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Charnysh E, Pal S, Reader JM, Uhlmann WR, McCain S, Sanghavi K, Blasco D, Brandt R, Feero WG, Ferber R, Giri VN, Hendy K, Prince AER, Lee C, Roberts JS. Health care utilization and behavior changes after workplace genetic testing at a large US health care system. Genet Med 2024; 26:101160. [PMID: 38733246 DOI: 10.1016/j.gim.2024.101160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE This study explored employee health behavior changes and health care utilization after workplace genetic testing (wGT). Wellness-program-associated wGT seeks to improve employee health, but the related health implications are unknown. METHODS Employees of a large US health care system offering wGT (cancer, heart disease, and pharmacogenomics [PGx]) were sent electronic surveys. Self-reported data from those who received test results were analyzed. Descriptive statistics characterized responses, whereas logistic regression analyses explored correlates of responses to wGT. RESULTS 53.9% (n = 418/776) of respondents (88.3% female, mean age = 44 years) reported receiving wGT results. 12.0% (n = 48/399) received results indicating increased risk (IR) of cancer, 9.5% (n = 38/398) had IR of heart disease, and 31.4% (n = 125/398) received informative PGx results. IR results for cancer and/or heart disease (n = 67) were associated with health behavior changes (adjusted odds ratio: 3.23; 95% CI 1.75, 6.13; P < .001) and health care utilization (adjusted odds ratio: 8.60; 95% CI 4.43, 17.5; P < .001). Informative PGx results (n = 125) were associated with medication changes (PGx-informative: 15.2%; PGx-uninformative: 4.8%; P = .002). CONCLUSION This study explored employee responses to wGT, contributing to the understanding of the ethical and social implications of wGT. Receiving IR results from wGT may promote health behavior changes and health care utilization in employees.
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Affiliation(s)
| | - Subhamoy Pal
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Jonathan M Reader
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Wendy R Uhlmann
- Departments of Internal Medicine and Human Genetics, University of Michigan School of Medicine, Ann Arbor, MI
| | - Sarah McCain
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Drew Blasco
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV
| | | | | | - Rebecca Ferber
- Departments of Internal Medicine and Human Genetics, University of Michigan School of Medicine, Ann Arbor, MI
| | - Veda N Giri
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | - Katherine Hendy
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Charles Lee
- The Jackson Laboratory for Genomic Medicine, Farmington, CT.
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
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2
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Karam PE, Hamad L, Elsherif M, Kreidieh K, Nakouzi G, El Asmar K, Kabakian-Khasholian T, Curi DA, Yazbek SN. Genetic literacy among primary care physicians in a resource-constrained setting. BMC MEDICAL EDUCATION 2024; 24:140. [PMID: 38350948 PMCID: PMC10863164 DOI: 10.1186/s12909-024-05110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Genetic literacy among primary healthcare providers is crucial for appropriate patient care with the advances in genetic and genomic medicine. Studies from high-income countries highlight the lack of knowledge in genetics and the need to develop curricula for continuing professional development of non-geneticists. Scarce data is available from resource-constrained countries in Middle East and North Africa. Lebanon is a small country in this region characterized by high rates of consanguinity and genetic disorders like several surrounding countries, such as Jordan, Syria, and Turkey. METHODS The primary aim of this study assessed the genetic literacy, self-perceived and actual knowledge as well as practices among primary care providers in Lebanon. The secondary aim identified their educational needs and proposed evidence-based continuing education programs. A cross-sectional survey-based study, using a self-administered questionnaire, was conducted targeting physicians from Family Medicine, Obstetrics and Gynecology, and Pediatrics. The questionnaire was divided into five sections: demographics, familiarity with genetic tests, self-reported and actual knowledge, genetic practices, and educational needs. Statistics were performed using SPSS v24. The Chi-square test was used for independent variables. Differences between mean scores were measured using paired sample t-tests for groups of two levels and one-way ANOVA for more than two. Multiple linear regression was used to study the variables associated with the knowledge score while controlling for other variables. RESULTS The survey included 123 physicians. They were mostly familiar with karyotype as first-tier genetic test. Although 38% perceived their knowledge as good, only 6% scored as such in knowledge assessment. A better knowledge score was observed in academic institutions as well as in urban settings (p<0.05). One third never ordered any genetic testing, mostly due to poor knowledge. Almost all (98%) were ready to attend continuing professional development sessions in genetics. CONCLUSION Our findings show the need to improve genetic literacy among healthcare frontliners, focusing on remote regions and nonacademic centers in Lebanon, a model for other resource-constrained country in the Middle East and North Africa region. This study advances recommendations for evidence-based genetic continuing education programs and highlighted the role of that the few genetic specialists can play in their successful implementation.
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Affiliation(s)
- Pascale E Karam
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Hamad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamed Elsherif
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghunwa Nakouzi
- Hudson Alpha Clinical Services Lab, LLC, Huntsville, AL, USA
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dany Assaf Curi
- Department of Pediatrics, Division of Hematology and Oncology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Soha N Yazbek
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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3
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Petry NJ, Van Heukelom J, Baye JF, Massmann A. The effect of medication reconciliation on generating an accurate medication list in a pharmacogenomics practice. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1259. [PMID: 36618791 PMCID: PMC9816821 DOI: 10.21037/atm-2022-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Background Medication reconciliation is recognized as a critically important medication safety element and a key initiative by multiple organizations. Within our precision medicine program, accurate medication lists are essential to our ability to make specific medication recommendations based on pharmacogenetic results. Our study aimed to identify discrepancies within the patient's medication list to improve medication management via genetic factors through a pharmacy team-based approach. Methods A dedicated team of pharmacists and trained student pharmacists conducted telephone interviews to complete medication reconciliation for individuals enrolled in our precision medicine preemptive screening program. Medication list discrepancies were tracked as well as if pharmacogenetic consults were altered by findings during the telephone interviews. Results Medication reconciliation was completed on 465 participants who had recently received or were awaiting pharmacogenetic testing. We found similar results to previously described rates of medication list discrepancies with an average of 4.9 medication discrepancies per patient as well as greater than 90% of individuals having at least one medication discrepancy. Pharmacogenetic recommendations for 20 individuals (4.3%) required adjustment following medication reconciliation. Conclusions This pilot program supports the value of a dedicated team for medication reconciliation and the importance of accurate medication lists to optimize precision medicine programs.
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Affiliation(s)
- Natasha J. Petry
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Department of Pharmacy Practice, North Dakota State University, Fargo, ND, USA
| | - Joel Van Heukelom
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Jordan F. Baye
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA;,College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD, USA
| | - Amanda Massmann
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
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Blout Zawatsky CL, Leonhard JR, Bell M, Moore MM, Petry NJ, Platt DM, Green RC, Hajek C, Christensen KD. Workforce Considerations When Building a Precision Medicine Program. J Pers Med 2022; 12:jpm12111929. [PMID: 36422106 PMCID: PMC9692406 DOI: 10.3390/jpm12111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/11/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
This paper describes one healthcare system’s approach to strategically deploying genetic specialists and pharmacists to support the implementation of a precision medicine program. In 2013, Sanford Health initiated the development of a healthcare system-wide precision medicine program. Here, we report the necessary staffing including the genetic counselors, genetic counseling assistants, pharmacists, and geneticists. We examined the administrative and electronic medical records data to summarize genetic referrals over time as well as the uptake and results of an enterprise-wide genetic screening test. Between 2013 and 2020, the number of genetic specialists employed at Sanford Health increased by 190%, from 10.1 full-time equivalents (FTEs) to 29.3 FTEs. Over the same period, referrals from multiple provider types to genetic services increased by 423%, from 1438 referrals to 7517 referrals. Between 2018 and 2020, 11,771 patients received a genetic screening, with 4% identified with potential monogenic medically actionable predisposition (MAP) findings and 95% identified with at least one informative pharmacogenetic result. Of the MAP-positive patients, 85% had completed a session with a genetics provider. A strategic workforce staffing and deployment allowed Sanford Health to manage a new genetic screening program, which prompted a large increase in genetic referrals. This approach can be used as a template for other healthcare systems interested in the development of a precision medicine program.
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Affiliation(s)
- Carrie L. Blout Zawatsky
- Genomes2People, Department of Medicine (Genetics), Brigham and Women’s Hospital, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Precision Population Health, Ariadne Labs, Boston, MA 02115, USA
- The MGH Institute of Health Professions, Boston, MA 02115, USA
| | - Jennifer R. Leonhard
- Department of Genetics, Sanford Health, Bemidji, MN 56601, USA
- Correspondence: ; Tel.: +1-218-333-5068
| | - Megan Bell
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD 57117, USA
| | | | - Natasha J. Petry
- Department of Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58105, USA
| | - Dylan M. Platt
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD 57117, USA
| | - Robert C. Green
- Genomes2People, Department of Medicine (Genetics), Brigham and Women’s Hospital, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Precision Population Health, Ariadne Labs, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine Hajek
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57117, USA
- Helix, San Mateo, CA 94401, USA
| | - Kurt D. Christensen
- Broad Institute, Cambridge, MA 02142, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
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5
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Carroll JC, Liddy C, Afkham A, Keely E, Goh ES, Graham GE, Permaul JA, Allanson J, Heisey R, Makuwaza T, Manca DP, O'Brien MA, Grunfeld E. Use of eConsult to enhance genetics service delivery in primary care: A multimethod study. Genet Med 2022; 24:2034-2041. [PMID: 35947109 DOI: 10.1016/j.gim.2022.07.003] [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: 03/03/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Electronic consultation (eConsult) is a freely-available secure online platform connecting primary care providers (PCPs) to geneticists. Our purpose was to determine whether eConsult is effective in improving genetics service delivery in primary care. METHODS PCP questionnaires regarding eConsult's utility, geneticists' tracking form assessments of eConsult type and appropriateness, and geneticists' interviews on implementing eConsult were carried out. RESULTS In 2 regions of Ontario, Canada, from January 2019 to June 2020, there were 305 genetics eConsults. For 169 (55%), PCPs indicated receiving good advice for a new course of action; for 110 (36%), referral was now avoided; and for 261 (86%), eConsult was perceived valuable for patient management. Of the 131 geneticist-completed tracking forms, cancer questions were most common (68, 52%). For 63 (48%), geneticists disagreed/strongly disagreed PCPs should know the answer to the referral question. From the interview data, it was observed that geneticists described eConsult positively and suggested how it might improve access and efficiencies if integrated into genetic service delivery. Dealing with eConsults virtually could reduce waitlists, and suggesting appropriate investigations for PCPs could improve efficiencies. CONCLUSION eConsult offers a potential solution for receiving timely genetics advice and avoiding unnecessary patient referrals, however, greater effect on access and wait times will need systematic integration into PCP and geneticist practice.
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Affiliation(s)
- June C Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Ontario, Canada.
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Endocrinology & Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Elaine S Goh
- Laboratory Medicine and Genetics and Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada
| | - Gail E Graham
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Judith Allanson
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ruth Heisey
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Tutsirai Makuwaza
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Donna P Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Ann O'Brien
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Lee A, Neidich J, Nguyen H. Outpatient Primary Care Genetic Testing Primer: What to Order and Testing Considerations. MISSOURI MEDICINE 2022; 119:390-396. [PMID: 36118815 PMCID: PMC9462914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The field of genetics has evolved rapidly over the last few decades, from testing methods to genetic diagnoses, bringing new genetic testing guidelines and considerations for health care providers. Overall geneticists are limited in number and availability, particularly in non-academic settings, and many patients first present to a primary care provider. Here, we aim to review various modalities of genetic testing, their indications, limitations, and other pretest considerations for the primary care provider. In addition, we comment on the limitations of direct-to-consumer (DTC) genetic testing, which has seen a rise in popularity among the general population.
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Affiliation(s)
- Angela Lee
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Julie Neidich
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Hoanh Nguyen
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri
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7
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Falah N, Umer A, Warnick E, Vallejo M, Lefeber T. Genetics education in primary care residency training: satisfaction and current barriers. BMC PRIMARY CARE 2022; 23:156. [PMID: 35718772 PMCID: PMC9208192 DOI: 10.1186/s12875-022-01765-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Genetics education can be integrated into general care medicine through primary care residency programs. A study of primary care residents was done to evaluate quality, satisfaction, and barriers in genetics education in residency training programs. Thus, providing more evidence for the necessity for its development and progress. METHODS A cross-sectional descriptive self-administered questionnaire survey was delivered to four primary care West Virginia University (WVU) residency training programs in 2020-2021. The anonymous 14-item survey included the following questionnaire domains: general data, genetics training satisfaction, and genetics education barriers. RESULTS The survey response rate was 52% (70/123) and 59 participants completed the survey. Overall, respondents viewed genetic education as critical to their chosen specialty (90%). Trainees at all educational levels obtained their education mostly from class based educational curricula (77% from lectures, 65% from didactic and 49% from grand rounds). The majority of survey respondents indicated insufficient experience with genetic patient care (34% ward genetic consultation, 5% clinic experience, 0% genetic department rotation). The percentage of residents who were satisfied with genetic topics were as follows: basic genetics (57%), capturing family history (82%), initiating basic genetic workup (15%), a basic understanding of the genetic report (23%), basic management surveillance in the genetic patient (18%), understanding the genetic referral and explaining it to a patient (47%). Residents reported barriers to genetic interest included complexity of the field (87%), followed by limited utility of genetics testing (41%). The most common suggestions for improving the genetic education component were to provide more lectures (61%), followed by enhanced advertisement of genetic education resources specifically rotations in the genetics department (22%). Other suggestions include the integration of genetic education in inpatient learning (20%) and providing research experience (7%). CONCLUSION Primary care residents were satisfied with their genetic knowledge in the classroom and stated a clear need for enhanced hands-on clinical skills and research experience in their current residency training. The survey suggestions for improvement can enhance primary care residents' genetic training that can lead to advances in rare disease recognition, precision medicine, and improve access to genetics testing.
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Affiliation(s)
- Nadia Falah
- Department of Pediatrics, Division of Genetics, 1 Medical Center Drive, West Virginia Medicine Children's Hospital, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.
- West Virginia University Cancer Institute, Morgantown, WV, 26506, USA.
| | - Amna Umer
- Department of Pediatrics, Division of Genetics, 1 Medical Center Drive, West Virginia Medicine Children's Hospital, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
- Department of Pediatrics, West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
| | - Emilea Warnick
- Department of Pediatrics, Division of Genetics, 1 Medical Center Drive, West Virginia Medicine Children's Hospital, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Manuel Vallejo
- Graduate Medical Education, West Virginia School of Medicine, Morgantown, WV, 26506, USA
| | - Timothy Lefeber
- Department of Pediatrics, Division of Genetics, 1 Medical Center Drive, West Virginia Medicine Children's Hospital, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
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8
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Public interest in unexpected genomic findings: a survey study identifying aspects of sequencing attitudes that influence preferences. J Community Genet 2022; 13:235-245. [DOI: 10.1007/s12687-022-00577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022] Open
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Carroll JC, Morrison S, Miller FA, Wilson BJ, Permaul JA, Allanson J. Anticipating the primary care role in genomic medicine: expectations of genetics health professionals. J Community Genet 2021; 12:559-568. [PMID: 34379295 DOI: 10.1007/s12687-021-00544-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
Our purpose was to explore genetics health professionals' (GHPs) expectations of primary care providers' (PCPs) role in genomic medicine now and in the future. Focus groups/interviews were conducted with GHPs in Ontario, Canada. Recordings were transcribed and analysed using qualitative descriptive analysis. Five focus groups (6 clinical geneticists, 24 genetic counselors, 1 nurse, 4 laboratory staff, 3 genetics program administrators) and 3 interviews (nurses) were conducted. GHPs described a key role for PCPs in genomic medicine that could be enhanced if GHPs and PCPs worked together more effectively, making better use of GHPs as a scarce specialist resource, improving PCP knowledge and awareness of genomics, and increasing GHPs' understanding of primary care practice and how to provide PCPs meaningful education and support. Health system change is needed to facilitate the GHP/PCP relationship and improve care. This might include: PCPs ordering more genetic tests independently or with GHP guidance prior to GHP consultations, genomic expertise in primary care clinics or GHPs being accessible through buddy systems or virtually through telemedicine or electronic consultation, and developing educational materials and electronic decision support for PCPs. Our findings highlight need for change in delivering genomic medicine, which requires building the relationship between GHPs and PCPs, and creating new service delivery models to meet future needs.
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Affiliation(s)
- June C Carroll
- Department of Family and Community Medicine, Sinai Health, University of Toronto, Toronto, Canada.
| | | | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Sinai Health, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada
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Etchegary H, Winsor M, Power A, Simmonds C. Public engagement with genomic medicine: a summary of town hall discussions. J Community Genet 2021; 12:27-35. [PMID: 32865775 PMCID: PMC7846649 DOI: 10.1007/s12687-020-00485-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022] Open
Abstract
Engaging with the public for their input about genomic medicine is critical before it is implemented into routine healthcare practice. In order to inform discussion and planning for the introduction of genome sequencing into clinical care in an Eastern Canadian province, we implemented a program of public engagement activities. Here, we report a qualitative summary of two town hall discussions utilizing a hybrid information-consultation approach with 20 residents of the province of Newfoundland and Labrador, Canada. Discussion revealed largely positive attitudes towards genomic medicine; however, critical reflection around informed consent models, the return of sequencing findings, and access to qualified healthcare professionals revealed numerous public concerns. Public support will be important to realize the potential benefits of genomics and precision medicine to health outcomes. Our findings highlight public concerns that must be addressed in educational and informed consent documents related to sequencing. Town hall attendees endorsed ongoing public education and awareness-building initiatives which could help foster transparency and trust as genomics is integrated into healthcare systems.
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Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
| | - Mercy Winsor
- Health Research Unit, Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
| | - Angela Power
- Newfoundland and Labrador Centre for Health Information, St. John’s, NL A1B 2C7 Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
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11
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Etchegary H, Wilson B, Rahman P, Simmonds C, Pullman D. Public interest in whole genome sequencing and information needs: an online survey study. Per Med 2020; 17:283-293. [DOI: 10.2217/pme-2019-0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aim: To survey the general public about whole genome sequencing interest, including pharmacogenomic testing, and to identify information important for sequencing decisions. Patients & methods: An online survey of 901 members of the general public in an eastern Canadian province. Results: Interest in whole genome sequencing, including pharmacogenomic testing, was high with few differences among demographic variables. Issues identified as very important to sequencing decisions included familial implications of testing, whether treatment was available for conditions tested and knowing who could access genomic information. Most respondents would value support when interpreting sequencing results. Conclusion: Findings reveal the kind of information and support users of sequencing services would value and could inform the implementation of sequencing into care in ways that accord with public preferences and needs.
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Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Memorial University, St John's, NL, Canada; Craig L. Dobbin Centre for Genetics, Rm 4M210, St John's, NL, A1B 3V6
| | - Brenda Wilson
- Professor of Medicine and Associate Dean, Community Health and Humanities, Memorial University, St John’s, NL A1B 3V6, Canada
| | - Proton Rahman
- Professor of Medicine (Rheumatology), Memorial University and Rheumatologist, Eastern Regional Health Authority, St John’s, NL A1B 3V6, Canada
| | - Charlene Simmonds
- Manager, Health Research Unit, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Daryl Pullman
- Professor of Medicine (Bioethics), Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
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12
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Carroll JC, Allanson J, Morrison S, Miller FA, Wilson BJ, Permaul JA, Telner D. Informing Integration of Genomic Medicine Into Primary Care: An Assessment of Current Practice, Attitudes, and Desired Resources. Front Genet 2019; 10:1189. [PMID: 31824576 PMCID: PMC6882282 DOI: 10.3389/fgene.2019.01189] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction: Preparing primary care providers for genomic medicine (GM) first requires assessment of their educational needs in order to provide clear, purposeful direction and justify educational activities. More understanding is needed about primary care providers’ perspectives on their role in newer areas of GM and what resources would be helpful in practice. Our objective was to determine family physicians’ (FP) current involvement and confidence in GM, attitudes regarding its clinical value, suggestions for integration of GM into practice, and resources and education required. Methods: A self-complete anonymous questionnaire was mailed to a random sample of 2,000 FPs in Ontario, Canada in September 2012. Results: Adjusted response rate was 26% (361/1,365), mean age was 51, and 53% were male. FPs reported many aspects of traditional GM as part of current practice (eliciting family history: 93%; deciding who to refer to genetics: 94%; but few reported confidence (44%, 32% respectively). Newer areas of GM were not part of most FPs’ current practice and confidence was low (pharmacogenetics: 28% part of practice, 5% confident; direct-to-consumer genetic testing: 14%/2%; whole genome sequencing: 8%/2%). Attitudes were mixed with 59% agreeing that GM would improve patient health outcomes, 41% seeing benefits to genetic testing, but only 36% agreeing it was their responsibility to incorporate GM into practice. Few could identify useful sources of genetic information (22%) or find information about genetic tests (21%). Educational resources participants anticipated would be useful included contact information for local genetics clinics (89%), summaries of genetic disorders (86%), and genetic referral (85%) and testing (86%) criteria. About 58% were interested in learning about new genetic technologies. Most (76%) wanted to learn through in-person teaching (lectures, seminars etc.), 66% wanted contact with a local genetic counselor to answer questions, and 59% were interested in a genetics education website. Conclusion: FPs lack confidence in GM skills needed for practice, particularly in emerging areas of GM. They see their role as making appropriate referrals, are somewhat optimistic about the contribution GM may make to patient care, but express caution about its current clinical benefits. There is a need for evidence-based educational resources integrated into primary care and improved communication with genetic specialists.
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Affiliation(s)
- June C Carroll
- Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Shawna Morrison
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne A Permaul
- Sinai Health System, Ray D Wolfe Department of Family Medicine, Toronto, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Attard CA, Carmany EP, Trepanier AM. Genetic counselor workflow study: The times are they a-changin’? J Genet Couns 2018; 28:130-140. [DOI: 10.1002/jgc4.1041] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Courtney A. Attard
- Cancer Genetic Counseling Service, Karmanos Cancer Institute; Detroit Michigan
| | - Erin P. Carmany
- Genetic Counseling Program; Wayne State University School of Medicine; Detroit Michigan
| | - Angela M. Trepanier
- Genetic Counseling Program; Wayne State University School of Medicine; Detroit Michigan
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Palmer L, Butcher NJ, Boot E, Hodgkinson KA, Heung T, Chow EWC, Guna A, Crowley TB, Zackai E, McDonald-McGinn DM, Bassett AS. Elucidating the diagnostic odyssey of 22q11.2 deletion syndrome. Am J Med Genet A 2018; 176:936-944. [PMID: 29575622 PMCID: PMC5873609 DOI: 10.1002/ajmg.a.38645] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 12/25/2022]
Abstract
Clinical molecular testing has been available for 22q11.2 deletion syndrome (22q11.2DS) for over two decades yet under-recognition and diagnostic delays are common. To characterize the "diagnostic odyssey" in 22q11.2DS we studied 202 well-characterized unrelated adults, none ascertained through an affected relative. We used a regression model to identify clinical and demographic factors associated with length of time to molecular diagnosis. Kaplan-Meier analysis compared time to diagnosis for the molecular testing era (since 1994) and earlier birth cohorts. The results showed that the median time to molecular diagnosis of the 22q11.2 deletion was 4.7 (range 0-20.7) years. Palatal and cardiac anomalies, but not developmental delay/intellectual disability, were associated with a shorter time to molecular diagnosis. Non-European ethnicity was associated with longer time to diagnosis. Inclusion of a cohort from another 22q11.2DS center increased power to observe a significantly earlier diagnosis for patients born in the molecular testing era. Nonetheless, only a minority were diagnosed in the first year of life. On average, patients were seen in seven (range 2-15) different clinical specialty areas prior to molecular diagnosis. The findings indicate that even for those born in the molecular testing era, individuals with 22q11.2DS and their families face a diagnostic odyssey that is often prolonged, particularly in the absence of typical physical congenital features or for those of non-European ancestry. The results support educational efforts to improve clinical recognition and testing, and ultimately newborn screening as a means of maximizing early detection that would provide the best opportunity to optimize outcomes.
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Affiliation(s)
- Lisa Palmer
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada
| | - Nancy J. Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Erik Boot
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Kathleen A. Hodgkinson
- Department of Epidemiology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Eva WC Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alina Guna
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - T. Blaine Crowley
- The 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elaine Zackai
- The 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Genetics Centre, The Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA
| | - Donna M. McDonald-McGinn
- The 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Genetics Centre, The Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA
- Section of Genetic Counseling, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Anne S. Bassett
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, and Toronto General Research Institute, University Health Network, University Health Network, Toronto, Ontario, Canada
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15
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Bugarín-González R, Carracedo Á. Genética y medicina de familia. Semergen 2018; 44:54-60. [DOI: 10.1016/j.semerg.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/04/2017] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
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Patient and genetic counselor perceptions of in-person versus telephone genetic counseling for hereditary breast/ovarian cancer. Fam Cancer 2017; 15:529-39. [PMID: 26969308 DOI: 10.1007/s10689-016-9900-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Telephone genetic counseling (TC) for high-risk women interested in BRCA1/2 testing has been shown to yield positive outcomes comparable to usual care (UC; in-person) genetic counseling. However, little is known about how genetic counselors perceive the delivery of these alternate forms of genetic counseling. As part of a randomized trial of TC versus UC, genetic counselors completed a 5-item genetic counselor process questionnaire (GCQ) assessing key elements of pre-test sessions (information delivery, emotional support, addressing questions and concerns, tailoring of session, and facilitation of decision-making) with the 479 female participants (TC, N = 236; UC, N = 243). The GCQ scores did not differ for TC vs. UC sessions (t (477) = 0.11, p = 0.910). However, multivariate analysis showed that participant race/ethnicity significantly predicted genetic counselor perceptions (β = 0.172, p < 0.001) in that the GCQ scores were lower for minorities in TC and UC. Exploratory analyses suggested that GCQ scores may be associated with patient preference for UC versus TC (t (79) = 2.21, p = 0.030). Additionally, we found that genetic counselor ratings of session effectiveness were generally concordant with patient perceptions of the session. These data indicate that genetic counselors perceive that key components of TC can be delivered as effectively as UC, and that these elements may contribute to specific aspects of patient satisfaction. However, undefined process differences may be present which account for lower counselor perceptions about the effectiveness of their sessions with minority women (i.e., those other than non-Hispanic Whites). We discuss other potential clinical and research implications of our findings.
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Childers CP, Childers KK, Maggard-Gibbons M, Macinko J. National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer. J Clin Oncol 2017; 35:3800-3806. [PMID: 28820644 DOI: 10.1200/jco.2017.73.6314] [Citation(s) in RCA: 217] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose In the United States, 3.8 million women have a history of breast (BC) or ovarian cancer (OC). Up to 15% of cases are attributable to heritable mutations, which, if identified, provide critical knowledge for treatment and preventive care. It is unknown how many patients who are at high risk for these mutations have not been tested and how rates vary by risk criteria. Methods We used pooled cross-sectional data from three Cancer Control Modules (2005, 2010, 2015) of the National Health Interview Survey, a national in-person household interview survey. Eligible patients were adult females with a history of BC and/or OC meeting select 2017 National Comprehensive Cancer Network eligibility criteria on the basis of age of diagnosis and family history. Outcomes included the proportion of individuals reporting a history of discussing genetic testing with a health professional, being advised to undergo genetic testing, or undergoing genetic testing for BC or OC. Results Of 47,218 women, 2.7% had a BC history and 0.4% had an OC history. For BC, 35.6% met one or more select eligibility criteria; of those, 29.0% discussed, 20.2% were advised to undergo, and 15.3% underwent genetic testing. Testing rates for individual eligibility criteria ranged from 6.2% (relative with OC) to 18.2% (diagnosis ≤ 45 years of age). For OC, 15.1% discussed, 13.1% were advised to undergo, and 10.5% underwent testing. Using only four BC eligibility criteria and all patients with OC, an estimated 1.2 to 1.3 million individuals failed to receive testing. Conclusion Fewer than one in five individuals with a history of BC or OC meeting select National Cancer Comprehensive Network criteria have undergone genetic testing. Most have never discussed testing with a health care provider. Large national efforts are warranted to address this unmet need.
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Affiliation(s)
- Christopher P Childers
- Christopher P. Childers and Melinda Maggard-Gibbons, David Geffen School of Medicine at University of California-Los Angeles; Christopher P. Childers and James Macinko, Fielding School of Public Health at University of California-Los Angeles; and Kimberly K. Childers, Providence Health & Services Southern California, Los Angeles, California
| | - Kimberly K Childers
- Christopher P. Childers and Melinda Maggard-Gibbons, David Geffen School of Medicine at University of California-Los Angeles; Christopher P. Childers and James Macinko, Fielding School of Public Health at University of California-Los Angeles; and Kimberly K. Childers, Providence Health & Services Southern California, Los Angeles, California
| | - Melinda Maggard-Gibbons
- Christopher P. Childers and Melinda Maggard-Gibbons, David Geffen School of Medicine at University of California-Los Angeles; Christopher P. Childers and James Macinko, Fielding School of Public Health at University of California-Los Angeles; and Kimberly K. Childers, Providence Health & Services Southern California, Los Angeles, California
| | - James Macinko
- Christopher P. Childers and Melinda Maggard-Gibbons, David Geffen School of Medicine at University of California-Los Angeles; Christopher P. Childers and James Macinko, Fielding School of Public Health at University of California-Los Angeles; and Kimberly K. Childers, Providence Health & Services Southern California, Los Angeles, California
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18
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Abstract
Many patients have concerns regarding their family's cancer history and may be appropriate for referral to genetic counseling. This article examines indications for referral for genetic counseling for hereditary cancer, the process of genetic counseling and testing, and ways for NPs to collaborate with genetics providers.
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Affiliation(s)
- Kate McReynolds
- Kate McReynolds is a genetic NP associate in medicine at the Division of Genetic Medicine, Clinical and Translational Hereditary Cancer Program, Vanderbilt University Medical Center, Nashville, Tenn. Sara Lewis is a genetic counselor assistant in medicine at the Division of Genetic Medicine, Clinical and Translational Hereditary Cancer Program, Vanderbilt University Medical Center, Nashville, Tenn
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19
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Kubendran S, Sivamurthy S, Schaefer GB. A novel approach in pediatric telegenetic services: geneticist, pediatrician and genetic counselor team. Genet Med 2017; 19:1260-1267. [PMID: 28471436 PMCID: PMC5682570 DOI: 10.1038/gim.2017.45] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/10/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose Our aim was to improve access to genetic services in an underserved region by developing a collaborative telegenetic service delivery model with a pediatrician, medical geneticist, and genetics counselor (GC). Methods Protocols for the evaluation of common genetic indications were developed. Patients referred with indications suggestive of a syndromic etiology were scheduled to see the geneticist directly via telegenetics. Other patients were scheduled to see the pediatrician and GC in person before follow-up with the geneticist if indicated. Patients seen by the geneticist and/or pediatrician/GC were enumerated and the next available appointment was tracked. Patient satisfaction surveys were conducted. Results Of the 265 patients evaluated during the study period, 116 (44%) were evaluated by a pediatrician and GC in person first, after which 82 (71% of those evaluated) required further follow-up with the geneticist. The next available appointment with a pediatrician and GC never exceeded 6 weeks, while new appointments with a geneticist ranged from 3 to 9 months. All patients reported high satisfaction with this genetic service model. Conclusion The pediatrician/GC clinic provides a model of collaborative care that is a medical home neighbor and exemplifies the integration of genetics into primary care. The telegenetics clinic offers a viable solution to providing competent and convenient access to a geneticist for patients in chronically underserved regions.
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Affiliation(s)
- Shobana Kubendran
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Siddharthan Sivamurthy
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Gerald Bradley Schaefer
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
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20
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Cragun D, Kinney AY, Pal T. Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing. Expert Rev Mol Diagn 2017; 17:57-70. [PMID: 27910721 PMCID: PMC5642111 DOI: 10.1080/14737159.2017.1267567] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered: NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert commentary: As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay.
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Affiliation(s)
- Deborah Cragun
- University of South Florida, Department of Global Health, College of Public Health
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center
- Department of Internal Medicine, University of New Mexico
| | - Tuya Pal
- Department of Cancer Epidemiology, Population Sciences, Moffitt Cancer Center
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21
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McBride KA, Schlub TE, Ballinger ML, Thomas DM, Tattersall MHN. International survey of awareness of genetic risk in the clinical sarcoma community. Asia Pac J Clin Oncol 2016; 12:133-42. [DOI: 10.1111/ajco.12457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kate A McBride
- School of Public Health; Sydney Medical School, University of Sydney; Camperdown New South Wales Australia
- The Familial Cancer Service; Crown Princess Mary Cancer Centre; Westmead Hospital; Westmead New South Wales Australia
| | - Timothy E Schlub
- School of Public Health; Sydney Medical School, University of Sydney; Camperdown New South Wales Australia
| | - Mandy L Ballinger
- Research Division; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - David M Thomas
- The Kinghorn Cancer Centre; Garvan Institute of Medical Research; Darlinghurst New South Wales Australia
| | - Martin HN Tattersall
- Department of Cancer Medicine, The Chris O'Brien Lifehouse; Sydney Medical School, University of Sydney; Camperdown New South Wales Australia
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Carroll JC, Grad R, Allanson JE, Pluye P, Permaul JA, Pimlott N, Wilson BJ. The Gene Messenger Impact Project: An Innovative Genetics Continuing Education Strategy for Primary Care Providers. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2016; 36:178-185. [PMID: 27583994 DOI: 10.1097/ceh.0000000000000079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Primary care providers (PCP) will need to be integrally involved in the delivery of genomic medicine. The GenetiKit trial demonstrated effectiveness of a knowledge translation intervention on family physicians' (FP) genetics referral decision-making. Most wanted to continue receiving Gene Messengers (GM), evidence-based summaries of new genetic tests with primary care recommendations. Our objective was to determine the value of GMs as a continuing education (CE) strategy in genomic medicine for FPs. METHODS Using a "push" model, we invited 19,060 members of the College of Family Physicians of Canada to participate. Participants read GMs online, receiving 12 emailed topics over 6 months. Participants completed an online Information Assessment Method questionnaire evaluating GMs on four constructs: cognitive impact, relevance, intended use of information for a patient, and expected health benefits. RESULTS One thousand four hundred two FPs participated, 55% rated at least one GM. Most (73%) indicated their practice would be improved after reading GMs, with referral to genetics ranked highly. Of those who rated a GM relevant, 94% would apply it to at least one patient and 79% would expect health benefits. This method of CE was found useful for genetics by 88% and 94% wanted to continue receiving GMs. DISCUSSION FPs found this novel CE strategy, brief individual reflective e-learning, to be valuable for learning about genetics. This method of information delivery may be an especially effective method for CE in genomic medicine where discoveries occur at a rapid pace and lack of knowledge is a barrier to integration of genetic services.
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Affiliation(s)
- June C Carroll
- Dr. Carroll: Professor, Sydney G. Frankfort Chair in Family Medicine, Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada. Dr. Grad: Associate Professor, McGill University, Herzl Family Practice Centre, Centre Médecine Familiale Herzl, Montréal, Quebec, Canada. Dr. Allanson: Department of Genetics, Children's Hospital of Eastern Ontario, Professor, Department of Paediatrics, University of Ottawa, Ottawa, Canada. Dr. Pluye: Full Professor, FRQS Senior Research Scholar, Department of Family Medicine, McGill University, Montréal, Quebec, Canada. Ms. Permaul: Research Associate, Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Toronto, Ontario, Canada. Dr. Pimlott: Assistant Professor, University of Toronto, Family Practice Health Centre, Women's College Hospital, Toronto, Ontario, Canada. Dr. Wilson: Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
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Botkin JR, Belmont JW, Berg JS, Berkman BE, Bombard Y, Holm IA, Levy HP, Ormond KE, Saal HM, Spinner NB, Wilfond BS, McInerney JD. Points to Consider: Ethical, Legal, and Psychosocial Implications of Genetic Testing in Children and Adolescents. Am J Hum Genet 2015; 97:6-21. [PMID: 26140447 PMCID: PMC4570999 DOI: 10.1016/j.ajhg.2015.05.022] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022] Open
Abstract
In 1995, the American Society of Human Genetics (ASHG) and American College of Medical Genetics and Genomics (ACMG) jointly published a statement on genetic testing in children and adolescents. In the past 20 years, much has changed in the field of genetics, including the development of powerful new technologies, new data from genetic research on children and adolescents, and substantial clinical experience. This statement represents current opinion by the ASHG on the ethical, legal, and social issues concerning genetic testing in children. These recommendations are relevant to families, clinicians, and investigators. After a brief review of the 1995 statement and major changes in genetic technologies in recent years, this statement offers points to consider on a broad range of test technologies and their applications in clinical medicine and research. Recommendations are also made for record and communication issues in this domain and for professional education.
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Affiliation(s)
| | | | - Jonathan S Berg
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Yvonne Bombard
- University of Toronto, Toronto, ON M5B 1T8, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | | | | | | | - Howard M Saal
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nancy B Spinner
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Jbilou J, Halilem N, Blouin-Bougie J, Amara N, Landry R, Simard J. Medical genetic counseling for breast cancer in primary care: a synthesis of major determinants of physicians' practices in primary care settings. Public Health Genomics 2014; 17:190-208. [PMID: 24993835 DOI: 10.1159/000362358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This paper aims to identify relevant potential predictors of medical genetic counseling for breast cancer (MGC-BC) in primary care and to develop a comprehensive questionnaire to study MGC-BC. METHODS A scoping review was conducted to identify the predictors of MGC-BC among primary care physicians. Relevant articles were identified in selected databases (PubMed, Embase, CINAHL, ISI Web of Science, PsycINFO, and Cochrane CENTRAL) and 4 selected relevant electronic journals. RESULTS An inductive analysis of the 193 quantitatively tested variables, conducted by 3 researchers, showed that 6 conceptual categories of determinants, namely (1) demographic, (2) organizational, (3) experiential, (4) professional, (5) psychological, and (6) cognitive, influence MGC-BC practices. CONCLUSION There is a scarcity of literature addressing the medical behavior determinants of MGC-BC. Future research is needed to identify effective strategies put into action to support the integration of MGC-BC in primary care medical practices and routines. However, our results shed light on 2 levels of actions that could improve genetic counseling services in primary care: (1) medical training and educational efforts emphasizing family history collection (individual level), and (2) clarification of roles and responsibilities in ordering and referral practices in genetic counseling and genetic testing for better healthcare management (organizational level).
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Affiliation(s)
- Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick, Université de Moncton, Moncton, N.B., Canada
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Marchant GE, Lindor RA. Personalized medicine and genetic malpractice. Genet Med 2013; 15:921-2. [PMID: 24071800 DOI: 10.1038/gim.2013.142] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/07/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gary E Marchant
- Center for Law, Science, Innovation, Arizona State University, Tempe, Arizona, USA
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Kolli VK, Abraham P, Isaac B, Selvakumar D. Neutrophil infiltration and oxidative stress may play a critical role in methotrexate-induced renal damage. Chemotherapy 2009; 55:83-90. [PMID: 19145077 DOI: 10.1159/000192391] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 10/26/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nephrotoxicity is one of the adverse side effects of methotrexate (MTX) chemotherapy. The mechanism of renotoxicity of MTX is not fully understood. It is essential to understand the mechanism of nephrotoxicity of MTX in order to diminish the side effects and hence maximize the benefits of chemotherapy. OBJECTIVES The aim of the study was to verify whether oxidative stress and neutrophil infiltration play a role in MTX-induced renal damage using a rat model. METHODS Adult male rats were administered MTX at the dose of 7 mg/kg body weight intraperitoneally for 3 consecutive days and sacrificed 12 or 24 h after the last dose. Vehicle-treated rats served as controls. The kidneys were removed and used for light microscopic and biochemical studies. Myeloperoxidase activity, a marker of neutrophil infiltration was measured in kidney homogenates along with the markers of oxidative damage including protein carbonyl content, protein thiol and malondialdehyde. The activities of the antioxidant enzymes, namely glutathione peroxidase, glutathione S-transferase, superoxide dismutase and catalase, were also assayed. RESULTS MTX treatment induced damage to the glomeruli and tubules. Plasma creatinine levels in the MTX-treated rats were significantly elevated compared with controls. A significant increase in myeloperoxidase activity (p<0.05) was observed in the kidneys of MTX-treated rats. Protein carbonyl content and malondialdehyde, sensitive and reliable markers of oxidative damage to proteins and lipids, respectively, were significantly elevated (p<0.01) in the kidneys of MTX-treated rats compared with controls. The activities of the antioxidant enzymes, namely, superoxide dismutase and glutathione peroxidase, were significantly elevated (p<0.01 and p<0.05, respectively) in kidneys of rats following MTX treatment. CONCLUSION The results of the present study provide evidence for the role of neutrophil infiltration and oxidative stress in MTX-induced renal damage. Administration of inhibitors of myeloperoxidase or scavenging hypochlorous acid, the product of myeloperoxidase, by supplementation with antioxidants as an adjuvant therapy may be promising in alleviating the renal side effect of MTX.
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