Luca Brunelli
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City
- University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha
| | - Kristen P. Fishler
- University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha
| | - Omar Abdul-Rahman
- University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha
| | - Joshua C. Euteneuer
- University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha
| | - Denise Hoover
- University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha
| | - David Dimmock
- Children’s Hospital of Orange County, Orange, California
- Rady Children’s Institute for Genomic Medicine, San Diego, California
| | - John Cleary
- Children’s Hospital of Orange County, Orange, California
| | - Lauge Farnaes
- Rady Children’s Institute for Genomic Medicine, San Diego, California
| | - Jason Knight
- Children’s Hospital of Orange County, Orange, California
| | | | | | - Kristin Wigby
- Rady Children’s Institute for Genomic Medicine, San Diego, California
- Division of Genetics, Department of Pediatrics, University of California San Diego
| | - Neda Zadeh
- Children’s Hospital of Orange County, Orange, California
| | - Marwan Shinawi
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Genetics and Genomic Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jennifer A. Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Newborn Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dustin Baldridge
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Genetics and Genomic Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - F. Sessions Cole
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Newborn Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Daniel J. Wegner
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Newborn Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nora Urraca
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
- Le Bonheur Children’s Hospital, Memphis, Tennessee
| | | | - Roya Mostafavi
- Le Bonheur Children’s Hospital, Memphis, Tennessee
- St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Henry J. Mroczkowski
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
- Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Eniko K. Pivnick
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
- Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Jewell C. Ward
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
- Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Ajay Talati
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
- Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Chester W. Brown
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
- Le Bonheur Children’s Hospital, Memphis, Tennessee
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Prince AE, Uhlmann WR, Suter SM, Scherer AM. Genetic testing and insurance implications: Surveying the US general population about discrimination concerns and knowledge of the Genetic Information Nondiscrimination Act (GINA). RISK MANAGEMENT AND INSURANCE REVIEW 2021; 24:341-365. [PMID: 35663290 PMCID: PMC9165621 DOI: 10.1111/rmir.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/05/2021] [Indexed: 06/15/2023]
Abstract
Globally, due to public concerns of genetic discrimination, some countries and insurance industries have adopted policies restricting insurer use of genetic information, such as the US Genetic Information Nondiscrimination Act (GINA). This study reports on combined analysis of two surveys assessing public knowledge of GINA and concerns of genetic discrimination in a diverse U.S. sample (N=1616). We focus on whether occupation, genetic testing history, and insurance status are correlated with knowledge of GINA or concerns of discrimination. While bivariate analysis identified some populations with higher subjective/objective knowledge and concern relative to counterparts, multivariable regression identified very few significant associations with outcomes of interest. Overall, this study highlights lack of awareness and understanding of GINA, even among subpopulations hypothesized to have greater knowledge of the law. These findings have implications for the broader debate around insurer use of genetic information.
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Affiliation(s)
| | - Wendy R. Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine; Department of Human Genetics; Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine
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14
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Return of individual research results from genomic research: A systematic review of stakeholder perspectives. PLoS One 2021; 16:e0258646. [PMID: 34748551 PMCID: PMC8575249 DOI: 10.1371/journal.pone.0258646] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.
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15
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Lemke AA, Amendola LM, Thompson J, Dunnenberger HM, Kuchta K, Wang C, Dilzell-Yu K, Hulick PJ. Patient-Reported Outcomes and Experiences with Population Genetic Testing Offered Through a Primary Care Network. Genet Test Mol Biomarkers 2021; 25:152-160. [PMID: 33596141 PMCID: PMC7891215 DOI: 10.1089/gtmb.2020.0275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aims: To explore patient experiences in a large-scale primary care-based, preemptive genetic testing program. Methods: Patients who received genetic results from the initiative were invited to participate in an online survey 3 weeks postresult disclosure. A 6-month follow-up survey was sent to assess changes over time. Results: The initial survey was completed by 1646 patients, with 544 completing the 6-month follow-up survey. The following outcomes were high overall: patient-reported understanding of results (cancer: 87%; cardiac: 86%); perceived utility (75%); positive emotions (relieved: 66.8%; happy: 62.0%); family result sharing (67.6%); and satisfaction (87%), although analysis by demographic factors identified groups who may benefit from additional education and emotional support. Results-related health behaviors and discussions with providers increased over time (screening procedures 6.1% to 14.2% p < 0.001; provider discussion 10.3% to 25.3%, p < 0.001), and were more likely to take place for patients with positive cancer and/or cardiac results (39.8% vs. 7.6%, p < 0.001). Forty-seven percent of patients reported insurance discrimination concerns, and most (79.4%) were not familiar with privacy and nondiscrimination laws. Concerns regarding discrimination and negative emotions decreased between the two survey time points (privacy issues 44.6% to 35.1% p < 0.001; life insurance discrimination concerns 35.5% to 29.6%, p = 0.001; anxiety 8.1% to 3.3%, p < 0.001; and uncertainty 19.8% to 12.8%, p < 0.001). These findings led to the development and integration of additional patient resources to improve program implementation. Conclusion: Our findings highlight patient experiences with and areas of need in a community-based genomic screening pilot initiative using a mixed primary care/genetics provider model to deliver precision medicine.
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Affiliation(s)
- Amy A Lemke
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Laura M Amendola
- Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - Jennifer Thompson
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Henry M Dunnenberger
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Kristine Kuchta
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Chi Wang
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Kristen Dilzell-Yu
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Peter J Hulick
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
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16
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Wake DT, Bell GC, Gregornik DB, Ho TT, Dunnenberger HM. Synthesis of major pharmacogenomics pretest counseling themes: a multisite comparison. Pharmacogenomics 2021; 22:165-176. [PMID: 33461326 DOI: 10.2217/pgs-2020-0168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The accessibility of pharmacogenomic (PGx) testing has grown substantially over the last decade and with it has arisen a demand for patients to be counseled on the use of these tests. While guidelines exist for the use of PGx results; objective determinants for who should receive PGx testing remain incomplete. PGx clinical services have been created to meet these screening and education needs and significant variability exists between these programs. This article describes the practices of four PGx clinics during pretest counseling sessions. A description of the major tenets of the benefits, limitations and risks of testing are compiled. Additional tools are provided to serve as a foundation for those wishing to begin or expand their own counseling service.
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Affiliation(s)
- Dyson T Wake
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Gillian C Bell
- Genetics & Personalized Medicine Department, Mission Health, Asheville, NC 28803, USA
| | - David B Gregornik
- Pharmacogenomics Program, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Teresa T Ho
- Department of Pharmacotherapeutics & Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, FL 33612, USA
| | - Henry M Dunnenberger
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA
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17
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Lewis ACF, Green RC. Polygenic risk scores in the clinic: new perspectives needed on familiar ethical issues. Genome Med 2021; 13:14. [PMID: 33509269 PMCID: PMC7844961 DOI: 10.1186/s13073-021-00829-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
Clinical use of polygenic risk scores (PRS) will look very different to the more familiar monogenic testing. Here we argue that despite these differences, most of the ethical, legal, and social issues (ELSI) raised in the monogenic setting, such as the relevance of results to family members, the approach to secondary and incidental findings, and the role of expert mediators, continue to be relevant in the polygenic context, albeit in modified form. In addition, PRS will reanimate other old debates. Their use has been proposed both in the practice of clinical medicine and of public health, two contexts with differing norms. In each of these domains, it is unclear what endpoints clinical use of PRS should aim to maximize and under what constraints. Reducing health disparities is a key value for public health, but clinical use of PRS could exacerbate race-based health disparities owing to differences in predictive power across ancestry groups. Finally, PRS will force a reckoning with pre-existing questions concerning biomarkers, namely the relevance of self-reported race, ethnicity and ancestry, and the relationship of risk factors to disease diagnoses. In this Opinion, we argue that despite the parallels to the monogenic setting, new work is urgently needed to gather data, consider normative implications, and develop best practices around this emerging branch of genomics.
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Affiliation(s)
- Anna C F Lewis
- E J Safra Center for Ethics, Harvard University, 124 Mount Auburn, Street, Cambridge, 02138, USA.
| | - Robert C Green
- Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
- Ariadne Labs, 401 Park Dr 3rd Floor, Boston, MA 02215, USA
- Broad Institute of Harvard and MIT, 415 Main St, Cambridge, MA 02142, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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18
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Rao SK, Thomas KA, Singh R, Biltibo E, Lammers PE, Wiesner GL. Increased ease of access to genetic counseling for low-income women with breast cancer using a point of care screening tool. J Community Genet 2021; 12:129-136. [PMID: 33389527 PMCID: PMC7846634 DOI: 10.1007/s12687-020-00499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022] Open
Abstract
Increased access to genetic counseling services is of prime importance in minority and underserved populations where genetic testing is currently underutilized. Our study tested a point of care screening tool to identify high-risk low-income patients for genetic counseling in a busy county hospital oncology clinic. Eligible breast patients treated at a "safety-net" hospital, were scored into 'high-risk' (> or = 6) or 'low-risk' (< 6) groups using a screening tool on personal and family history of cancer. Genetic counseling and testing were provided at the Vanderbilt Hereditary Cancer Program (VHCP) to all 'high-risk' and some 'low-risk' participants considered to need genetic counseling by their oncologist. Ninety-nine women with a history of breast cancer were enrolled onto the study over a period of 26 months. 53.5% (53/99) had a 'high-risk' score and ethnic predominance of African-American (60.4%). Of these, 67.9% (36/53) were counseled, and 91.6% (33/36) tested with a 9% (3/33) mutation positive rate. In the 'low-risk' group, 28.2% (13/46) still met current NCCN guidelines and were referred by their oncologist. 69.2% (9/13) were counseled and tested. The 'low-risk' group of predominantly Caucasian (41.3%) participants carried a 20% (2/10) mutation positive rate; which was later adjusted to 10% to exclude a mutation not conferring a strong breast cancer risk. The screening tool was well accepted by patients; and increased access to genetic counseling. There was a subset of breast cancer affected women under 45 with no reported family history that failed to be identified. Minor alterations to the tool would enhance concordance with current NCCN guidelines.
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Affiliation(s)
- Smita K Rao
- Vanderbilt Clinical and Translational Hereditary Cancer Program, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | | | | | | | - Georgia L Wiesner
- Vanderbilt Clinical and Translational Hereditary Cancer Program, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Long-awaited progress in addressing genetic discrimination in the United States. Genet Med 2020; 23:429-431. [PMID: 33077893 DOI: 10.1038/s41436-020-01002-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/08/2022] Open
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20
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Moriarty K, Wolf SM, Veach PM, LeRoy B, MacFarlane IM, Zierhut HA. A roadmap for precision medicine research recruitment: empirical assessment of the public's willingness to participate. Per Med 2020; 17:345-359. [PMID: 32804044 DOI: 10.2217/pme-2019-0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: Precision medicine research recruitment poses challenges. To better understand factors impacting recruitment, this study assessed hypothetical willingness, public opinions of and familiarity with precision medicine research. Materials & methods: Adult attendees (n = 942) at the 2017 Minnesota State Fair completed an electronic survey. Results: Few respondents had heard of 'precision medicine' (18%), and familiarity came mostly from media (43%). Fifty-six percent expressed hypothetical willingness to participate in precision medicine research. Significant predictors of willingness were: comfort with unconditional research; perceiving precision medicine research as beneficial, trustworthy and confidential; having a graduate degree; comfort with self- but not family-participation; and familiarity with precision/personalized medicine. Conclusion: This study identified predictors of hypothetical willingness to participate in precision medicine research. Alternative recruitment strategies are needed.
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Affiliation(s)
- Kelsey Moriarty
- Department of Genetics, Cell Biology & Development, University of Minnesota - Twin Cities, Minneapolis, MN 55455 USA
| | - Susan M Wolf
- Law School, Medical School & Consortium on Law & Values in Health, Environment & The Life Sciences, University of Minnesota - Twin Cities, Minneapolis, MN 55455 USA
| | - Patricia M Veach
- Department of Genetics, Cell Biology & Development, University of Minnesota - Twin Cities, Minneapolis, MN 55455 USA
| | - Bonnie LeRoy
- Department of Genetics, Cell Biology & Development, University of Minnesota - Twin Cities, Minneapolis, MN 55455 USA
| | - Ian M MacFarlane
- Department of Psychology, Elizabethtown College, Elizabethtown, PA 17022 USA
| | - Heather A Zierhut
- Department of Genetics, Cell Biology & Development, University of Minnesota - Twin Cities, Minneapolis, MN 55455 USA
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Riggs MJ, Huang B, Chen Q, Bocklage T, Schuh MR, Poi M, Villano JL, Cavnar MJ, Arnold SM, Miller RW, Ueland FR, Kolesar JM. Factors Predicting Participation in the Prospective Genomic Sequencing Study, Total Cancer Care (TCC), in Kentucky. J Rural Health 2020; 38:5-13. [PMID: 32633045 DOI: 10.1111/jrh.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Large-scale genomic sequencing studies are driving oncology drug development. However, rural populations, like those residing in Appalachian Kentucky, are underrepresented in these efforts. In this study, we determined the frequency of participation, reasons for nonparticipation, and factors predicting the decision to participate in the Total Cancer Care (TCC) prospective genomic cohort study. METHODS A total of 1,188 patients were invited to enroll in the TCC prospective cohort from December 2018 to May 2019. Declining patients were queried for their rationale for nonparticipation and their patient data were obtained from the Kentucky Cancer Registry (KCR). Logistic regression was used to assess the association between characteristics and study participation. The association of study participation with survival was modeled with Cox proportional-hazards regression. RESULTS 90.9% (1,081) patients consented to participate. In multivariate analysis, factors significantly associated with participation were age, gender, treatment status, and race. Though overall more women participated in the study, men were more likely to participate than women when invited (OR 1.57). Younger, Caucasian individuals who had received chemotherapy, but not surgery, were also more likely to participate. Patients in the Kentucky Appalachian cohort were primarily rural, had less educational attainment, and lower socioeconomic status. Kentucky Appalachian patients were no less likely to enroll in TCC than non-Appalachian patients. Consented individuals had higher overall survival compared to those who declined. CONCLUSION Though minorities, those with low socioeconomic status, and rural populations are underrepresented in genomic studies, they were no less likely to participate when given the opportunity, and participation was associated with better clinical outcomes.
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Affiliation(s)
- McKayla J Riggs
- Department of Obstetrics and Gynecology/Division of Gynecologic Oncology, University of Kentucky, Lexington, Kentucky
| | - Bin Huang
- Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, Lexington, Kentucky
| | - Quan Chen
- Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, Lexington, Kentucky
| | - Therese Bocklage
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Marissa R Schuh
- Precision Medicine Center, Markey Cancer Center, Lexington, Kentucky
| | | | - John L Villano
- Department of Hematology & Oncology, Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Michael J Cavnar
- Department of Surgery/Division of Surgical Oncology, University of Kentucky, Lexington, Kentucky
| | - Susanne M Arnold
- Department of Hematology & Oncology, Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Rachel W Miller
- Department of Obstetrics and Gynecology/Division of Gynecologic Oncology, University of Kentucky, Lexington, Kentucky
| | - Frederick R Ueland
- Department of Obstetrics and Gynecology/Division of Gynecologic Oncology, University of Kentucky, Lexington, Kentucky
| | - Jill M Kolesar
- Department of Pharmacy, University of Kentucky, Lexington, Kentucky
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22
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Hill M, Hammond J, Lewis C, Mellis R, Clement E, Chitty LS. Delivering genome sequencing for rapid genetic diagnosis in critically ill children: parent and professional views, experiences and challenges. Eur J Hum Genet 2020; 28:1529-1540. [PMID: 32561901 PMCID: PMC7575551 DOI: 10.1038/s41431-020-0667-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/02/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
Rapid genomic sequencing (RGS) is increasingly being used in the care of critically ill children. Here we describe a qualitative study exploring parent and professional perspectives around the usefulness of this test, the potential for unintended harms and the challenges for delivering a wider clinical service. The Rapid Paediatric Sequencing (RaPS) study offered trio RGS for diagnosis of critically ill children with a likely monogenic disorder. Main and actionable secondary findings were reported. Semi-structured interviews were conducted with parents of children offered RGS (n = 11) and professionals (genetic clinicians, non-genetic clinicians, scientists and consenters) (n = 19) by telephone (parents n = 10/professionals n = 1) or face-to-face (parents n = 1/professionals n = 18). We found that participants held largely positive views about RGS, describing clinical and emotional benefits from the opportunity to obtain a rapid diagnosis. Parental stress surrounding their child's illness complicates decision making. Parental concerns are heightened when offered RGS and while waiting for results. The importance of multidisciplinary team working to enable efficient delivery of a rapid service was emphasised. Our findings give insight into the perceived value of RGS for critically ill children. Careful pre-test counselling is needed to support informed parental decision making. Many parents would benefit from additional support while waiting for results. Education of mainstream clinicians is required to facilitate clinical implementation.
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Affiliation(s)
- Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rhiannon Mellis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Emma Clement
- Clinical Genetics and Genomic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lyn S Chitty
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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23
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Howard Sharp KM, Jurbergs N, Ouma A, Harrison L, Gerhardt E, Taylor L, Hamilton K, McGee RB, Nuccio R, Quinn E, Hines-Dowell S, Kesserwan C, Sunkara A, Gattuso JS, Pritchard M, Mandrell B, Relling MV, Haidar CE, Kang G, Johnson LM, Nichols KE. Factors Associated with Declining to Participate in a Pediatric Oncology Next Generation Sequencing Study. JCO Precis Oncol 2020; 4:202-211. [PMID: 32395682 PMCID: PMC7213582 DOI: 10.1200/po.19.00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE For the advances of pediatric oncology next generation sequencing (NGS) research to equitably benefit all children, a diverse and representative sample of participants is needed. However, little is known about demographic and clinical characteristics that differentiate families who decline enrollment in pediatric oncology NGS research. METHODS Demographic and clinical data were retrospectively extracted for 363 pediatric oncology patients (0-21 years) approached for enrollment on Genomes for Kids (G4K), a study examining the feasibility of comprehensive clinical genomic analysis of tumors and paired normal samples. Demographic and clinical factors that significantly differentiated which families declined were subsequently compared to enrollment in Clinical Implementation of Pharmacogenetics (PG4KDS) for 348 families, a pharmacogenomics study with more explicit therapeutic benefit examining genes affecting drug responses and metabolism. RESULTS Fifty-three (14.6%) families declined enrollment in G4K. Race/ethnicity was the only variable that significantly differentiated study refusal using multivariate logistic regression, with families of black children more likely to decline enrollment compared to families of non-Hispanic or Hispanic white children. Reasons for declining G4K were generally consistent with other pediatric genomics research, with feeling overwhelmed and insurance discrimination fears most frequently cited. Families of black children were also more likely to decline enrollment in PG4KDS. Thirteen (3.7%) of the 348 families approached for both studies declined PG4KDS. CONCLUSION Race/ethnicity differentiated study declination across two different pediatric oncology genomics studies, suggesting enrollment disparities in the context of pediatric oncology genomics research. Genomics research participant samples that do not fully represent racial and ethnic minorities risk further exacerbating health disparities. Additional work is needed to understand the nuances of parental decision making in genomic research and facilitate enrollment of diverse patient populations.
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Affiliation(s)
| | - Niki Jurbergs
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, TN
| | - Annastasia Ouma
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Leslie Taylor
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Kayla Hamilton
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Rose B. McGee
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Regina Nuccio
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Emily Quinn
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Stacy Hines-Dowell
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Chimene Kesserwan
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Anusha Sunkara
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Jami S. Gattuso
- Division of Nursing Research, St Jude Children’s Research Hospital, Memphis, TN
| | - Michelle Pritchard
- Division of Nursing Research, St Jude Children’s Research Hospital, Memphis, TN
| | - Belinda Mandrell
- Division of Nursing Research, St Jude Children’s Research Hospital, Memphis, TN
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, TN
| | - Cyrine E. Haidar
- Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, TN
| | - Guolian Kang
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Liza M. Johnson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Kim E. Nichols
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
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24
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Cuccaro ML, Manrique CP, Quintero MA, Martinez R, McCauley JL. Understanding Participation in Genetic Research Among Patients With Multiple Sclerosis: The Influences of Ethnicity, Gender, Education, and Age. Front Genet 2020; 11:120. [PMID: 32231680 PMCID: PMC7082924 DOI: 10.3389/fgene.2020.00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
This study examined reasons for participation in a genetic study of risk for multiple sclerosis (MS). Our sample consisted of 101 patients diagnosed with MS who were approached about enrolling in the Multiple Sclerosis Genetic Susceptibility Study. Participants were predominantly Hispanic (80%), female (80%), and well educated (71%), having at least some level of college education. Of these 101 individuals who were approached, 95 agreed to participate and are the focus of this report. Among enrollees, the most frequently cited reasons for participation were to find a cure for MS (56%), having MS (46%), and helping future generations (37%). Regression models comparing ethnic groups, Hispanics endorsed having MS as a reason to participate significantly more frequently than non-Hispanics (HI 52%, non-HI 19%, p = 0.015) while non-Hispanics endorsed finding new and better treatments significantly more frequently than Hispanics (Hispanic 17%, non-Hispanic 50%, p = 0.003). Among our three age groups, younger individuals endorsed finding a cure for MS significantly more frequently (74% of 18-35-year olds vs. 56% of 36-55 year olds vs. 39% of >55 year olds). Our results suggest that motivations for participation in genetic research vary by ethnicity, and that these influences need to be considered in developing more inclusive programs of disease-related genetic research. Future efforts should focus on development of standard methods for understanding participation in genetic and genomic research, especially among underrepresented groups as a catalyst for engaging all populations.
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Affiliation(s)
- Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States.,Dr. John T. Macdonald Foundation, Department of Human Genetics and Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Clara P Manrique
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maria A Quintero
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ricardo Martinez
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States.,Dr. John T. Macdonald Foundation, Department of Human Genetics and Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
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25
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Kimberly RP. Translational Research-For the Individual and the Community. J Health Care Poor Underserved 2019; 30:79-85. [PMID: 31735721 DOI: 10.1353/hpu.2019.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The potential for translational research to improve human health is unprecedented, as the integration of genetic health risks with other data influencing health provides substantial opportunities for improvement. However, how integrating these data sources in a fair, unbiased and appropriate way without reinforcing pre-existing assumptions requires thoughtful implementation. Furthermore, integration of new technologies requires assessment of needs and benefits for the individual balanced with community needs and goals. Thus, examination of values, goals and implicit assumptions through transparent, authentic engagement of individuals and communities is essential.
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26
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Evaluation of the cost and effectiveness of diverse recruitment methods for a genetic screening study. Genet Med 2019; 21:2371-2380. [PMID: 30930462 DOI: 10.1038/s41436-019-0497-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/12/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Recruitment of participants from diverse backgrounds is crucial to the generalizability of genetic research, but has proven challenging. We retrospectively evaluated recruitment methods used for a study on return of genetic results. METHODS The costs of study design, development, and participant enrollment were calculated, and the characteristics of the participants enrolled through the seven recruitment methods were examined. RESULTS A total of 1118 participants provided consent, a blood sample, and questionnaire data. The estimated cost across recruitment methods ranged from $579 to $1666 per participant and required a large recruitment team. Recruitment methods using flyers and staff networks were the most cost-efficient and resulted in the highest completion rate. Targeted sampling that emphasized the importance of Latino/a participation, utilization of translated materials, and in-person recruitments contributed to enrolling a demographically diverse sample. CONCLUSIONS Although all methods were deployed in the same hospital or neighborhood and shared the same staff, each recruitment method was different in terms of cost and characteristics of the enrolled participants, suggesting the importance of carefully choosing the recruitment methods based on the desired composition of the final study sample. This analysis provides information about the effectiveness and cost of different methods to recruit adults for genetic research.
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27
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Genetti CA, Schwartz TS, Robinson JO, VanNoy GE, Petersen D, Pereira S, Fayer S, Peoples HA, Agrawal PB, Betting WN, Holm IA, McGuire AL, Waisbren SE, Yu TW, Green RC, Beggs AH, Parad RB. Parental interest in genomic sequencing of newborns: enrollment experience from the BabySeq Project. Genet Med 2019; 21:622-630. [PMID: 30209271 PMCID: PMC6420384 DOI: 10.1038/s41436-018-0105-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Newborn genomic sequencing (nGS) has great potential to improve pediatric care. Parental interest and concerns about genomics are relatively unexplored. Understanding why parents decline research consent for nGS may reveal implementation barriers. METHODS We evaluated parental interest in a randomized trial of nGS in well-baby and intensive care unit nursery settings. Interested families attended an informational enrollment session (ES) with a genetic counselor prior to consenting. Reason(s) for declining participation and sociodemographic associations were analyzed. RESULTS Of 3860 eligible approached families, 10% attended ES, 67% of whom enrolled. Of 1760 families queried for decline reasons, 58% were uninterested in research. Among 499 families considering research, principal reasons for decline prior to ES included burdensome study logistics (48%), feeling overwhelmed postpartum (17%), and lack of interest/discomfort with genetic testing (17%). Decliners after ES more often cited concerns about privacy/insurability (41%) and uncertain/unfavorable results (23%). CONCLUSION Low interest in research and study logistics were major initial barriers to postpartum enrollment and are likely generic to many postpartum research efforts. Concerns over privacy and result implications were most commonly cited in decliners after ES. Understanding parental concerns around research nGS may inform future integration of nGS into newborn screening, predictive testing, and pediatric diagnostics.
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Affiliation(s)
- Casie A Genetti
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Talia S Schwartz
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Grace E VanNoy
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Devan Petersen
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Shawn Fayer
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hayley A Peoples
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Pankaj B Agrawal
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Wendi N Betting
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Susan E Waisbren
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy W Yu
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Robert C Green
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Alan H Beggs
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Richard B Parad
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
- Harvard Medical School, Boston, Massachusetts, USA.
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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28
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Morgan J, Coe RR, Lesueur R, Kenny R, Price R, Makela N, Birch PH. Indigenous Peoples and genomics: Starting a conversation. J Genet Couns 2018; 28:407-418. [PMID: 30629780 PMCID: PMC7379939 DOI: 10.1002/jgc4.1073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022]
Abstract
Compared to European ancestral groups, Indigenous Canadians are more likely to have uninterpretable genome-wide sequencing results due to non-representation in reference databases. We began a conversation with Indigenous Canadians to raise awareness and give voice to this issue. We co-created a video explaining genomic non-representation that included diverse Indigenous view-points. We audio-recorded the focus groups including 30 First Nations, Métis, and Inuit individuals living in Greater Vancouver. After watching an introductory video explaining genomic testing, participants discussed issues surrounding collecting Indigenous genomic data, its control, and usage. Transcripts were analyzed, and participants' quotes representing main themes were incorporated into the introductory video. Indigenous participants discussed data interpretation and gave approval for quote usage. The 20 participants who provided feedback concurred with the thematic interpretation: Systemic racism interlaced most conversations, particularly within the theme of trust. Themes of governance emphasized privacy and fear of discrimination. Some participants thought a separate, Indigenous-controlled database was essential; others recognized advantages of international databases. The theme of implementation included creative ideas to collect Indigenous genomes, but prior approval from Indigenous leaders was emphasized. The final video (https://youtu.be/-wivIBDjoi8) was shared with participants to use as they wish to promote awareness and ongoing discussion of genomic diagnostic inequity.
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Affiliation(s)
- Jenny Morgan
- Indigenous Health Program, BC Women's and Children's Hospitals, Vancouver, BC, Canada
| | - Rachel R Coe
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Rochelle Lesueur
- Indigenous Health Program, BC Women's and Children's Hospitals, Vancouver, BC, Canada
| | - Ruth Kenny
- Indigenous Health Program, BC Women's and Children's Hospitals, Vancouver, BC, Canada
| | - Roberta Price
- Indigenous Health Program, BC Women's and Children's Hospitals, Vancouver, BC, Canada
| | - Nancy Makela
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Patricia H Birch
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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29
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Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT, Biesecker BB, Biesecker LG, Cooper GM, East K, Filipski K, Fullerton SM, Gelb BD, Goddard KA, Hailu B, Hart R, Hassmiller-Lich K, Joseph G, Kenny EE, Koenig BA, Knight S, Kwok PY, Lewis KL, McGuire AL, Norton ME, Ou J, Parsons DW, Powell BC, Risch N, Robinson M, Rini C, Scollon S, Slavotinek AM, Veenstra DL, Wasserstein MP, Wilfond BS, Hindorff LA, Plon SE, Jarvik GP, Jarvik GP. The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations. Am J Hum Genet 2018; 103:319-327. [PMID: 30193136 DOI: 10.1016/j.ajhg.2018.08.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/26/2023] Open
Abstract
The Clinical Sequencing Evidence-Generating Research (CSER) consortium, now in its second funding cycle, is investigating the effectiveness of integrating genomic (exome or genome) sequencing into the clinical care of diverse and medically underserved individuals in a variety of healthcare settings and disease states. The consortium comprises a coordinating center, six funded extramural clinical projects, and an ongoing National Human Genome Research Institute (NHGRI) intramural project. Collectively, these projects aim to enroll and sequence over 6,100 participants in four years. At least 60% of participants will be of non-European ancestry or from underserved settings, with the goal of diversifying the populations that are providing an evidence base for genomic medicine. Five of the six clinical projects are enrolling pediatric patients with various phenotypes. One of these five projects is also enrolling couples whose fetus has a structural anomaly, and the sixth project is enrolling adults at risk for hereditary cancer. The ongoing NHGRI intramural project has enrolled primarily healthy adults. Goals of the consortium include assessing the clinical utility of genomic sequencing, exploring medical follow up and cascade testing of relatives, and evaluating patient-provider-laboratory level interactions that influence the use of this technology. The findings from the CSER consortium will offer patients, healthcare systems, and policymakers a clearer understanding of the opportunities and challenges of providing genomic medicine in diverse populations and settings, and contribute evidence toward developing best practices for the delivery of clinically useful and cost-effective genomic sequencing in diverse healthcare settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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30
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Rich K. Genetic Information Nondiscrimination Act and the Affordable Care Act: When Two Is Better Than One. Genet Test Mol Biomarkers 2018; 22:331-332. [PMID: 29847153 DOI: 10.1089/gtmb.2018.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kelly Rich
- Genetic Alliance , Washington, District of Columbia
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