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Alkhatib KY, Filipas DK, Briggs L, Frego N, Koelker M, Lipsitz SR, Pierorazio PM, Rebbeck T, Kilbridge K, Kibel AS, Trinh QD, Rana HQ, Cole AP. Racial differences in knowledge, attitudes, and sources of information about germline cancer genetic testing in the U.S.A.: An analysis of the health information National Trends Survey System. Prev Med 2024; 178:107779. [PMID: 37967620 DOI: 10.1016/j.ypmed.2023.107779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To understand racial disparities in germline cancer genetic testing and the role of prior knowledge, attitudes, and sources of information. METHODS A cross-sectional analysis of the Health Information National Trends Survey 5 (HINTS 5) was conducted between February 24th and June 15th, 2020. The study aimed to investigate knowledge and receipt of genetic testing, attitudes toward the importance of genetic testing in preventing, detecting, and treating cancer, and information sources of genetic testing in the United States of America. RESULTS Non-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with lower odds of being informed about genetic testing, whereas those of NHB race were more likely to endorse the importance of genetic testing in cancer prevention and treatment. Regarding sources of information about genetic testing: Non-Hispanic Asians were less likely to be informed about genetic testing from television (Mean Predicted Probability (MPP) 0.38 95%CI; 0.21-0.55, (Adjusted Risk Difference) ARD vs. Non-Hispanic White (NHW); -0.228, p = 0.01), NHB were less likely to report being informed about genetic testing from social media (MPP 0.27 95%CI; 0.20-0.34, ARD vs. NHW; -0.139, p < 0.01). CONCLUSIONS NHB and Hispanic groups face unequal access to information about genetic testing. There are significant race-based differences in information sources. These differences could be used to promote equitable access to cancer genetic testing.
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Affiliation(s)
- Khalid Y Alkhatib
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (Penn LDI), Wharton, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dejan K Filipas
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Logan Briggs
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urologic Surgery, Mayo Clinic, Phoenix, AZ.
| | - Nicola Frego
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy.
| | - Mara Koelker
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stuart R Lipsitz
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Phillip M Pierorazio
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (Penn LDI), Wharton, University of Pennsylvania, Philadelphia, PA, USA.
| | - Tim Rebbeck
- Division of Cancer Genetics and Prevention and Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Kerry Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Urology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Adam S Kibel
- Department of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Huma Q Rana
- Division of Cancer Genetics and Prevention and Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Alexander P Cole
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Peng W, Chuan CH, Morgan SE. Assessing the role of interactivity: An evaluation of information aids to support the enrollment of precision medicine research programs. PATIENT EDUCATION AND COUNSELING 2023; 110:107648. [PMID: 36753934 DOI: 10.1016/j.pec.2023.107648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Recruiting diverse participants for precision medicine (PM) research programs should overcome low literacy and varied expectations. Information aids (IA) can address these barriers through patient-centered education. The purpose of this study was to evaluate the effectiveness of three information aids (IA) on participating in PM. METHODS An experiment with 290 U.S. participants recruited from Mturk was conducted to compare the effects of three IAs on the outcomes related to participation. Three conditions included an interactive IA (i.e., providing PM-related information responding to each participant's questions), a static IA (i.e., providing uniform PM-related information), and a control condition (i.e., providing non-interactive information irrelevant to PM). RESULTS Both interactive and non-interactive IAs increased attitudes and information-seeking intentions, but not knowledge or participation intention. Perceived control and responsiveness mediated the effects of interactive IA. CONCLUSION Both interactive and static IAs supported enrollment efforts for PM through fostering attitudes and follow-up information-seeking. Increased perceived control and responsiveness are key to the effects of interactive IA. PRACTICE IMPLICATIONS IAs provide effective education and enrollment support for PM. Interactive IA can respond to individuals' inquiries and control the learning process.
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Affiliation(s)
- Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Pullman, WA 99164, USA.
| | - Ching-Hua Chuan
- Department of Interactive Media, University of Miami, Coral Gables, FL 33146, USA
| | - Susan E Morgan
- Department of Communication Studies, University of Miami, Coral Gables, FL 33146, USA
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Tiner JC, Mechanic LE, Gallicchio L, Gillanders EM, Helzlsouer KJ. Awareness and use of genetic testing: An analysis of the Health Information National Trends Survey 2020. Genet Med 2022; 24:2526-2534. [PMID: 36136089 PMCID: PMC9746668 DOI: 10.1016/j.gim.2022.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Genetic testing is a tool used in a variety of settings for medical and nonhealth related purposes. The goal of this analysis was to better understand the awareness and use of genetic testing in the United States. METHODS Data from the 2020 Health Information National Trends Survey 5 cycle 4 were used to assess the awareness and use of genetic testing by demographic characteristics, personal cancer history, and family cancer history. RESULTS Overall, 75% of participants were aware of genetic testing and 19% of participants had genetic testing. Ancestry testing was the most common type of testing that the participants were aware of and had received. Non-Hispanic Asian, Non-Hispanic Black, and Hispanic respondents and participants with incomes less than $20,000 were less likely to be aware of and have received any type of genetic testing than the Non-Hispanic White participants and participants with higher income, respectively. Participants with a family history of cancer were more likely to be aware of cancer genetic testing than those without, and participants with a personal history of cancer were more likely to have had cancer genetic testing. CONCLUSION It appears awareness of genetic testing is increasing in the United States, and differences in awareness persist by race/ethnicity and income.
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Affiliation(s)
- Jessica C Tiner
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Leah E Mechanic
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Elizabeth M Gillanders
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kathy J Helzlsouer
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Cernat A, Bashir NS, Ungar WJ. Considerations for developing regulations for direct-to-consumer genetic testing: a scoping review using the 3-I framework. J Community Genet 2022; 13:155-170. [PMID: 35171498 PMCID: PMC8941003 DOI: 10.1007/s12687-022-00582-3] [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: 11/12/2021] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Direct-to-consumer (DTC) genetic testing exists largely outside of any regulatory schemes, and studies providing a comprehensive overview of the ethical, social, legal, and technological considerations for regulating these types of technologies are lacking. This paper uses the 3-I framework for policy analysis to analyze the ideas, interests, and institutions relevant to policy development for DTC genetic testing in North America and internationally. A scoping review was conducted. Citation databases were searched for papers addressing the ethical, social, legal, and technological implications of DTC genetic testing; stakeholder perspectives on and experiences with DTC genetic testing; or the effect of such testing on the healthcare system. Ninety-nine publications, organizational reports, governmental documents, or pieces of legislation were included. The ideas included are autonomy, informed decision making, privacy, and clinical validity and utility. The interests discussed are those of the public and healthcare providers. The institutions included are regulatory organizations such as the Food and Drug Administration in the United States, laws governing the implementation or delivery of genetic testing in general, and legislation created to protect against genetic discrimination. This analysis clarifies the ethical, social, legal, and technological issues of DTC genetic testing regulation. This information can be used by policy makers to develop or strengthen regulations for DTC genetic testing such as requiring an assessment of the clinical validity of tests before they become publicly available, controlling how tests are marketed, and stipulating requirements for healthcare provider involvement and informed consent.
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Affiliation(s)
- Alexandra Cernat
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Naazish S Bashir
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
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Docherty A, Kious B, Brown T, Francis L, Stark L, Keeshin B, Botkin J, DiBlasi E, Gray D, Coon H. Ethical concerns relating to genetic risk scores for suicide. Am J Med Genet B Neuropsychiatr Genet 2021; 186:433-444. [PMID: 34472199 PMCID: PMC8692426 DOI: 10.1002/ajmg.b.32871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/02/2023]
Abstract
Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.
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Affiliation(s)
- Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Brent Kious
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Teneille Brown
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Leslie Francis
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Louisa Stark
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Genetic Science Learning Center, University of Utah, Salt Lake City, UT USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Brooks Keeshin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT USA
| | - Jeffrey Botkin
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Doug Gray
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
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"Being proactive, not reactive": exploring perceptions of genetic testing among White, Latinx, and Pacific Islander Populations. J Community Genet 2021; 12:617-630. [PMID: 34415555 DOI: 10.1007/s12687-021-00542-3] [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] [Received: 11/04/2020] [Accepted: 07/25/2021] [Indexed: 12/20/2022] Open
Abstract
Genetic testing is becoming an integral part of healthcare, but evidence suggests that both race and ethnicity influence access to and utilization of genetic testing. Given this barrier, data are needed on the perceptions of genetic testing in racial and ethnic minority groups. The purpose of this study was to explore the perceptions of three types of genetic testing (genetic testing for adult-onset conditions, prenatal screening, and newborn screening) in a sample of US participants who identified as White, Pacific Islander, and Latinx (10 dyads from each group for 60 participants total). Data were collected through semi-structured dyadic interviews and assessed using thematic analysis. The major themes were knowledge as empowering, knowledge as stressful, and predictive nature of prenatal testing and newborn screening. Some differences were seen in themes by race and ethnicity. A sense of collective and familial health appeared to be a more important theme for Pacific Islander and Latinx participants compared to White participants. Adult-onset genetic testing was viewed variously across all groups with some noting how it may increase anxiety, particularly if the disease screened for was unable to be prevented with action. All three groups reported on the positives of prenatal testing and newborn screening yet often were confused on the differences between them. This study presents novel perceptions of genetic testing in participants from diverse communities across three types of genetic testing. Genetic healthcare providers should incorporate participants' perceptions, values, and beliefs into their counseling delivery as a way to engage with diverse communities.
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Young JL, Mak J, Stanley T, Bass M, Cho MK, Tabor HK. Genetic counseling and testing for Asian Americans: a systematic review. Genet Med 2021; 23:1424-1437. [PMID: 33972720 DOI: 10.1038/s41436-021-01169-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Asian Americans have been understudied in the literature on genetic and genomic services. The current study systematically identified, evaluated, and summarized findings from relevant qualitative and quantitative studies on genetic health care for Asian Americans. METHODS A search of five databases (1990 to 2018) returned 8,522 unique records. After removing duplicates, abstract/title screening, and full text review, 47 studies met inclusion criteria. Data from quantitative studies were converted into "qualitized data" and pooled together with thematic data from qualitative studies to produce a set of integrated findings. RESULTS Synthesis of results revealed that (1) Asian Americans are under-referred but have high uptake for genetic services, (2) linguistic/communication challenges were common and Asian Americans expected more directive genetic counseling, and (3) Asian Americans' family members were involved in testing decisions, but communication of results and risk information to family members was lower than other racial groups. CONCLUSION This study identified multiple barriers to genetic counseling, testing, and care for Asian Americans, as well as gaps in the research literature. By focusing on these barriers and filling these gaps, clinical genetic approaches can be tailored to meet the needs of diverse patient groups, particularly those of Asian descent.
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Affiliation(s)
- Jennifer L Young
- Stanford Center for Biomedical Ethics, Stanford University, CA, USA.
| | - Julie Mak
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, CA, USA
| | - Talia Stanley
- Stanford Center for Biomedical Ethics, Stanford University, CA, USA
| | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, MA, USA
| | - Mildred K Cho
- Department of Pediatrics, Stanford University, CA, USA
- Department of Medicine, Stanford University, CA, USA
| | - Holly K Tabor
- Department of Medicine, Stanford University, CA, USA
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Berrigan M, Austrie J, Fleishman A, Tercyak KP, Pollak MR, Pavlakis M, Rohan V, Baliga PK, Kayler LK, Feeley TH, Rodrigue JR. Opinions of African American adults about the use of apolipoprotein L1 (ApoL1) genetic testing in living kidney donation and transplantation. Am J Transplant 2021; 21:1197-1205. [PMID: 32659871 PMCID: PMC7854990 DOI: 10.1111/ajt.16206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
Apolipoprotein L1 (ApoL1) predictive genetic testing for kidney disease, and its emerging role in transplantation, remains controversial as it may exacerbate underlying disparities among African Americans (AAs) at increased risk. We conducted an online simulation among AAs (N = 585) about interest in ApoL1 testing and its cofactors, under 2 scenarios: as a potential living donor (PLD), and as a patient awaiting transplantation. Most respondents (61%) expressed high interest in genetic testing as a PLD: age ≥35 years (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.18, 2.60, P = .01), AA identity (aOR, 1.67; 95% CI, 1.02, 2.72, P = .04), perceived kidney disease risk following donation (aOR, 1.68; 95% CI, 1.03, 2.73, P = .03), interest in genetics (aOR, 2.89; 95% CI, 1.95, 4.29, P = .001), and genetics self-efficacy (aOR, 2.38; 95% CI, 1.54, 3.67, P = .001) were positively associated with ApoL1 test interest. If awaiting transplantation, most (89%) believed that ApoL1 testing should be done on AA deceased donors, and older age (aOR, 1.85; 95% CI, 1.03, 3.32, P = .04) and greater interest in genetics (aOR, 2.61; 95% CI, 1.41, 4.81, P = .002) were associated with interest in testing deceased donors. Findings highlight strong support for ApoL1 testing in AAs and the need to examine such opinions among PLDs and transplant patients to enhance patient education efforts.
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Affiliation(s)
- Margaret Berrigan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jasmine Austrie
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth P Tercyak
- Departments of Oncology and Pediatrics, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Martin R Pollak
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Martha Pavlakis
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vinayak Rohan
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prabhakar K Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Liise K Kayler
- Department of Surgery, University at Buffalo (SUNY) Jacobs School of Medicine & Biomedical Sciences and Erie County Medical Center, Buffalo, New York, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo (SUNY), Buffalo, New York, USA
| | - James R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Carroll NM, Blum‐Barnett E, Madrid SD, Jonas C, Janes K, Alvarado M, Bedoy R, Paolino V, Aziz N, McGlynn EA, Burnett‐Hartman AN. Demographic differences in the utilization of clinical and direct‐to‐consumer genetic testing. J Genet Couns 2019; 29:634-643. [DOI: 10.1002/jgc4.1193] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Nikki M. Carroll
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | | | - Sarah D. Madrid
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Cabell Jonas
- Mid‐Atlantic Permanente Research Institute Kaiser Permanente Mid‐Atlantic States Rockville MD USA
| | - Kristen Janes
- Kaiser Permanente Care Management Institute Oakland CA USA
| | - Monica Alvarado
- Southern California Permanente Medical Group Pasadena CA USA
| | - Ruth Bedoy
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Valerie Paolino
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
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Physician Experience with Direct-To-Consumer Genetic Testing in Kaiser Permanente. J Pers Med 2019; 9:jpm9040047. [PMID: 31683813 PMCID: PMC6963876 DOI: 10.3390/jpm9040047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 02/08/2023] Open
Abstract
Health systems and physicians nationwide aspire to consistently and reliably apply genetic and genomic information to guide disease prevention, management, and treatment. However, clinical information, including genetics/genomics data from within and outside of the care delivery system, is expanding rapidly. Between November 2017 and April 2018, we surveyed 1502 Permanente Medical Group primary care and specialist physicians to assess the degree to which direct-to-consumer genetic test results were being presented to physicians and identify genetics educational needs among physicians (response rate 15%). Adjusted logistic regression (according to respondent characteristics) was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing responses within groups. Results showed 35% and 12% of respondents reported receiving at least one direct-to-consumer health risk genetic result (DTC-health risk) or direct-to-consumer pharmacogenomic test result (DTC-PGx), respectively, from a patient in the past year. Of those receiving at least one test result, 40% (DTC-health risk) and 39% (DTC-PGx) of physicians reported 1+ referral(s); 78% (DTC-health risk) and 42% (DTC-PGx) of referrals were to clinical genetics. In total, 85% of physicians would spend ≥2 h/year on genetics/genomics education.
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11
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Giri VN, Selvan P, Mohanty S, Lum R, Serrao S, Leader AE. Exploring Asian Indian views about cancer and participation in cancer research: an evaluation of a culturally tailored educational intervention. J Community Genet 2019; 11:193-203. [PMID: 31522341 DOI: 10.1007/s12687-019-00436-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/29/2019] [Indexed: 01/22/2023] Open
Abstract
Asian Indians (AIs) are a growing population in the United States (US) with increased cancer incidence and mortality. However, screening rates among this population are low, and the population has been underrepresented in clinical research. This pilot study aims to address gaps in the literature in order to understand if a culturally tailored educational intervention will improve knowledge, risk perceptions, and awareness of cancer risk assessments among AIs. We delivered an educational intervention comprised of culturally tailored case studies describing risk factors for developing cancer in both males and females. We assessed knowledge gaps about cancer risk and genetic testing, cancer risk perceptions, and willingness to participate in medical research studies, pre- and post-intervention. Among 23 participants, knowledge of genetic testing use and screening recommendations significantly improved post-intervention, with increased willingness to discuss cancer with family members, participate in medical research, and undergo genetic testing for cancer risk assessment. However, findings at the 1-month follow-up time did not show significant changes, except for one knowledge item. Culturally tailored educational interventions, delivered in a community setting, can influence knowledge and risk perceptions about cancer risk and genetics among AIs. Our findings lay the groundwork to continue educational efforts in the area of cancer risk and genetic testing in the AI population, a growing population that has been understudied in the US.
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Affiliation(s)
- Veda N Giri
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Preethi Selvan
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Salini Mohanty
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3141 Chestnut St, Philadelphia, PA, 19104, USA.,Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Ray Lum
- Department of Management and Health Policy, Dornsife School of Public Health, Drexel University, 3141 Chestnut St, Philadelphia, PA, 19104, USA
| | - Samantha Serrao
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3141 Chestnut St, Philadelphia, PA, 19104, USA
| | - Amy E Leader
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Kim J, Edge MD, Algee-Hewitt BFB, Li JZ, Rosenberg NA. Statistical Detection of Relatives Typed with Disjoint Forensic and Biomedical Loci. Cell 2018; 175:848-858.e6. [PMID: 30318150 DOI: 10.1016/j.cell.2018.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/10/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
In familial searching in forensic genetics, a query DNA profile is tested against a database to determine whether it represents a relative of a database entrant. We examine the potential for using linkage disequilibrium to identify pairs of profiles as belonging to relatives when the query and database rely on nonoverlapping genetic markers. Considering data on individuals genotyped with both microsatellites used in forensic applications and genome-wide SNPs, we find that ∼30%-32% of parent-offspring pairs and ∼35%-36% of sib pairs can be identified from the SNPs of one member of the pair and the microsatellites of the other. The method suggests the possibility of performing familial searches of microsatellite databases using query SNP profiles, or vice versa. It also reveals that privacy concerns arising from computations across multiple databases that share no genetic markers in common entail risks, not only for database entrants, but for their close relatives as well.
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Affiliation(s)
- Jaehee Kim
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Michael D Edge
- Department of Evolution and Ecology, University of California, Davis, Davis, CA 95616, USA
| | | | - Jun Z Li
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Noah A Rosenberg
- Department of Biology, Stanford University, Stanford, CA 94305, USA.
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13
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Towards Cultural Competence in the Genomic Age: a Review of Current Health Care Provider Educational Trainings and Interventions. CURRENT GENETIC MEDICINE REPORTS 2018. [DOI: 10.1007/s40142-018-0150-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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Johnston J, Lantos JD, Goldenberg A, Chen F, Parens E, Koenig BA. Sequencing Newborns: A Call for Nuanced Use of Genomic Technologies. Hastings Cent Rep 2018; 48 Suppl 2:S2-S6. [PMID: 30133723 PMCID: PMC6901349 DOI: 10.1002/hast.874] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self-directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered. In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct-to-consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole-exome or whole-genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed. In a symptomatic newborn, targeted or genome-wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome-wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome-wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context.
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15
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Willingness to Participate in a National Precision Medicine Cohort: Attitudes of Chronic Kidney Disease Patients at a Cleveland Public Hospital. J Pers Med 2018; 8:jpm8030021. [PMID: 29949895 PMCID: PMC6164471 DOI: 10.3390/jpm8030021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/27/2022] Open
Abstract
Multiple ongoing, government-funded national efforts longitudinally collect health data and biospecimens for precision medicine research with ascertainment strategies increasingly emphasizing underrepresented groups in biomedical research. We surveyed chronic kidney disease patients from an academic, public integrated tertiary care system in Cleveland, Ohio, to examine local attitudes toward participation in large-scale government-funded studies. Responses (n = 103) indicate the majority (71%) would participate in a hypothetical national precision medicine cohort and were willing to send biospecimens to a national repository and share de-identified data, but <50% of respondents were willing to install a phone app to track personal data. The majority of participants (62%) indicated that return of research results was very important, and the majority (54%) also wanted all of their research-collected health and genetic data returned. Response patterns did not differ by race/ethnicity. Overall, we found high willingness to participate among this Cleveland patient population already participating in a local genetic study. These data suggest that despite common perceptions, subjects from communities traditionally underrepresented in genetic research will participate and agree to store samples and health data in repositories. Furthermore, most participants want return of research results, which will require a plan to provide these data in a secure, accessible, and understandable manner.
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Apathy NC, Menser T, Keeran LM, Ford EW, Harle CA, Huerta TR. Trends and Gaps in Awareness of Direct-to-Consumer Genetic Tests From 2007 to 2014. Am J Prev Med 2018; 54:806-813. [PMID: 29656919 DOI: 10.1016/j.amepre.2018.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Direct-to-consumer genetic tests for inherited disease risks have gained recent approvals from the Food and Drug Administration, and interest in these tests has continued to grow. Broad use of these tests coupled with planning and discussion with health providers regarding genetic risks and potential protective behavior changes have been proposed as preventive tools to reduce health disparities and improve equity in health outcomes. However, awareness of direct-to-consumer genetic testing has historically demonstrated differences by education, income, and race; these disparities could jeopardize potential benefits by limiting access and use. METHODS The national survey data from the Health Information National Trends Survey was analyzed to understand how overall awareness of direct-to-consumer genetic testing and disparities in awareness across sociodemographic groups have changed since 2007. RESULTS The findings showed persistent disparities, as well as a widening gap in awareness between Hispanics and non-Hispanic whites (OR2007 =1.52, OR2014 =0.58, pchange =0.0056), despite overall increases in awareness over time. CONCLUSIONS Given these findings, policies regulating direct-to-consumer genetic tests should prioritize equitable distribution of benefits by including provisions that counteract prevailing disparities in awareness.
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Affiliation(s)
- Nate C Apathy
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Lindsay M Keeran
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
| | - Eric W Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher A Harle
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio; Department of Biomedical Informatics, Ohio State University, Columbus, Ohio.
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Landry LG, Ali N, Williams DR, Rehm HL, Bonham VL. Lack Of Diversity In Genomic Databases Is A Barrier To Translating Precision Medicine Research Into Practice. Health Aff (Millwood) 2018; 37:780-785. [DOI: 10.1377/hlthaff.2017.1595] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Latrice G. Landry
- Latrice G. Landry is a fellow in the Laboratory for Molecular Medicine, Partners Personalized Medicine, in Cambridge, Massachusetts, and in the Office of Minority Health, Food and Drug Administration, in Silver Spring, Maryland
| | - Nadya Ali
- Nadya Ali is an MD candidate in the Michigan State University College of Human Medicine, in East Lansing
| | - David R. Williams
- David R. Williams is a professor in the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, and in the Department of African and African American Studies, Harvard University, in Cambridge
| | - Heidi L. Rehm
- Heidi L. Rehm is the chief genomic officer in the Center for Genomic Medicine and Department of Medicine at Massachusetts General Hospital, in Boston, and medical director of the Broad Institute Clinical Research Sequencing Platform, in Cambridge
| | - Vence L. Bonham
- Vence L. Bonham is an associate investigator in the Social and Behavioral Research Branch, Division of Intramural Research, and senior adviser to the director on genomics and health disparities at the National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
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Cornel MC, Bonham VL. Genomics for all in the 21st century? J Community Genet 2017; 8:249-251. [PMID: 28905227 PMCID: PMC5614891 DOI: 10.1007/s12687-017-0333-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/03/2017] [Indexed: 01/08/2023] Open
Abstract
As the field of genomics enters the second decade after the completion of the International Human Genome Project, human genomics research is still far from reflective of the ancestral diversity found in global populations. This special issue of the Journal of Community Genetics brings together a global perspective on the need for researchers and health care professionals to support achievable milestones that will enhance global ancestral diversity in genomic research for the 21st century, and integrate the resulting knowledge into health care that benefits everyone. As the publications in this special issue illustrate, this will require focused community engagement, including often overlooked isolated populations, as well as meaningful integration of genomics and health services across the global landscape. With the advancement of sequencing technology and reduction in the cost, the time has come to address critical barriers.
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Affiliation(s)
- Martina C Cornel
- Department of Clinical Genetics and Amsterdam Public Health Research Institute, Section Community Genetics, VU University Medical Center, BS7, A527, Mail A509 APH, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Vence L Bonham
- Division of Intramural Research, Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, MD, USA
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