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Adams DR, Dm van Karnebeek C, Agullo SB, Faundes V, Jamuar SS, Lynch SA, Pintos-Morell G, Puri RD, Shai R, Steward CA, Tumiene B, Verloes A. Addressing Diagnostic Gaps and Priorities of the Global Rare Diseases Community: Recommendations from the IRDiRC Diagnostics Scientific Committee. Eur J Med Genet 2024:104951. [PMID: 38848991 DOI: 10.1016/j.ejmg.2024.104951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
The International Rare Diseases Research Consortium (IRDiRC) Diagnostic Scientific Committee (DSC) is charged with discussion and contribution to progress on diagnostic aspects of the IRDiRC core mission. Specifically, IRDiRC goals include timely diagnosis, use of globally coordinated diagnostic pipelines, and assessing the impact of rare diseases on affected individuals. As part of this mission, the DSC endeavored to create a list of research priorities to achieve these goals. We present a discussion of those priorities along with aspects of current, global rare disease needs and opportunities that support our prioritization. In support of this discussion, we also provide clinical vignettes illustrating real-world examples of diagnostic challenges.
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Affiliation(s)
- David R Adams
- National Human Genome Research Institute, National Institutes of Health, USA.
| | - Clara Dm van Karnebeek
- Departments of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam Gastro-enterology Endocrinology Metabolism, Amsterdam University Medical Centers, The Netherlands
| | - Sergi Beltran Agullo
- Centre Nacional d'Anàlisi Genòmica (CNAG), Spain; Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona (UB), Spain
| | - Víctor Faundes
- Laboratorio de Genética y Enfermedades Metabólicas, Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Chile
| | - Saumya Shekhar Jamuar
- Genetics Service, KK Women's and Children's Hospital and Paediatrics ACP, Duke-NUS Medical School, Singapore; Singhealth Duke-NUS Institute of Precision Medicine, Singapore
| | | | - Guillem Pintos-Morell
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital, Spain; MPS-Spain Patient Advocacy Organization, Spain
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, India
| | - Ruty Shai
- Pediatric Cancer Molecular Lab, Sheba Medical Center, Israel
| | | | - Biruté Tumiene
- Vilnius University, Faculty of Medicine, Institute of Biomedical Sciences, Lithuania
| | - Alain Verloes
- Département de Génétique, CHU Paris - Hôpital Robert Debré, France
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White S, Turbitt E, Rogers K, Tucker K, McEwen A, Best M, Phillips JL, Jacobs C. A survey of genetic and palliative care health professionals' views of integrating genetics into palliative care. Eur J Hum Genet 2024; 32:109-116. [PMID: 37344570 PMCID: PMC10772073 DOI: 10.1038/s41431-023-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/14/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Genetic counselling and testing have utility for people with palliative care needs and their families. However, genetic and palliative care health professionals have described difficulties initiating palliative-genetic discussions. Between March and July 2022, we received n = 73 surveys (6% response rate) from genetic and palliative care health professionals in Australia and New Zealand that assessed and compared barriers and facilitators. The main perceived barrier to both groups was palliative care health professionals' lack of genetic knowledge (44%). Most palliative care health professionals were 'not at all confident' performing several activities, including discussing DNA banking (52%) and knowing their legal responsibilities when sharing genetic information (58%). The most frequently selected facilitator for genetic health professionals was fostering close relationships with palliative care health professionals (52%), while palliative care health professionals indicated a genetic referral template (51%) would be of assistance. Almost all participants agreed genetic discussions do not undermine the central ethos of palliative care (87%). Fewer palliative care health professionals considered themselves well situated to have genetic discussions with a palliative patient's family compared to genetic health professionals (p = 0.014). Our results suggest that genetic and palliative care health professionals support integrating genetics into palliative care, although refinement of the palliative care health professionals' role in this process is required. We have identified intervention targets to overcome barriers related to knowledge and confidence, which ought to be integrated into future interventions designed to support health professionals deliver the benefits of genetic information to people with palliative care needs and their families.
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Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kathy Tucker
- Hereditary Cancer Centre, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, Division of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Ward AJ, Lambert DM, Butterly D, O'Byrne JJ, McGrath V, Lynch SA. Genetic services survey-experience of people with rare diseases and their families accessing genetic services in the Irish Republic. J Community Genet 2023; 14:583-592. [PMID: 37632685 PMCID: PMC10725380 DOI: 10.1007/s12687-023-00664-w] [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: 05/19/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Abstract
Irish Health Service objectives state that patients with rare diseases should have timely access to genomic diagnostics with appropriate pre and post-test counselling. However, waiting times for clinical genetics outpatient appointments, during the study period, were up to two years as staffing levels remain low. A targeted public online survey was conducted in January 2022 to capture the experiences of Rare Disease families trying to access genetic testing and clinical genetic clinics in the Irish Republic. Irish patients experience significant waiting times to access clinical genetic services and self-report anxiety and stress, related to delayed access to diagnosis, clarity around recurrence risk and follow-up management. This negatively impacts personal decisions around family planning, education and employment and has a significant impact on family members seeking clarity on their own risk. Mainstream genetic testing activity is significant. Families report concern over the competency of health care professionals arranging and delivering genetic results and delays in accessing clinical genetics expertise to take them through the clinical implications. Timely access to clinical genetics expertise is important to ensure families with rare diseases have an appropriate understanding of the medical and reproductive implications of a genetic diagnosis and access to relevant care pathways. A national framework to develop competency in genomic literacy for health-care professionals including a national genetic test directory may be beneficial. Clinical genetics teams require ongoing support and investment to ensure the delivery of a safe and effective service for Irish families with rare diseases.
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Affiliation(s)
- A J Ward
- University College Dublin, School of Medicine, Dublin, Ireland
| | - D M Lambert
- University College Dublin, School of Medicine, Dublin, Ireland
| | - D Butterly
- University College Dublin, School of Medicine, Dublin, Ireland
| | - J J O'Byrne
- University College Dublin, School of Medicine, Dublin, Ireland
- Mater Misericordiae University Hospital, National Centre for Inherited Metabolic Disorders, Dublin, Ireland
- Trinity College Dublin, School of Medicine, Dublin, Ireland
| | - V McGrath
- Rare Diseases Ireland, Dublin, Ireland
| | - S A Lynch
- University College Dublin, School of Medicine, Dublin, Ireland.
- Children's Health Ireland (CHI) at Crumlin, Clinical Genetics, Dublin, Ireland.
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Fellner A, Goldberg Y, Basel-Salmon L. Ordering genetic testing by neurologists: points to consider. J Neurol 2023:10.1007/s00415-023-11758-3. [PMID: 37154893 DOI: 10.1007/s00415-023-11758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
A significant challenge limiting the comprehensive utilization of genomic medicine is the lack of timely access to genetics specialists. Although neurologists see patients for whom genetic testing should be considered, the knowledge regarding the choice of the optimal genetic test for each case and the management of the test results are out of the scope of their everyday practice. In this review, we provide a step-by-step guide for non-geneticist physicians through the decision-making process when ordering diagnostic genetic testing for monogenic neurological diseases and when dealing with their results.
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Affiliation(s)
- Avi Fellner
- The Neurogenetics Clinic, Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
| | - Yael Goldberg
- Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lina Basel-Salmon
- Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Felsenstein Medical Research Center, Tel-Aviv University, Tel-Aviv, Israel
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McVeigh TP, Sweeney KJ, Brennan DJ, McVeigh UM, Ward S, Strydom A, Seal S, Astbury K, Donnellan P, Higgins J, Keane M, Kerin MJ, Malone C, McGough P, McLaughlin R, O'Leary M, Rushe M, Barry MK, MacGregor G, Sugrue M, Yousif A, Al-Azawi D, Berkeley E, Boyle TJ, Connolly EM, Nolan C, Richardson E, Giffney C, Doyle SB, Broderick S, Boyd W, McVey R, Walsh T, Farrell M, Gallagher DJ, Rahman N, George AJ. A pilot study investigating feasibility of mainstreaming germline BRCA1 and BRCA2 testing in high-risk patients with breast and/or ovarian cancer in three tertiary Cancer Centres in Ireland. Fam Cancer 2023; 22:135-149. [PMID: 36029389 DOI: 10.1007/s10689-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
In the Republic of Ireland (ROI), BRCA1/BRCA2 genetic testing has been traditionally undertaken in eligible individuals, after pre-test counselling by a Clinical Geneticist/Genetic Counsellor. Clinical Genetics services in ROI are poorly resourced, with routine waiting times for appointments at the time of this pilot often extending beyond a year. The consequent prolonged waiting times are unacceptable where therapeutic decision-making depends on the patient's BRCA status. "Mainstreaming" BRCA1/BRCA2 testing through routine oncology/surgical clinics has been implemented successfully in other centres in the UK and internationally. We aimed to pilot this pathway in three Irish tertiary centres. A service evaluation project was undertaken over a 6-month period between January and July 2017. Eligible patients, fulfilling pathology and age-based inclusion criteria defined by TGL clinical, were identified, and offered constitutional BRCA1/BRCA2 testing after pre-test counselling by treating clinicians. Tests were undertaken by TGL Clinical. Results were returned to clinicians by secure email. Onward referrals of patients with uncertain/pathogenic results, or suspicious family histories, to Clinical Genetics were made by the treating team. Surveys assessing patient and clinician satisfaction were sent to participating clinicians and a sample of participating patients. Data was collected with respect to diagnostic yield, turnaround time, onward referral rates, and patient and clinician feedback. A total of 101 patients underwent diagnostic germline BRCA1/BRCA2 tests through this pathway. Pathogenic variants were identified in 12 patients (12%). All patients in whom variants were identified were appropriately referred to Clinical Genetics. At least 12 additional patients with uninformative BRCA1/BRCA2 tests were also referred for formal assessment by Clinical Geneticist or Genetic Counsellor. Issues were noted in terms of time pressures and communication of results to patients. Results from a representative sample of participants completing the satisfaction survey indicated that the pathway was acceptable to patients and clinicians. Mainstreaming of constitutional BRCA1/BRCA2 testing guided by age- and pathology-based criteria is potentially feasible for patients with breast cancer as well as patients with ovarian cancer in Ireland.
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Affiliation(s)
- Terri Patricia McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.
| | - Karl J Sweeney
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Donal J Brennan
- Mater Misericordiae University Hospital, Dublin, Ireland
- The National Maternity Hospital, Holles St, Dublin, Ireland
| | | | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Katherine Astbury
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Paul Donnellan
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Joanne Higgins
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Maccon Keane
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael J Kerin
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - Carmel Malone
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - Pauline McGough
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Ray McLaughlin
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael O'Leary
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Margaret Rushe
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael Kevin Barry
- Saolta Health Care Group, Mayo University Hospital, Co Mayo, Castlebar, Ireland
| | - Geraldine MacGregor
- Saolta University Health Care Group, Letterkenny University Hospital, Co Donegal, Letterkenny, Ireland
| | - Michael Sugrue
- Saolta University Health Care Group, Letterkenny University Hospital, Co Donegal, Letterkenny, Ireland
| | - Ala Yousif
- Saolta University Hospital Group, Sligo University Hospital, Sligo, Ireland
| | | | | | | | | | | | | | | | | | | | - William Boyd
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ruaidhri McVey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Thomas Walsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - David J Gallagher
- St James's University Hospital, Dublin, Ireland
- Mater Private Hospital, Dublin, Ireland
| | | | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
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Warner NZ, Groarke A. A qualitative reflexive thematic analysis into the experiences of being identified with a BRCA1/2 gene alteration: "So many little, little traumas could have been avoided". BMC Health Serv Res 2022; 22:1007. [PMID: 35933387 PMCID: PMC9357316 DOI: 10.1186/s12913-022-08372-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background BRCA1/2 alterations increase females’ lifetime breast cancer risk to 40 – 90%, ovarian cancer to 10 – 60%, and males’ lifetime prostate cancer risk to ~ 10 – 25%. Psychosocial issues such as heightened distress can, therefore, occur in this population. This study aimed to explore the subjective experiences and needs of the BRCA1/2 alteration population in navigating cancer risk reduction measures. Method This study aimed to explore the experiences and identify the needs of 18 BRCA1/2 alteration carriers, recruited through strategic sampling. A public and patient panel (N = 6) collaborated on study development. Data were analysed using reflexive thematic analysis. Results Two themes were identified: (i) Healthcare Services as a Burden to Navigate, and (ii) Burden Experienced Through Interactions with Healthcare Professionals. Results indicated uncertainty regarding care pathways, alongside a lack of relevant information. Participants felt unsupported by healthcare professionals, and as though healthcare professionals often perceive them as a burden. Conclusions These findings suggest that the quality of interactions in healthcare systems are of relevance to the BRCA1/2 alteration population, and that uncertainty surrounding access to services and information is prevalent. The establishment of specialist hereditary cancer clinics could reduce such burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08372-w.
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Affiliation(s)
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Ireland
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Duplication of referral, a tsunami of paper: how much does it cost the Irish health services? Ir J Med Sci 2022; 191:2439-2444. [PMID: 35001335 PMCID: PMC8743075 DOI: 10.1007/s11845-021-02866-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/18/2021] [Indexed: 12/04/2022]
Abstract
Background Prolonged waiting lists increase costs as medical problems may become more expensive to fix. There are also hidden financial costs. Irish Clinical Genetic services have long out-patient waiting times. We noticed duplicate referrals (patients on the waiting list) being re-referred because the patient still had not been seen. These re-referrals waste consultant and administrative time, pose a clinical risk by distracting clinician time, and are costly to our health service. Methods We prospectively collected duplicate referral data over a 3-month period (1 October 2020–31 January 2021) in order to estimate costs. We costed (1) referring consultant and administrative time; (2) stationary, postage, and storage cost; and (3) receiving consultant and administrative time processing these referrals. Results We noted 82/986 (8%) referrals to our service over the trial period were duplicate. The mean length of time between first and duplicate referral was 306 days. In 35/82 (42.68%), a duplicate referral had already been received (e.g. 3rd or more referral for same patient). In total, we received 132 re-referral letters for 82 patients. Duplicate referrals changed triage outcome in 7/82 (8.54%) cases. Conclusion National Treatment Purchase Fund data suggests that 271,560 patients are waiting > 12 months for both in- and out-patient public appointments on 1 January 2021. Assuming duplicate referrals are occurring across the Irish health system with equal frequency after 12 months of waiting (8% of total appointments), then we estimate a conservative cost of 757,392 € per quarter to the health service and an annual cost to the HSE of 3,029,568 €.
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