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Jacobsmeyer AT, Carter LB, Buitrago-Mogollon TL, White B, Charles JR, Clarke-Pounder JP, Amador J. Improving genetic testing utilization in a tertiary care neonatal intensive care unit through quality improvement. Am J Med Genet A 2024:e63834. [PMID: 39132941 DOI: 10.1002/ajmg.a.63834] [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: 05/13/2024] [Revised: 07/12/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
There is an increasing recognition of the importance of diagnosing genetic conditions with an ever-growing list of genetic testing options. However, most providers do not have formal genetics training, which makes choosing the most appropriate test to order challenging. Our project sought to improve cytogenetic testing utilization in a tertiary care neonatal intensive care unit (NICU) through utilizing quality improvement techniques, specifically the Model for Improvement framework with rapid Plan-Do-Study-Act cycles. Our project utilized various interventions including the implementation of a NICU genetic testing algorithm. Interventions demonstrated improvement in all areas, specifically a 92% reduction in unnecessary cytogenetic testing with improvement in the diagnostic rate. Our work also resulted in a 59% decrease in charges with an estimated projected savings of $21,000 per year. Quality improvement can minimize redundancies and inefficiencies in genetic testing in a Level IV NICU in a large tertiary care children's hospital and result in substantial cost-savings.
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Affiliation(s)
- Andrew T Jacobsmeyer
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Lauren B Carter
- Division of Medical Genetics, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Talia L Buitrago-Mogollon
- Center for Advancing Pediatric Excellence, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Blanche White
- Center for Advancing Pediatric Excellence, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jasmyne-Rian Charles
- Center for Advancing Pediatric Excellence, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jessica P Clarke-Pounder
- Division of Neonatology, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jodi Amador
- Division of Neonatology, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
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2
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Walters S, Aldous C, Malherbe H. Knowledge, attitudes, and practices of primary healthcare practitioners in low- and middle-income countries: a scoping review on genetics. J Community Genet 2024:10.1007/s12687-024-00721-y. [PMID: 39120782 DOI: 10.1007/s12687-024-00721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Individualised treatment, including genetic services, calls for an increased role of primary healthcare practitioners (pHCPs) in diagnosing and caring for individuals with genetic conditions. PHCPs' genetics knowledge and practices must be current to ensure adequate care. A scoping review was conducted to explore peer-reviewed articles on the knowledge, attitudes, and practices (KAPs) of pHCPs concerning genetics, genetic testing, and genetic services. English-language human genetics/genomics articles published between January 1990 and April 2022 in low- and middle-income countries (LMICs) were included. Twenty-eight articles from 16 LMICs in five World Health Organisation (WHO)-defined regions met the inclusion criteria and showed a steady increase in publications, with varied contributions by region. The Eastern Mediterranean Region (EMR) contributed the most articles (n = 8), while the Western Pacific Region (WPR) had the least (n = 2). Brazil published the most articles (n = 6), while ten countries contributed one article each. Fifteen articles included knowledge, 19 included attitudes towards genetics, and eight included genetic practices. The findings indicate that pHCPs in LMICs lack knowledge of genetics and its applications despite their positive outlook towards genetic services. Barriers such as limited resources, financial constraints, and cultural or religious beliefs hinder access to genetic services. Enhancing pHCPs' genetics education is vital for improving care for those affected by genetic conditions. The scarcity of literature in LMICs emphasises the need for research on educational interventions to improve patient outcomes and family support.
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Affiliation(s)
- Sarah Walters
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Colleen Aldous
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Helen Malherbe
- Director of Research and Epidemiology, Rare Diseases South Africa, NPC, Bryanston, Sandton, Gauteng, South Africa
- Centre for Human Metabolomics, North-West University, Potchefstroom, South Africa
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3
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Nisselle A, Terrill B, Janinski M, Martyn M, Jordan H, Kaunein N, Metcalfe S, Gaff C. Ensuring best practice in genomics education: A theory- and empirically informed evaluation framework. Am J Hum Genet 2024; 111:1497-1507. [PMID: 38959883 PMCID: PMC11339609 DOI: 10.1016/j.ajhg.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024] Open
Abstract
Implementation of genomic medicine into healthcare requires a workforce educated through effective educational approaches. However, ascertaining the impact of genomics education activities or resources is limited by a lack of evaluation and inconsistent descriptions in the literature. We aim to support those developing genomics education to consider how best to capture evaluation data that demonstrate program outcomes and effectiveness within scope. Here, we present an evaluation framework that is adaptable to multiple settings for use by genomics educators with or without education or evaluation backgrounds. The framework was developed as part of a broader program supporting genomic research translation coordinated by the Australian Genomics consortium. We detail our mixed-methods approach involving an expert workshop, literature review and iterative expert input to reach consensus and synthesis of a new evaluation framework for genomics education. The resulting theory-informed and evidence-based framework encompasses evaluation across all stages of education program development, implementation and reporting, and acknowledges the critical role of stakeholders and the effects of external influences.
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Affiliation(s)
- Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Bronwyn Terrill
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Monika Janinski
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Melissa Martyn
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | - Helen Jordan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nadia Kaunein
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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4
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Nisselle A, Terrill B, Janinski M, Metcalfe S, Gaff C. Ensuring best practice in genomics education: A scoping review of genomics education needs assessments and evaluations. Am J Hum Genet 2024; 111:1508-1523. [PMID: 38959884 PMCID: PMC11339611 DOI: 10.1016/j.ajhg.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024] Open
Abstract
A health workforce capable of implementing genomic medicine requires effective genomics education. Genomics education interventions developed for health professions over the last two decades, and their impact, are variably described in the literature. To inform an evaluation framework for genomics education, we undertook an exploratory scoping review of published needs assessments for, and/or evaluations of, genomics education interventions for health professionals from 2000 to 2023. We retrieved and screened 4,659 records across the two searches with 363 being selected for full-text review and consideration by an interdisciplinary working group. 104 articles were selected for inclusion in the review-60 needs assessments, 52 genomics education evaluations, and eight describing both. Included articles spanned all years and described education interventions in over 30 countries. Target audiences included medical specialists, nurses/midwives, and/or allied health professionals. Evaluation questions, outcomes, and measures were extracted, categorized, and tabulated to iteratively compare measures across stages of genomics education evaluation: planning (pre-implementation), development and delivery (implementation), and impact (immediate, intermediate, or long-term outcomes). They are presented here along with descriptions of study designs. We document the wide variability in evaluation approaches and terminology used to define measures and note that few articles considered downstream (long-term) outcomes of genomics education interventions. Alongside the evaluation framework for genomics education, results from this scoping review form part of a toolkit to help educators to undertake rigorous genomics evaluation that is fit for purpose and can contribute to the growing evidence base of the contribution of genomics education in implementation strategies for genomic medicine.
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Affiliation(s)
- Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Bronwyn Terrill
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Monika Janinski
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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5
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Alexander KE, Rolfe M, Gabbett MT. Assessing genomics confidence and learning needs in Australian nurses and midwives: an educational program evaluation. Front Genet 2024; 15:1419302. [PMID: 39081808 PMCID: PMC11286479 DOI: 10.3389/fgene.2024.1419302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction: The mainstreaming of genomics across healthcare specialties necessitates that all nurses and midwives have a high literacy in genomics. Methods: We aimed to design, develop, implement and evaluate a genomics education workshop for nurses and midwives using action research principles. Results: Registered nurses and midwives completed an online survey regarding genomics confidence and learning needs (n = 274). The results of this survey were used to develop the genomics education workshop. The workshop was run three times (n = 105) with evaluation data being collected both before and after each workshop. Significant improvements in confidence across all learning domains was found following the workshops (p < 0.001). A desire for more education across all learning domains except for genetics knowledge was also identified (p < 0.001). Discussion: Genomics education workshops were found to increase the confidence of nurses and midwives across a range of specialties. Nurses and midwives also expressed a desire for further education in genomics.
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Affiliation(s)
- Kim E. Alexander
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Melanie Rolfe
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael T. Gabbett
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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6
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Coleman TF, Pugh J, Kelley WV, East KM, Greve V, Finnila CR, Henson A, Korf BR, Barsh GS, Cooper GM, Cochran ME. Errors in genome sequencing result disclosures: A randomized controlled trial comparing neonatology non-genetics healthcare professionals and genetic counselors. Genet Med 2024; 26:101198. [PMID: 38943479 DOI: 10.1016/j.gim.2024.101198] [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: 03/18/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024] Open
Abstract
PURPOSE We compared the rate of errors in genome sequencing (GS) result disclosures by genetic counselors (GC) and trained non-genetics healthcare professionals (NGHPs) in SouthSeq, a randomized trial utilizing GS in critically ill infants. METHODS Over 400 recorded GS result disclosures were analyzed for major and minor errors. We used Fisher's exact test to compare error rates between GCs and NGHPs and performed a qualitative content analysis to characterize error themes. RESULTS Major errors were identified in 7.5% of disclosures by NGHPs and in no disclosures by GCs. Minor errors were identified in 32.1% of disclosures by NGHPs and in 11.4% of disclosures by GCs. Although most disclosures lacked errors, NGHPs were significantly more likely to make any error than GCs for all result types (positive, negative, or uncertain). Common major error themes include omission of critical information, overstating a negative result, and overinterpreting an uncertain result. The most common minor error was failing to disclose negative secondary findings. CONCLUSION Trained NGHPs made clinically significant errors in GS result disclosures. Characterizing common errors in result disclosure can illuminate gaps in education to inform the development of future genomics training and alternative service delivery models.
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Affiliation(s)
| | - Jada Pugh
- HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | | | - Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL
| | | | | | - Ava Henson
- HudsonAlpha Institute for Biotechnology, Huntsville, AL; Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center UTHealth Houston, Houston, TX
| | - Bruce R Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
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7
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Park SY, Kim Y, Katapodi MC, Kim YJ, Chae H, Choi YJ, Ryu KH, Lee EG, Kong SY, Jung SY. Healthcare Professionals' Learning Needs and Perspectives on Essential Information in Genetic Cancer Care: A Systematic Review. Cancers (Basel) 2024; 16:1963. [PMID: 38893084 PMCID: PMC11171145 DOI: 10.3390/cancers16111963] [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: 05/02/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The increased demand for genetic testing and counseling necessitates healthcare professionals (HCPs) to improve their genetic competency through training programs. This systematic review identified HCPs' learning needs and their perspectives on essential information for families with hereditary cancer. METHODS This review covered studies published from 2013 to 2024 across five databases. Data were analyzed using a content analysis. RESULTS Thirteen studies involving 332 HCPs were analyzed. Most studies focused on the learning needs of physicians caring for families affected by Hereditary Breast and Ovarian Cancer in North America and Europe. HCPs required training emphasizing practical counseling skills over the basics of genetics. Learning needs varied by profession: physicians needed training in assessing cancer risk and supporting decision-making in risk management; nurses required information on resources and the genetic care system; genetic counselors sought guidance on family communication and planning. Essential information identified for families included risk-reducing strategies, personalized cancer risk assessment, family implications, psychological issues, (cascade) genetic testing, and social concerns. CONCLUSIONS The findings have implications for the development of training programs for HCPs, emphasizing the need for tailored training based on professions. Future research should explore the needs of HCPs caring for families with diverse hereditary cancers and cultural backgrounds.
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Affiliation(s)
- Sun-Young Park
- College of Nursing, Daegu Catholic University, Daegu 42472, Republic of Korea;
| | - Youlim Kim
- College of Nursing, Kosin University, Busan 49104, Republic of Korea;
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland;
| | - Yeon-Joo Kim
- Department of Radiation Oncology, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Heejung Chae
- Center for Breast Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (H.C.); (E.-G.L.)
| | - Yoon-Jung Choi
- Department of Cancer Control & Population Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Republic of Korea; (Y.-J.C.); (K.H.R.)
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
- Center for Cancer Prevention & Detection, National Cancer Center, Goyang 10408, Republic of Korea
| | - Kum Hei Ryu
- Department of Cancer Control & Population Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Republic of Korea; (Y.-J.C.); (K.H.R.)
| | - Eun-Gyeong Lee
- Center for Breast Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (H.C.); (E.-G.L.)
| | - Sun-Young Kong
- Department of Laboratory Medicine & Genetic Counseling Clinic, National Cancer Center, Goyang 10408, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (H.C.); (E.-G.L.)
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8
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Setiawan H, Firmansyah A, Purwati AE. Integration of genomic nursing in nursing education curriculum in Indonesia: A perspective. J Taibah Univ Med Sci 2024; 19:250-251. [PMID: 38205430 PMCID: PMC10776630 DOI: 10.1016/j.jtumed.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Henri Setiawan
- Department of Nursing, STIKes Muhammadiyah Ciamis, Indonesia
| | | | - Ayu E. Purwati
- Department of Midwifery, STIKes Muhammadiyah Ciamis, Indonesia
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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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10
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Edelman EA, Logan K, Ingram Nissen T, Reed EK, Wicklund C, Duquette D, Dellefave-Castillo L. A team-based approach to cardiogenomic education. J Genet Couns 2024; 33:216-221. [PMID: 37849384 DOI: 10.1002/jgc4.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/07/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
While many genetic professionals are involved in the education of lay and professional audiences, most do not have formal training in education theory and program design. Partnerships with adult education experts can provide additional resources and improve the level of instruction, thereby increasing the impact of an educational intervention. This report discusses the experience of a multidisciplinary team of educators, clinicians, and researchers partnering to develop evidence-based education for cardiology practitioners. It includes practical advice for how clinicians and educators can develop more effective education through collaboration, needs assessment, instructional design, and iterative content development.
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Affiliation(s)
- Emily A Edelman
- Clinical Education Program, Genomic Education, The Jackson Laboratory, Farmington, Connecticut, USA
| | - Kalisi Logan
- Clinical Education Program, Genomic Education, The Jackson Laboratory, Farmington, Connecticut, USA
| | - Therese Ingram Nissen
- Clinical Education Program, Genomic Education, The Jackson Laboratory, Farmington, Connecticut, USA
| | - E Kate Reed
- Clinical Education Program, Genomic Education, The Jackson Laboratory, Farmington, Connecticut, USA
| | - Catherine Wicklund
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Debra Duquette
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa Dellefave-Castillo
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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11
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Oliva A, Kaphle A, Reguant R, Sng LMF, Twine NA, Malakar Y, Wickramarachchi A, Keller M, Ranbaduge T, Chan EKF, Breen J, Buckberry S, Guennewig B, Haas M, Brown A, Cowley MJ, Thorne N, Jain Y, Bauer DC. Future-proofing genomic data and consent management: a comprehensive review of technology innovations. Gigascience 2024; 13:giae021. [PMID: 38837943 PMCID: PMC11152178 DOI: 10.1093/gigascience/giae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024] Open
Abstract
Genomic information is increasingly used to inform medical treatments and manage future disease risks. However, any personal and societal gains must be carefully balanced against the risk to individuals contributing their genomic data. Expanding our understanding of actionable genomic insights requires researchers to access large global datasets to capture the complexity of genomic contribution to diseases. Similarly, clinicians need efficient access to a patient's genome as well as population-representative historical records for evidence-based decisions. Both researchers and clinicians hence rely on participants to consent to the use of their genomic data, which in turn requires trust in the professional and ethical handling of this information. Here, we review existing and emerging solutions for secure and effective genomic information management, including storage, encryption, consent, and authorization that are needed to build participant trust. We discuss recent innovations in cloud computing, quantum-computing-proof encryption, and self-sovereign identity. These innovations can augment key developments from within the genomics community, notably GA4GH Passports and the Crypt4GH file container standard. We also explore how decentralized storage as well as the digital consenting process can offer culturally acceptable processes to encourage data contributions from ethnic minorities. We conclude that the individual and their right for self-determination needs to be put at the center of any genomics framework, because only on an individual level can the received benefits be accurately balanced against the risk of exposing private information.
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Affiliation(s)
- Adrien Oliva
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Anubhav Kaphle
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Roc Reguant
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Letitia M F Sng
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Natalie A Twine
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Yuwan Malakar
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, 41 Boggo Rd, Dutton Park QLD 4102, Australia
| | - Anuradha Wickramarachchi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Marcel Keller
- Data61, Commonwealth Scientific and Industrial Research Organisation, Level 5/13 Garden St, Eveleigh NSW 2015, Australia
| | - Thilina Ranbaduge
- Data61, Commonwealth Scientific and Industrial Research Organisation, Building 101, Clunies Ross St, Black Mountain, Canberra, ACT 2601, Australia
| | - Eva K F Chan
- NSW Health Pathology, Sydney, 1 Reserve Road, St Leonards NSW 2065, Australia
| | - James Breen
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Sam Buckberry
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Boris Guennewig
- Sydney Medical School, Brain and Mind Centre, The University of Sydney, Sydney, 94 Mallett St, Camperdown NSW 2050, Australia
| | - Matilda Haas
- Australian Genomics, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
| | - Alex Brown
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Mark J Cowley
- Children’s Cancer Institute, Lowy Cancer Research Centre, Level 4, Lowy Cancer Research Centre Corner Botany & High Streets UNSW Kensington Campus UNSW Sydney, Kensington NSW 2052, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW Sydney, Kensington NSW 2052, Australia
| | - Natalie Thorne
- University of Melbourne, Melbourne, Parkville VIC 3052, Australia
- Melbourne Genomics Health Alliance, Melbourne 1G, Walter and Eliza Hall Institute/1G Royal Parade, Parkville VIC 3052, Australia
- Walter and Eliza Hall Institute, Melbourne, 1G, Walter and Eliza Hall Institute/1G Royal Parade, Parkville VIC 3052, Australia
| | - Yatish Jain
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Applied BioSciences 205B Culloden Rd Macquarie University, NSW 2109, Australia
| | - Denis C Bauer
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Applied BioSciences 205B Culloden Rd Macquarie University, NSW 2109, Australia
- Department of Biomedical Sciences, MQ Health General Practice - Macquarie University, Suite 305, Level 3/2 Technology Pl, Macquarie Park NSW 2109, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Gate 13, Kintore Avenue University of Adelaide, Adelaide SA 5000, Australia
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12
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French EL, Kader L, Young EE, Fontes JD. Physician Perception of the Importance of Medical Genetics and Genomics in Medical Education and Clinical Practice. MEDICAL EDUCATION ONLINE 2023; 28:2143920. [PMID: 36345884 PMCID: PMC9648379 DOI: 10.1080/10872981.2022.2143920] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The objective of this study was to determine physician perceptions regarding the importance of and comfort with the use of medical genetics and genomics in medical education and practice, as well as physician expectations for medical trainees. METHODS A retrospective survey was sent to physicians employed by a health system associated with a public medical school to assess their perceived training in medical genetics and genomics and their comfort level with ordering genetic testing. METHODS Despite reporting formal genetics training in medical schools, clinicians' comfort with and knowledge in this content area does not meet personal expectations of competency. Though physicians report some discomfort with the use of medical genetics and genomics, the majority also believe that its impact on practice will increase in the next five years. Survey recipients were also asked about their expectations for preparation in the same domains for medical students and incoming residents. The surveyed physicians expect a high level of competency for medical students and incoming residents. METHODS Our study revealed that practicing physicians feel current medical curricula do not produce physicians with the necessary competency in medical genetics and genomics. This is despite physicians' perceived importance of this domain in medical practice. Our findings suggest a need for re-evaluation of medical genetics and genomics education at all levels of training.
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Affiliation(s)
| | - Leena Kader
- Department of Anatomy and Cell Biology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Erin E. Young
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Joseph D. Fontes
- Department of Biochemistry and Molecular Biology, University of Kansas School of Medicine, Kansas City, KS, USA
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13
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Ginnan N, Bordenstein SR. It is time to authenticate the Microbiome Sciences with accredited educational programs and departments. PLoS Biol 2023; 21:e3002420. [PMID: 38060452 PMCID: PMC10703218 DOI: 10.1371/journal.pbio.3002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
The Microbiome Sciences are at a crucial maturation stage. Scientists and educators should now view the Microbiome Sciences as a flourishing and autonomous discipline, creating degree programs and departments that are conducive to cohesive growth.
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Affiliation(s)
- Nichole Ginnan
- The One Health Microbiome Center, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Seth R. Bordenstein
- The One Health Microbiome Center, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Entomology, The Pennsylvania State University, University Park, Pennsylvania, United States of America
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14
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Omran S, Leong SL, Blebil A, Mohan D, Teoh SL. Effectiveness of pharmacogenomics educational interventions on healthcare professionals and health professions students: A systematic review. Res Social Adm Pharm 2023; 19:1399-1411. [PMID: 37586945 DOI: 10.1016/j.sapharm.2023.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The field of pharmacogenomics is rapidly advancing, but its adoption and implementation remain slow and lacking. Lack of pharmacogenomics knowledge among healthcare professionals is the most frequently cited barrier to adopting and implementing pharmacogenomics in clinical settings. OBJECTIVES This study aimed to critically evaluate and determine the effectiveness of educational interventions in improving pharmacogenomics knowledge and practice. METHODS Four electronic databases were searched: MEDLINE, EMBASE, CENTRAL, and PsycINFO. Studies on pharmacogenomics educational interventions for health care professionals and students with pre- and post-intervention assessments and results were included. No restrictions were placed on time, language, or educational contexts. The educational outcomes measured include both objective and subjective outcomes. The pharmacogenomics competency domains used to judge educational interventions are based on the competency domains listed by the American Association of Colleges of Pharmacies (AACP). The National Heart, Lung, and Blood Institute of the National Institutes of Health was used for the quality assessment of pre-post studies with no control group and the controlled intervention studies. No meta-analysis was conducted; the data were synthesized qualitatively. The systematic review was reported in accordance with the PRISMA statement. RESULTS Fifty studies were included in this review. All included studies integrated the AACP pharmacogenomics competency domains into their educational interventions. Most of the studies had educational interventions that integrated clinical cases (n = 44; 88%). Knowledge was the most frequently evaluated outcome (n = 34; 68%) and demonstrated significant improvement after the educational intervention that integrated AACP pharmacogenomics competency domains and employed active learning with clinical case inclusion. CONCLUSION This review provided evidence of the effectiveness of educational interventions in improving pharmacogenomics knowledge and practice. Incorporating pharmacogenomics competency domains into education and training, with patient cases for healthcare professionals and students, dramatically improved their pharmacogenomics knowledge, attitudes, and confidence in practice.
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Affiliation(s)
- Safa Omran
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
| | - Siew Lian Leong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Ali Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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15
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Bowen A, Gómez-Trillos S, Curran G, Graves KD, Sheppard VB, Schwartz MD, Peshkin BN, Campos C, Garcés N, Dash C, Aburto L, Valencia-Rojas N, Hernández G, Villa A, Cupertino P, Carrera P, Hurtado-de-Mendoza A. Advancing health equity: A qualitative study assessing barriers and facilitators of implementing hereditary breast and ovarian cancer risk screening tools in community-based organizations. J Genet Couns 2023; 32:965-981. [PMID: 37062905 PMCID: PMC10577152 DOI: 10.1002/jgc4.1705] [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: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community-based organizations (CBOs) may play a role in identifying at-risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening ("HBOC risk screening tool"). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre-implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at-risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS-7). Participants (N = 35) highlighted how the FHS-7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow-up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration-related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi-level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.
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Affiliation(s)
| | - Sara Gómez-Trillos
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kristi D. Graves
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Marc D. Schwartz
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Beth N. Peshkin
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Nathaly Garcés
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Chiranjeev Dash
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | | | | | - Antonio Villa
- Virginia Commonwealth University, Richmond, Virginia, USA
- La Casa de la Salud, Richmond, Virginia, USA
| | - Paula Cupertino
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
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16
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Preys CL, Blout Zawatsky CL, Massmann A, Heukelom JV, Green RC, Hajek C, Hickingbotham MR, Zoltick ES, Schultz A, Christensen KD. Attitudes about pharmacogenomic testing vary by healthcare specialty. Pharmacogenomics 2023; 24:539-549. [PMID: 37458095 PMCID: PMC10621761 DOI: 10.2217/pgs-2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Aim: To understand how attitudes toward pharmacogenomic (PGx) testing among healthcare providers varies by specialty. Methods: Providers reported comfort ordering PGx testing and its perceived utility on web-based surveys before and after genetics education. Primary quantitative analyses compared primary care providers (PCPs) to specialty providers at both timepoints. Results: PCPs were more likely than specialty care providers to rate PGx testing as useful at both timepoints. Education increased comfort ordering PGx tests, with larger improvements among PCPs than specialty providers. Over 90% of cardiology and internal medicine providers rated PGx testing as useful at pre- and post-education. Conclusion: PCPs overwhelmingly perceive PGx to be useful, and provider education is particularly effective for improving PCPs' confidence. Education for all specialties will be essential to ensure appropriate integration into routine practice.
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Affiliation(s)
- Charlene L Preys
- MGH Institute of Health Professions, Charlestown, MA 02129, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Carrie L Blout Zawatsky
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Ariadne Labs, Boston, MA 02215, USA
| | - Amanda Massmann
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermilion, SD 57069, USA
| | - Joel Van Heukelom
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermilion, SD 57069, USA
| | - Robert C Green
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Ariadne Labs, Boston, MA 02215, USA
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Catherine Hajek
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Helix OpCo, LLC, San Diego, CA 92121, USA
| | - Madison R Hickingbotham
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Emilie S Zoltick
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - April Schultz
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermilion, SD 57069, USA
| | - Kurt D Christensen
- Ariadne Labs, Boston, MA 02215, USA
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA 02115, USA
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17
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Patterson WG, Ward LD. Genetics and Genomics Education for Physician Assistant Students: A Review of the Literature. J Physician Assist Educ 2023; 34:62-68. [PMID: 36728117 DOI: 10.1097/jpa.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The purpose of this study was to critically review the literature and determine what is known about genetics-genomics education for physician assistants (PAs). METHODS A rapid review method was used to search CINAHL, MEDLINE, PubMed, and Web of Science databases. The review is presented historically to describe the development of genetics-genomics education in PA programs. RESULTS Of 594 publications retrieved, 11 articles met inclusion criteria. Retained articles include an assessment of PA programs, genetics-genomics competencies, educational efforts developed by PA programs regarding genetics-genomics, and continuing education programs for PAs. DISCUSSION A paucity of published literature regarding genetics-genomics education for PAs was found. The few studies retrieved describe content being taught in PA programs, the number of genetics-genomics contact hours that PA students receive, and recommendations for continuing education programs. Most of the available literature is outdated, leaving a need for more current information to inform the education of genetic- and genomic-competent PAs. Recommendations for future research include assessment of PA programs regarding genetics-genomics education; development and validation of an assessment tool to measure genetics-genomics knowledge; and utilization of the RISE2 Genomics standards to plan, implement, evaluate, and report educational interventions. These recommendations are necessary to build an evidence base regarding genomics education for PA students and practicing PAs.
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Affiliation(s)
- Wesley G Patterson
- Wesley G. Patterson, PhD, MSPA,PA-C, is a genetics physician assistant at Greenwood Genetic Center in Greenwood, South Carolina
- Linda D. Ward, PhD, FNP-C, is an associate professor at Clemson University School of Nursing in Clemson, South Carolina
| | - Linda D Ward
- Wesley G. Patterson, PhD, MSPA,PA-C, is a genetics physician assistant at Greenwood Genetic Center in Greenwood, South Carolina
- Linda D. Ward, PhD, FNP-C, is an associate professor at Clemson University School of Nursing in Clemson, South Carolina
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18
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Coleman T, Bensend T, Mills R, Orlando LA, Doyle L. Critical components of genomic medicine practice for non-genetics healthcare professionals: Genetic counselors' perspectives and implications for medical education. J Genet Couns 2023. [PMID: 36808791 DOI: 10.1002/jgc4.1689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 01/14/2023] [Accepted: 01/21/2023] [Indexed: 02/22/2023]
Abstract
Genetic services are increasingly provided by non-genetics healthcare professionals (NGHPs) with minimal formal training in genetics/genomics. Research demonstrates gaps in knowledge and clinical practices in genetics/genomics among NGHPs, but there is a lack of consensus on the specific knowledge needed by NGHPs to effectively provide genetic services. As clinical genetics professionals, genetic counselors (GCs) have insight into the critical components of genetics/genomics knowledge and practices needed by NGHPs. This study explored GCs' beliefs regarding whether NGHPs should provide genetic services and identified GCs' perceptions of the components of knowledge and clinical practice in genetics/genomics that are most critical for NGHPs providing genetic services. Two hundred and forty GCs completed an online quantitative survey with 17 participating in a follow-up qualitative interview. Descriptive statistics and cross-comparisons were generated for survey data. Interview data were analyzed using an inductive qualitative method for cross-case analysis. Most GCs disagreed with NGHPs providing genetic services, but beliefs varied widely, ranging from disagreement due to perceived gaps in knowledge or clinical skills to acceptance of NGHPs providing genetic services due to limited access to genetics professionals. Across survey and interview data, GCs endorsed the interpretation of genetic test results, understanding implications of results, collaboration with genetics professionals, knowledge of the risks and benefits to testing, and recognizing indications for genetic testing as critical components of knowledge and clinical practice for NGHPs. Several recommendations for improving the provision of genetic services were provided by respondents including educating NGHPs to provide genetic services through case-based continuing medical education and increasing collaboration between NGHPs and genetics professionals. As GCs are healthcare providers with experience and vested interests in educating NGHPs, their perspectives can help inform the creation of continuing medical education to ensure patients' access to high-quality genomic medicine care from providers of varying backgrounds.
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Affiliation(s)
- Tanner Coleman
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA.,MS Genetic Counseling Program, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | | | - Rachel Mills
- MS Genetic Counseling Program, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lori A Orlando
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Doyle
- MS Genetic Counseling Program, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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19
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Haga SB, Chung WK, Cubano LA, Curry TB, Empey PE, Ginsburg GS, Mangold K, Miyake CY, Prakash SK, Ramsey LB, Rowley R, Rohrer Vitek CR, Skaar TC, Wynn J, Manolio TA. Development of Competency-based Online Genomic Medicine Training (COGENT). Per Med 2023; 20:55-64. [PMID: 36416152 PMCID: PMC10291206 DOI: 10.2217/pme-2022-0101] [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: 09/02/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
The fields of genetics and genomics have greatly expanded across medicine through the development of new technologies that have revealed genetic contributions to a wide array of traits and diseases. Thus, the development of widely available educational resources for all healthcare providers is essential to ensure the timely and appropriate utilization of genetics and genomics patient care. In 2020, the National Human Genome Research Institute released a call for new proposals to develop accessible, sustainable online education for health providers. This paper describes the efforts of the six teams awarded to reach the goal of providing genetic and genomic training modules that are broadly available for busy clinicians.
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Affiliation(s)
- Susanne B Haga
- Department of Medicine, Duke University School of Medicine, Program in Precision Medicine, 101 Science Drive, Durham, NC 27708, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, 1150 St. Nicholas Avenue, Room 620 New York, NY 10032, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Luis A Cubano
- National Human Genome Research Institute, Division of Genomic Medicine, 6700B Rockledge Dr, Suite 3100, Bethesda, MD 20892-6908, USA
| | - Timothy B Curry
- Center for Individualized Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Anesthesia & Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Philip E Empey
- Department of Pharmacy & Therapeutics, Pharmacogenomics Center of Excellence, University of Pittsburgh School of Pharmacy, 9064 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261, USA
| | - Geoffrey S Ginsburg
- National Institutes of Health, All of Us Research Program, Bethesda, MD 20892, USA
| | - Kara Mangold
- Center for Individualized Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Christina Y Miyake
- Department of Pediatrics, Texas Children’s Hospital, 6651 Main Street, Suite E1960.22, Houston, TX 77030, USA
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Siddharth K Prakash
- Department of Internal Medicine, Division of Medical Genetics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Laura B Ramsey
- Divisions of Clinical Pharmacology & Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Robb Rowley
- National Human Genome Research Institute, Division of Genomic Medicine, 6700B Rockledge Dr, Suite 3100, Bethesda, MD 20892-6908, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Todd C Skaar
- Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, 1150 St. Nicholas Avenue, Room 620 New York, NY 10032, USA
| | - Teri A Manolio
- National Human Genome Research Institute, Division of Genomic Medicine, 6700B Rockledge Dr, Suite 3100, Bethesda, MD 20892-6908, USA
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20
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Primiero CA, Finnane A, Yanes T, Peach B, Soyer HP, McInerney-Leo AM. Protocol to evaluate a pilot program to upskill clinicians in providing genetic testing for familial melanoma. PLoS One 2022; 17:e0275926. [PMID: 36477719 PMCID: PMC9728910 DOI: 10.1371/journal.pone.0275926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/22/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Genetic testing for hereditary cancers can improve long-term health outcomes through identifying high-risk individuals and facilitating targeted prevention and screening/surveillance. The rising demand for genetic testing exceeds the clinical genetic workforce capacity. Therefore, non-genetic specialists need to be empowered to offer genetic testing. However, it is unknown whether patient outcomes differ depending on whether genetic testing is offered by a genetics specialist or a trained non-genetics clinician. This paper describes a protocol for upskilling non-genetics clinicians to provide genetic testing, randomise high-risk individuals to receive testing from a trained clinician or a genetic counsellor, and then determine whether patient outcomes differed depending on provider-type. METHODS An experiential training program to upskill dermatologically-trained clinicians to offer genetic testing for familial melanoma is being piloted on 10-15 clinicians, prior to wider implementation. Training involves a workshop, comprised of a didactic learning presentation, case studies, simulated sessions, and provision of supporting documentation. Clinicians later observe a genetic counsellor led consultation before being observed leading a consultation. Both sessions are followed by debriefing with a genetic counsellor. Thereafter, clinicians independently offer genetic testing in the clinical trial. Individuals with a strong personal and/or family history of melanoma are recruited to a parallel-group trial and allocated to receive pre- and post- genetic testing consultation from a genetic counsellor, or a dermatologically-trained clinician. A mixed method approach measures psychosocial and behavioural outcomes. Longitudinal online surveys are administered at five timepoints from baseline to one year post-test disclosure. Semi-structured interviews with both patients and clinicians are qualitatively analysed. SIGNIFICANCE This is the first program to upskill dermatologically-trained clinicians to provide genetic testing for familial melanoma. This protocol describes the first clinical trial to compare patient-reported outcomes of genetic testing based on provider type (genetic counsellors vs trained non-genetic clinicians).
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Affiliation(s)
- Clare A. Primiero
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Anna Finnane
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Tatiane Yanes
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Betsy Peach
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - H. Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
- * E-mail:
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Livingstone KM, Ramos-Lopez O, Pérusse L, Kato H, Ordovas JM, Martínez JA. Reprint of: Precision nutrition: A review of current approaches and future endeavors. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Primiero CA, Baker AM, Wallingford CK, Maas EJ, Yanes T, Fowles L, Janda M, Young MA, Nisselle A, Terrill B, Lodge JM, Tiller JM, Lacaze P, Andersen H, McErlean G, Turbitt E, Soyer HP, McInerney-Leo AM. Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma. Front Genet 2022; 13:919134. [PMID: 36353112 PMCID: PMC9638172 DOI: 10.3389/fgene.2022.919134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Melanoma genetic testing reportedly increases preventative behaviour without causing psychological harm. Genetic testing for familial melanoma risk is now available, yet little is known about dermatologists’ perceptions regarding the utility of testing and genetic testing ordering behaviours. Objectives: To survey Australasian Dermatologists on the perceived utility of genetic testing, current use in practice, as well as their confidence and preferences for the delivery of genomics education. Methods: A 37-item survey, based on previously validated instruments, was sent to accredited members of the Australasian College of Dermatologists in March 2021. Quantitative items were analysed statistically, with one open-ended question analysed qualitatively. Results: The response rate was 56% (256/461), with 60% (153/253) of respondents between 11 and 30 years post-graduation. While 44% (112/252) of respondents agreed, or strongly agreed, that genetic testing was relevant to their practice today, relevance to future practice was reported significantly higher at 84% (212/251) (t = -9.82, p < 0.001). Ninety three percent (235/254) of respondents reported rarely or never ordering genetic testing. Dermatologists who viewed genetic testing as relevant to current practice were more likely to have discussed (p < 0.001) and/or offered testing (p < 0.001). Respondents indicated high confidence in discussing family history of melanoma, but lower confidence in ordering genetic tests and interpreting results. Eighty four percent (207/247) believed that genetic testing could negatively impact life insurance, while only 26% (63/244) were aware of the moratorium on using genetic test results in underwriting in Australia. A minority (22%, 55/254) reported prior continuing education in genetics. Face-to-face courses were the preferred learning modality for upskilling. Conclusion: Australian Dermatologists widely recognise the relevance of genetic testing to future practice, yet few currently order genetic tests. Future educational interventions could focus on how to order appropriate genetic tests and interpret results, as well as potential implications on insurance.
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Affiliation(s)
- Clare A. Primiero
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Amy M. Baker
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Courtney K. Wallingford
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Ellie J. Maas
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Tatiane Yanes
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Lindsay Fowles
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Bronwyn Terrill
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jason M. Lodge
- School of Education, The University of Queensland, Brisbane, QLD, Australia
| | - Jane M. Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hayley Andersen
- Melanoma and Skin Cancer Advocacy Network, Carlton, VIC, Australia
| | - Gemma McErlean
- SWS Nursing and Midwifery Research Alliance, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Erin Turbitt
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - H. Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Aideen M. McInerney-Leo,
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Livingstone KM, Ramos-Lopez O, Pérusse L, Kato H, Ordovas JM, Martínez JA. Precision nutrition: A review of current approaches and future endeavors. Trends Food Sci Technol 2022; 128:253-264. [DOI: https:/doi.org/10.1016/j.tifs.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
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Livingstone KM, Ramos-Lopez O, Pérusse L, Kato H, Ordovas JM, Martínez JA. Precision nutrition: A review of current approaches and future endeavors. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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25
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Charron M, Kaiser B, Dauge A, Gallois H, Lapointe J, Dorval M, Nabi H, Joly Y. Integrating hereditary breast and ovarian cancer genetic counselling and testing into mainstream clinical practice: Legal and ethical challenges. Crit Rev Oncol Hematol 2022; 178:103797. [PMID: 36031172 DOI: 10.1016/j.critrevonc.2022.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
Health professionals not specialized in genetics are expected to take an increasing role in genetic services delivery. This article aims to identify legal and ethical challenges related to a collaborative oncogenetics service model, where non-genetic health professionals provide genetic services to patients. Through a scoping literature review, we identified issues to the provision of hereditary breast and ovarian cancer, or other hereditary adult cancers, genetic testing under this model. Concerns that arose in the literature were informed consent, lack of adherence to best practice guidelines, lack of education of non-genetic health professionals on the provision of genetic services, psychological impacts of genetic testing, continuity of care, the complexity of genetic test results, confidentiality, risks of medical mismanagement, and the associated medical responsibility liabilities. Despite these challenges, there is a growing consensus towards the feasibility of cancer genetic testing being undertaken by non-genetic healthcare professionals in a collaborative oncogenetics service model.
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Affiliation(s)
- Marilou Charron
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada.
| | - Beatrice Kaiser
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
| | - Aurélie Dauge
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
| | - Hortense Gallois
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
| | - Julie Lapointe
- Oncology Division, CHU de Québec - Université Laval Research Center, Québec, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Université Laval, Researcher Oncology Division, CHU de Québec - Université Laval Research Center, Canada
| | - Hermann Nabi
- Faculty of Medicine, Université Laval, Researcher Oncology Division, CHU de Québec - Université Laval Research Center, Canada
| | - Yann Joly
- Centre of Genomics and Policy (CGP), McGill University, Montreal, Québec, Canada
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Gates RW, Hudgins L, Huffman LC. Medical genetics education for pediatrics residents: A brief report. Genet Med 2022; 24:2408-2412. [PMID: 36029300 DOI: 10.1016/j.gim.2022.08.003] [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: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Genetic testing is ubiquitous in the field of medicine and is often ordered or requested by primary care providers, nongenetics subspecialists, and patients themselves. Other studies have shown that providers are often not comfortable ordering genetic testing. There have been initiatives to teach these concepts via continuing medical education; however, there is not a standardized training program for teaching resident physicians about genetic testing. METHODS During September to October 2020, we recruited all the pediatrics residents at our institution via email (N = 102). Residents were invited to complete a Qualtrics electronic survey that addressed self-perceived level of knowledge about core concepts of genetic testing, as well as self-perceived confidence discussing these concepts with families. RESULTS Response rate was 46 to 102 (45%). Proportions of respondents reporting they felt insufficiently knowledgeable ranged from 28% (basic concepts of genetics) to 80% (Genetic Information Nondiscrimination Act). Most pediatrics residents agreed that a curriculum teaching basics of genetic testing would be helpful to them. Desired curricular topics included indications and limitations of genetic testing, testing procedures, and counseling families. CONCLUSION Despite its expanding importance across medicine, genetics education is lacking in pediatrics residency programs and residents would benefit from a curriculum teaching basic concepts of genetic testing.
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Affiliation(s)
- Ryan W Gates
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
| | - Louanne Hudgins
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lynne C Huffman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Stanford Medicine, Stanford, CA
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Real-World Implementation of Precision Psychiatry: A Systematic Review of Barriers and Facilitators. Brain Sci 2022; 12:brainsci12070934. [PMID: 35884740 PMCID: PMC9313345 DOI: 10.3390/brainsci12070934] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Despite significant research progress surrounding precision medicine in psychiatry, there has been little tangible impact upon real-world clinical care. Objective: To identify barriers and facilitators affecting the real-world implementation of precision psychiatry. Method: A PRISMA-compliant systematic literature search of primary research studies, conducted in the Web of Science, Cochrane Central Register of Controlled Trials, PsycINFO and OpenGrey databases. We included a qualitative data synthesis structured according to the ‘Consolidated Framework for Implementation Research’ (CFIR) key constructs. Results: Of 93,886 records screened, 28 studies were suitable for inclusion. The included studies reported 38 barriers and facilitators attributed to the CFIR constructs. Commonly reported barriers included: potential psychological harm to the service user (n = 11), cost and time investments (n = 9), potential economic and occupational harm to the service user (n = 8), poor accuracy and utility of the model (n = 8), and poor perceived competence in precision medicine amongst staff (n = 7). The most highly reported facilitator was the availability of adequate competence and skills training for staff (n = 7). Conclusions: Psychiatry faces widespread challenges in the implementation of precision medicine methods. Innovative solutions are required at the level of the individual and the wider system to fulfil the translational gap and impact real-world care.
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28
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Niehaus AD, Rassbach CE, Stevenson DA. A survey of program directors for combined pediatrics and medical genetics and genomics residency programs: Perspectives when evaluating applicants. Am J Med Genet A 2022; 188:2315-2324. [PMID: 35633299 DOI: 10.1002/ajmg.a.62846] [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: 04/27/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
While combined pediatrics and medical genetics and genomics residency programs are growing in number and applicants, there are still workforce shortages within the medical genetics field. Medical students would benefit from additional information on the training pathways and insight into the application process itself. Program Directors of combined pediatrics and medical genetics and genomics residency programs were surveyed to characterize factors that influence interview selection and rank list decisions, application logistics, recruitment, and training pathways. When evaluating applicants, representatives from both pediatrics and medical genetics are involved in the screening process. Additionally, both groups value prior research experience, but do not have a clear preference for a particular subcategory or domain of research. Most program directors think that all currently-available training pathways can provide optimal training. Further action is needed to provide medical students with the knowledge to make more informed decisions about their career and medical school advisors with objective data to counsel students. There was support among program directors to initiate consideration of creating a pathway for medical students to match directly into a medical genetics and genomics residency.
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Affiliation(s)
- Annie D Niehaus
- Division of Medical Genetics, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
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29
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Schaibley VM, Ramos IN, Woosley RL, Curry S, Hays S, Ramos KS. Limited Genomics Training Among Physicians Remains a Barrier to Genomics-Based Implementation of Precision Medicine. Front Med (Lausanne) 2022; 9:757212. [PMID: 35372454 PMCID: PMC8971187 DOI: 10.3389/fmed.2022.757212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/18/2022] [Indexed: 01/12/2023] Open
Abstract
The field of precision medicine has undergone significant growth over the past 10 years. Despite increasing applications of clinical genetic and genomic testing, studies consistently report limited knowledge of genetics and genomics among healthcare providers. This study explored barriers to the implementation of precision medicine by surveying physicians working in a large academic medical center. We assessed prior training in genetics, use of genetic testing in the clinic, desire for additional resources in genetics and genomic medicine and perceived barriers to successful integration of precision medicine. Only 20% of respondents reported moderate or extensive training in genetics. Physicians with limited or no training in genetics were less likely to have ordered a genetic test for any purpose. Furthermore, 41% of physicians responded that their lack of training identifying appropriate genetic tests and how to interpret genetic testing results was the most significant barrier to ordering genetic testing for their patients. These findings suggest that future efforts to realize the promise of precision medicine should focus on the integration of training programs for non-genetics trained healthcare providers.
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Affiliation(s)
- Valerie M. Schaibley
- Center for Applied Genetics and Genomic Medicine, The University of Arizona Health Sciences, Tucson, AZ, United States
- Genetic Counseling Graduate Program, University of Arizona College of Medicine – Tucson, Tucson, AZ, United States
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine – Tucson, Tucson, AZ, United States
| | - Irma N. Ramos
- Center for Applied Genetics and Genomic Medicine, The University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, United States
| | - Raymond L. Woosley
- Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Steven Curry
- Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Sean Hays
- SciPinion, Bozeman, MT, United States
| | - Kenneth S. Ramos
- Center for Applied Genetics and Genomic Medicine, The University of Arizona Health Sciences, Tucson, AZ, United States
- Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
- Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, United States
- *Correspondence: Kenneth S. Ramos,
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A Web Screening on Training Initiatives in Cancer Genomics for Healthcare Professionals. Genes (Basel) 2022; 13:genes13030430. [PMID: 35327984 PMCID: PMC8950486 DOI: 10.3390/genes13030430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 02/05/2023] Open
Abstract
The disruptive advances in genomics contributed to achieve higher levels of precision in the diagnosis and treatment of cancer. This scientific advance entails the need for greater literacy for all healthcare professionals. Our study summarizes the training initiatives conducted worldwide in cancer genomics field for healthcare professionals. We conducted a web search of the training initiatives aimed at improving healthcare professionals’ literacy in cancer genomics undertaken worldwide by using two search engines (Google and Bing) in English language and conducted from 2003 to 2021. A total of 85,649 initiatives were identified. After the screening process, 36 items were included. The majority of training programs were organized in the United States (47%) and in the United Kingdom (28%). Most of the initiatives were conducted in the last five years (83%) by universities (30%) and as web-based modalities (80%). In front of the technological advances in genomics, education in cancer genomics remains fundamental. Our results may contribute to provide an update on the development of educational programs to build a skilled and appropriately trained genomics health workforce in the future.
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Vidgen ME, Fowles LF, Istiko SN, Evans E, Cutler K, Sullivan K, Bean J, Healy L, Hondow G, McInerney-Leo AM, Pratt G, Robins D, Best S, Finlay K, Ramarao-Milne P, Waddell N. Evaluation of a Genetics Education Program for Health Interpreters: A Pilot Study. Front Genet 2022; 12:771892. [PMID: 35186003 PMCID: PMC8850313 DOI: 10.3389/fgene.2021.771892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Health Interpreters enable effective communication between health practitioners and patients with limited knowledge of the predominant language. This study developed and evaluated a training session introducing Health Interpreters to genetics. The online training was delivered multiple times as a single 2-h session comprising lectures and activities. Participants completed questionnaires (pre-, post-, and 6-months follow-up) to assess the impact of training on knowledge, attitude, self-efficacy, and self-reported practice behaviour. Questionnaires were analysed using descriptive statistics, Fisher’s Exact, or independent t-test. In total, 118 interpreters participated in the training sessions. Respondent knowledge improved, with gains maintained at 6-months (p < 0.01). There were no changes in self-efficacy, and attitudes. Training did not change self-reported practice behaviour, but there was notable pre-existing variability in participants’ methods of managing unknown genetic words. Most respondents agreed that training was useful (93%) and relevant (79%) to their work. More respondents reported learning more from the case study activity (86%) than the group activity (58%). Health Interpreters found the training acceptable and demonstrated sustained improvement in knowledge of genetic concepts. Increased delivery of this training and associated research is needed to assess findings in a larger cohort and to measure the impact on patients.
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Affiliation(s)
- Miranda E. Vidgen
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- *Correspondence: Miranda E. Vidgen,
| | - Lindsay F. Fowles
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Satrio Nindyo Istiko
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Erin Evans
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
- Health Consumers Queensland, Brisbane, QLD, Australia
| | - Katrina Cutler
- Queensland Genomics, The University of Queensland, Brisbane, QLD, Australia
| | - Kate Sullivan
- Queensland Genomics, The University of Queensland, Brisbane, QLD, Australia
| | - Jessica Bean
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Louise Healy
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Gary Hondow
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Deborah Robins
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Stephanie Best
- Australian Genomics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Macquarie University, Sydney, NSW, Australia
| | - Keri Finlay
- Australian Genomics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Genetic Support Network of Victoria, Melbourne, VIC, Australia
| | - Priya Ramarao-Milne
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
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Rahman B, McEwen A, Phillips JL, Tucker K, Goldstein D, Jacobs C. Genetic and genomic learning needs of oncologists and oncology nurses in the era of precision medicine: a scoping review. Per Med 2022; 19:139-153. [PMID: 35060769 DOI: 10.2217/pme-2021-0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic and genomic data are increasingly guiding clinical care for cancer patients. To meet the growing demand for precision medicine, patient-facing oncology staff will be a part of leading the provision of genomic testing. A scoping review was undertaken to identify the range of genetic and genomic learning needs of oncologists and oncology nurses. Learning needs were reported relating to interpretation of genomic data, clinical decision-making, patient communication and counseling, and fundamentals of genetics and genomics. There was a lack of empirical research specific to oncology nurses and their learning needs in tumor sequencing. Our findings suggest that oncologists and oncology nurses need tailored support, education and training to improve their confidence and skills in adopting genomic testing into clinical practice.
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Affiliation(s)
- Belinda Rahman
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, QLD, Australia.,IMPACCT, University of Technology Sydney, NSW, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, NSW, Australia
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Hajek C, Hutchinson AM, Galbraith LN, Green RC, Murray MF, Petry N, Preys CL, Zawatsky CLB, Zoltick ES, Christensen KD. Improved provider preparedness through an 8-part genetics and genomic education program. Genet Med 2022; 24:214-224. [PMID: 34906462 PMCID: PMC9121992 DOI: 10.1016/j.gim.2021.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/25/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Large-scale genetics education appropriate for general practice providers is a growing priority. We describe the content and impact of a mandatory system-wide program implemented at Sanford Health. METHODS The Imagenetics Initiative at Sanford Health developed a 2-year genetics education program with quarterly web-based modules that were mandatory for all physicians and advanced practice providers. Scores of 0 to 5 were calculated for each module on the basis of the number of objectives that the participants reported as fulfilled. In addition, the participants completed surveys before starting and after finishing the education program, which included a 7-item measure scored 7 to 28 on the perceived preparedness to practice genetics. RESULTS Between 2252 and 2822 Sanford Health employees completed each of the 8 quarterly education modules. The ratings were highest for the module about using genomics to improve patient management (mean score = 4.3) and lowest for the module about different types of genetic tests and specialists. The mean perceived preparedness scores increased from 15.7 at pre-education to 19.1 at post-education (P < .001). CONCLUSION Web-based genetics education was highly effective in increasing health care providers' confidence about using genetics. Both comfort with personal knowledge and confidence regarding access to the system's genomic medicine experts increased significantly. The results demonstrate how scalable approaches can improve provider preparedness.
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Affiliation(s)
- Catherine Hajek
- Sanford Health Imagenetics, Sioux Falls, SD; Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.
| | | | - Lauren N Galbraith
- Department of Population Medicine, Center for Healthcare Research in Pediatrics (CHERP), Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Department of Medicine, Harvard Medical School, Boston, MA; Ariadne Labs, Boston, MA
| | | | - Natasha Petry
- Sanford Health Imagenetics, Fargo, ND; Department of Pharmacy Practice, School of Pharmacy, North Dakota State University, Fargo, ND
| | - Charlene L Preys
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA; MGH Institute of Health Professions, Boston, MA
| | - Carrie L B Zawatsky
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Ariadne Labs, Boston, MA
| | - Emilie S Zoltick
- Department of Population Medicine, Center for Healthcare Research in Pediatrics (CHERP), Harvard Pilgrim Health Care Institute, Boston, MA
| | - Kurt D Christensen
- Department of Population Medicine, Center for Healthcare Research in Pediatrics (CHERP), Harvard Pilgrim Health Care Institute, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Department of Population Medicine, Harvard Medical School, Boston, MA
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Bazarbashi S, Su WP, Wong SW, Singarachari RA, Rawal S, Volkova MI, Bastos DA. A Narrative Review of Implementing Precision Oncology in Metastatic Castration-Resistant Prostate Cancer in Emerging Countries. Oncol Ther 2021; 9:311-327. [PMID: 34236692 PMCID: PMC8593077 DOI: 10.1007/s40487-021-00160-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
The therapeutic landscape of metastatic castration-resistant prostate cancer (mCRPC) has evolved considerably with the introduction of newer agents, such as poly-ADP ribose polymerase (PARP) inhibitors targeting DNA damage repair mutations. Combining and sequencing novel and existing therapies appropriately is necessary for optimizing the management of mCRPC and ensuring better treatment outcomes. The purpose of this review is to provide evidence-based answers to key clinical questions on treatment selection, treatment sequencing patterns, and factors influencing treatment decisions in the management of mCRPC in the era of PARP inhibitors. This article can also serve as a comprehensive guide to clinicians for optimizing genetic testing and counseling and management of patients with mCRPC. Although the PROfound study has validated the concept of PARP sensitivity across multiple genes associated with homologous recombination repair (HRR) in mCRPC and highlighted the importance of genomic testing in this at-risk patient population, it still remains unclear how patients with rarer HRR mutations will respond to PARP inhibitors. Therefore, real-world data obtained through registry-based randomized controlled trials in the future may help produce robust scientific evidence for supporting optimal clinician decision-making in the management of mCRPC.
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Affiliation(s)
- Shouki Bazarbashi
- Oncology, King Faisal Specialist Hospital and Research Center, Alzahrawi Street, Riyadh, 11211, Saudi Arabia.
| | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 35, Rd. Xiao-Tong, Tainan, Taiwan
- Departments of Oncology and Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 35, Rd. Xiao-Tong, Tainan, Taiwan
| | - Siew W Wong
- Medical Oncology, The Cancer Centre, Orchard Road, Singapore, 238859, Singapore
| | - Ramanujam A Singarachari
- Division of Oncology and Hematology, Department of Internal Medicine, Sheikh Khalifa Medical City, Karamah Street, Abu Dhabi, UAE
| | - Sudhir Rawal
- Uro-Oncology, Rajev Gandhi Cancer Institute & Research Centre, Rohini, New Delhi, India
| | - Maria I Volkova
- Oncourology, N.N. Blokhin Cancer Center, Kashirskoye shosse, 24, Moscow, 115478, Russia
| | - Diogo A Bastos
- Oncology, Hospital Sirio-Libanês, 91 Adma Jafet street, São Paulo, Brazil
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An innovative medical school curriculum to enhance exposure to genetics and genomics: Updates and outcomes. Genet Med 2021; 24:722-728. [PMID: 34906481 DOI: 10.1016/j.gim.2021.10.017] [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: 07/13/2021] [Revised: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE In 2011, we introduced an innovative parallel curriculum at Baylor College of Medicine, formerly called the Genetics Track Curriculum and now called the Genetics and Genomics Pathway, aimed at providing an opportunity for an enriched educational experience throughout medical school. In this report, we describe our 10-year experience with the program and highlight growth in enrollment as well as academic achievements of graduating students. METHODS We reviewed the data of students enrolled in this pathway, including retention, satisfaction, student-driven curriculum changes, scholarly outcomes, and career outcomes. RESULTS From September 2011 to June 2021, 121 students were enrolled in the Genetics and Genomics Pathway program. In total, 64 students (64/121 = 53%) left the program before graduating (the majority, after their first year). Of the 57 remaining students, 29 graduated (29/57, approximately 51%), and 4 of the 29 students (4/29 = 14%) matched into a genetics training program. CONCLUSION This novel program serves as a mechanism for garnering increased interest and competence in medical genetics. The longitudinal nature of the program fosters enthusiasm for genetics and provides ample opportunity to develop valuable research skills. Given the ongoing shortage of providers in this field, such programs are vital to increase the size of the workforce and broaden the knowledge of providers in diverse fields.
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Uebergang E, Best S, de Silva MG, Finlay K. Understanding genomic health information: how to meet the needs of the culturally and linguistically diverse community-a mixed methods study. J Community Genet 2021; 12:549-557. [PMID: 34185265 PMCID: PMC8554909 DOI: 10.1007/s12687-021-00537-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
Abstract
Clinical genomic testing, analysis of your entire genetic material for healthcare purposes, is a complex topic for various medical specialities. Although Australia is a multicultural society, most genomic resources are produced in English which can make understanding challenging for people from culturally and linguistically diverse (CALD) backgrounds. A mixed methods approach explored the views of healthcare interpreters and people from CALD backgrounds to identify knowledge gaps and inform the provision of more equitable services. Eighteen healthcare interpreters completed a survey from two public hospitals in Melbourne. Descriptive data analysis informed the four pilot interviews with individuals from CALD backgrounds identified through online advertisements. Interpreters revealed variable satisfaction with patient understanding of genomic concepts and suggested that basic training and resources on genomics would help facilitate interpretation. Three themes arose from the pilot interviews: (1) cultural factors; (2) perceptions of genomics; and (3) language barriers and complex terminology. Resources that consider cultural differences and language barriers will help to ensure people from CALD backgrounds are adequately informed about genomic testing. The pilot interviews will inform future in-depth studies of the views of people from the CALD community.
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Affiliation(s)
- Eloise Uebergang
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Stephanie Best
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
| | - Michelle G de Silva
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | - Keri Finlay
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genetic Support Network of Victoria, Melbourne, VIC, Australia
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Li M, Zhao S, Young CM, Foster M, Huei-Yu Wang J, Tseng TS, Kwok OM, Chen LS. Family Health History-Based Interventions: A Systematic Review of the Literature. Am J Prev Med 2021; 61:445-454. [PMID: 34226092 DOI: 10.1016/j.amepre.2021.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT National efforts have advocated for the need to deliver family health history-based interventions to the lay public for more than a decade. Yet, the numbers, characteristics, and outcomes of such interventions are unknown. This first-of-its-kind systematic literature review examines the characteristics and effectiveness of the existing family health history-based interventions. EVIDENCE ACQUISITION The research team systematically searched peer-reviewed articles published between January 2003 and July 2020 in MEDLINE, Embase, CINAHL, and Google Scholar. EVIDENCE SYNTHESIS A total of 35 articles met the inclusion criteria. These studies assessed various behaviors, including family health history collection/communication with family members, family health history communication with healthcare providers, healthy diet adoption, physical activity level, uptake of medical screenings and genetic tests, and being proactive in healthcare matters. The average methodologic quality score of the studies was 9.9 (SD=1.6) of a theoretical range from 2 to 16. CONCLUSIONS Many family health history-based interventions exist to examine a variety of behaviors. Yet, there is room for improvement in methodology because few studies used a randomized or quasi-experimental design. In addition, most included studies did not report objective or longer-term outcome data to examine the effectiveness of family health history-based interventions.
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Affiliation(s)
- Ming Li
- Department of Health Sciences, College of Health Professions, Towson University, Towson, Maryland
| | - Shixi Zhao
- Department College of Health Professions, Exercise & Sports Sciences, College of Education & Human Sciences, The University of New Mexico, Albuquerque, New Mexico
| | | | - Margaret Foster
- Medical Science Library, Texas A&M University, College Station, Texas
| | - Judy Huei-Yu Wang
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Tung-Sung Tseng
- Behavioral & Community Health Sciences Program, LSU School of Public Health, LSU Health New Orleans, New Orleans, Louisiana
| | - Oi-Man Kwok
- Department of Educational Psychology, College of Education & Human Development, Texas A&M University, College Station, Texas
| | - Lei-Shih Chen
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas.
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Nisselle A, King EA, McClaren B, Janinski M, Metcalfe S, Gaff C. Measuring physician practice, preparedness and preferences for genomic medicine: a national survey. BMJ Open 2021; 11:e044408. [PMID: 34244249 PMCID: PMC8273463 DOI: 10.1136/bmjopen-2020-044408] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Even as genomic medicine is implemented globally, there remains a lack of rigorous, national assessments of physicians' current genomic practice and continuing genomics education needs. The aim of this study was to address this gap. DESIGN A cross-sectional survey, informed by qualitative data and behaviour change theory, to assess the current landscape of Australian physicians' genomic medicine practice, perceptions of proximity and individual preparedness, and preferred models of practice and continuing education. The survey was advertised nationally through 10 medical colleges, 24 societies, 62 hospitals, social media, professional networks and snowballing. RESULTS 409 medical specialists across Australia responded, representing 30 specialties (majority paediatricians, 20%), from mainly public hospitals (70%) in metropolitan areas (75%). Half (53%) had contacted their local genetics services and half (54%) had ordered or referred for a gene panel or exome/genome sequencing test in the last year. Two-thirds (67%) think genomics will soon impact their practice, with a significant preference for models that involved genetics services (p<0.0001). Currently, respondents mainly perform tasks associated with pretest family history taking and counselling, but more respondents expect to perform tasks at all stages of testing in the future, including tasks related to the test itself, and reporting results. While one-third (34%) recently completed education in genomics, only a quarter (25%) felt prepared to practise. Specialists would like (more) education, particularly on genomic technologies and clinical utility, and prefer this to be through varied educational strategies. CONCLUSIONS This survey provides data from a breadth of physician specialties that can inform models of genetic service delivery and genomics education. The findings support education providers designing and delivering education that best meet learner needs to build a competent, genomic-literate workforce. Further analyses are underway to characterise early adopters of genomic medicine to inform strategies to increase engagement.
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Affiliation(s)
- Amy Nisselle
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Emily A King
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Belinda McClaren
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Monika Janinski
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sylvia Metcalfe
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Clara Gaff
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
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Cléophat JE, Dorval M, El Haffaf Z, Chiquette J, Collins S, Malo B, Fradet V, Joly Y, Nabi H. Whether, when, how, and how much? General public's and cancer patients' views about the disclosure of genomic secondary findings. BMC Med Genomics 2021; 14:167. [PMID: 34174888 PMCID: PMC8236159 DOI: 10.1186/s12920-021-01016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data on the modalities of disclosing genomic secondary findings (SFs) remain scarce. We explore cancer patients' and the general public's perspectives about disclosing genomic SFs and the modalities of such disclosure. METHODS Sixty-one cancer patients (n = 29) and members of the public (n = 32) participated in eight focus groups in Montreal and Quebec City, Canada. They were asked to provide their perspectives of five fictitious vignettes related to medically actionable and non-actionable SFs. Two researchers used a codification framework to conduct a thematic content analysis of the group discussion transcripts. RESULTS Cancer patients and members of the public were open to receive genomic SFs, considering their potential clinical and personal utility. They believed that the right to know or not and share or not such findings should remain the patient's decision. They thought that the disclosure of SFs should be made mainly in person by the prescribing clinician. Maintaining confidentiality when so requested and preventing genetic discrimination were considered essential. CONCLUSION Participants in this study welcomed the prospect of disclosing genomic SFs, as long as the right to choose to know or not to know is preserved. They called for the development of policies and practice guidelines that aim to protect genetic information confidentiality as well as the autonomy, physical and psychosocial wellbeing of patients and families.
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Affiliation(s)
- Jude Emmanuel Cléophat
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Laval University Cancer Research Center, Quebec City, QC, Canada
- Research Center of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada
| | - Zaki El Haffaf
- Division of Genetics, Department of Medicine, Hospital Center of the University of Montreal, Montreal, QC, Canada
- Oncology Division, Research Center of the Hospital Center of the University of Montreal, Montreal, QC, Canada
| | - Jocelyne Chiquette
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Benjamin Malo
- Infectious and Immune Diseases Division, Research center of the Quebec City University Hospital, Quebec City, QC, Canada
| | - Vincent Fradet
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Laval University Cancer Research Center, Quebec City, QC, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Yann Joly
- Center of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Hermann Nabi
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.
- Laval University Cancer Research Center, Quebec City, QC, Canada.
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
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The impact of needs-based education on the change of knowledge and attitudes towards medical genetics in medical students. Eur J Hum Genet 2021; 29:726-735. [PMID: 33398082 PMCID: PMC8110770 DOI: 10.1038/s41431-020-00791-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 01/29/2023] Open
Abstract
In this research we aimed to (1) develop and validate a new questionnaire examining attitudes and knowledge towards medical genetics, (2) examine the knowledge and attitudes towards medical genetics in students of the Medical Faculty in Rijeka, Croatia and (3) evaluate the impact of education from the mandatory course Medical Genetics on the change of knowledge and attitudes. The study was conducted on 191 fifth- and sixth-year students of the Integrated Undergraduate and Graduate University Study of Medicine in the academic year 2019/2020. Students completed the validated online questionnaire anonymously and voluntarily. Fifth-year students completed the questionnaire twice (beginning/end of the course), while sixth-year students completed the questionnaire once, 3 months after completing the course. The education was carefully designed for medical students according to the CoreCompetences in Genetics for Health Professionals in Europe issued by the European Society of Human Genetics. Using the Kruskal-Wallis test, a statistically significant difference was found between fifth year before and after education and between the fifth year before education and sixth year for (a) total knowledge (P < 0.001), (b) total attitudes (P < 0.001) and (c) personal assessment of knowledge in medical genetics (P < 0.001). Moreover, positive attitudes were associated with higher levels of knowledge. In conclusion, our results emphasise the importance of needs-based education in medical genetics for medical students, which is indispensable for the increase in the level of knowledge and development of positive attitudes in order to provide better health care for patients with genetic disorders.
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Roberts MC, Spees LP, Freedman AN, Klein WMP, Prabhu Das I, Butler EN, de Moor JS. Oncologist-Reported Reasons for Not Ordering Multimarker Tumor Panels: Results From a Nationally Representative Survey. JCO Precis Oncol 2021; 5:PO.20.00431. [PMID: 34250411 PMCID: PMC8232803 DOI: 10.1200/po.20.00431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
This study examines oncologist-reported reasons for not using multimarker tumor panel testing and the association between these reasons and oncologist-level, facility-level, and patient-mix characteristics. METHODS We used data collected from a nationally representative sample (N = 1,281) of medical oncologists participating in the National Cancer Institute's National Survey of Precision Medicine in Cancer Treatment. RESULTS In addition to testing not being seen as relevant (87%) and no evidence of test utility (77%), the most frequently reported reasons for not ordering a multimarker tumor panel test was difficulty in obtaining sufficient tissue (57%) and using individual gene tests (72%). These reasons were more likely to be reported by oncologists practicing in rural clinics and less likely to be reported by oncologists with an academic affiliation or with access to genetic services such as on-site genetic counselors and internal genetic testing policies. CONCLUSION Modifiable, organizational factors were associated with ordering multimarker tumor panels. Receipt of genomics training and organizational policies related to the use of genomics were associated with lower reporting of barriers to ordering multimarker tumor panels, pointing to potential targets for future studies aimed at increasing appropriate multimarker tumor panel testing in cancer treatment management.
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Affiliation(s)
- Megan C. Roberts
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa P. Spees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew N. Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - William M. P. Klein
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Irene Prabhu Das
- Office of the Director, National Institutes of Health, Bethesda, MD
| | - Eboneé N. Butler
- Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, MD
| | - Janet S. de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Ensuring best practice in genomics education and evaluation: reporting item standards for education and its evaluation in genomics (RISE2 Genomics). Genet Med 2021; 23:1356-1365. [PMID: 33824503 DOI: 10.1038/s41436-021-01140-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Widespread, quality genomics education for health professionals is required to create a competent genomic workforce. A lack of standards for reporting genomics education and evaluation limits the evidence base for replication and comparison. We therefore undertook a consensus process to develop a recommended minimum set of information to support consistent reporting of design, development, delivery, and evaluation of genomics education interventions. METHODS Draft standards were derived from literature (25 items from 21 publications). Thirty-six international experts were purposively recruited for three rounds of a modified Delphi process to reach consensus on relevance, clarity, comprehensiveness, utility, and design. RESULTS The final standards include 18 items relating to development and delivery of genomics education interventions, 12 relating to evaluation, and 1 on stakeholder engagement. CONCLUSION These Reporting Item Standards for Education and its Evaluation in Genomics (RISE2 Genomics) are intended to be widely applicable across settings and health professions. Their use by those involved in reporting genomics education interventions and evaluation, as well as adoption by journals and policy makers as the expected standard, will support greater transparency, consistency, and comprehensiveness of reporting. Consequently, the genomics education evidence base will be more robust, enabling high-quality education and evaluation across diverse settings.
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Martyn M, McClaren B, Janinski M, Lynch E, Cunningham F, Gaff C. "It's something I've committed to longer term": The impact of an immersion program for physicians on adoption of genomic medicine. PATIENT EDUCATION AND COUNSELING 2021; 104:480-488. [PMID: 33268232 DOI: 10.1016/j.pec.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To foster implementation of genomic testing in medical care by providing a cadre of physicians with 'hands on' experience in genomics, positioning them as opinion leaders in their medical speciality. This paper presents qualitative evaluation of immediate outcomes, in particular its impact on peer interactions. METHODS Program design and delivery was informed by implementation science, behavior change and experiential learning theories. Inductive content analysis of transcribed audio-recordings from semi-structured post-project interviews with all participants (n = 12) was conducted. RESULTS Participants reported the immersion experience improved their genomic capability, established them as credible genomic experts within their speciality and altered their practice in genomic medicine. Participants reported strengthening and widening of peer-to-peer and interdisciplinary communication, with both passive diffusion and active dissemination of information to peers. Some also became a resource for genetic professionals. CONCLUSIONS Genomic immersion participants described elements which support sustained integration of an innovation, including immediate changes (e.g. use of genomic tests) and wider impacts (e.g. professional networks). PRACTICE IMPLICATIONS This study supports a role for immersion as a successful strategy for enhancing engagement of non-geneticist physicians in genomics. Additional study is needed to understand how immersion experiences change the delivery of genomic services at the provider, practice and health system level.
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Affiliation(s)
- Melissa Martyn
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne Genomics Health Alliance, c/o Walter and Eliza Hall Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Belinda McClaren
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Monika Janinski
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne Genomics Health Alliance, c/o Walter and Eliza Hall Institute, Parkville, Australia
| | - Elly Lynch
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne Genomics Health Alliance, c/o Walter and Eliza Hall Institute, Parkville, Australia; Victorian Clinical Genetics Services, The Royal Children's Hospital, Parkville, Australia
| | - Fiona Cunningham
- Melbourne Genomics Health Alliance, c/o Walter and Eliza Hall Institute, Parkville, Australia; Monash Genetics, Monash Health, Clayton, Australia
| | - Clara Gaff
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne Genomics Health Alliance, c/o Walter and Eliza Hall Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
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Family Health History-Based Cancer Prevention Training for Community Health Workers. Am J Prev Med 2021; 60:e159-e167. [PMID: 33358550 DOI: 10.1016/j.amepre.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022]
Abstract
Cancer is the second leading cause of death in the U.S. Utilizing family health history in cancer prevention holds promise in lessening the burden of cancer. Nevertheless, family health history is underutilized in public health and preventive medicine. Community health workers, also known as lay health educators, are ideal candidates to offer basic cancer family history-based education and services to the general public. The authors developed the first cancer family history-based genomics training program in cancer prevention tailored for community health workers. This paper details the development and pilot testing findings of the training. Specifically, a multidisciplinary research team of geneticists, genetic counselors, health educators, community health workers, and community health worker instructors developed a 7-module, 6-hour, bilingual (English and Spanish) cancer family history-based training focusing on cancer family history-based risk assessment, lifestyle recommendations, and genetic evaluation and testing. The curriculum was based on an integrated theoretical framework, the National Comprehensive Cancer Network guidelines, the community health worker core competencies, and the 4MAT instructional model. The Texas Department of State Health Services approved and certified the curriculum with 2 delivery formats: in-person/face-to-face workshops and online training. A total of 34 community health workers completed the pilot training in person (n=17) and online (n=17) in 2018 and 2019. Participating community health workers' knowledge, attitudes, self-efficacy, and intention in delivering basic cancer family history-based genomics education and services significantly increased on the immediate post-test measures compared with their pretest data. Positive ratings and feedback were also reported by the community health workers. Findings from this pilot study suggest that wider training is warranted for educating more community health workers in the U.S.
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Skinner SJ, Clay AT, McCarron MCE, Liskowich S. Interpretation and management of genetic test results by Canadian family physicians: a multiple choice survey of performance. J Community Genet 2021; 12:479-484. [PMID: 33619689 DOI: 10.1007/s12687-021-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 10/22/2022] Open
Abstract
Family physicians (FPs) will encounter genetic concerns within community practice. To determine how FPs compare to genetic counselors (GCs), a cross-sectional survey was distributed to Canadian FPs and GCs in 2019. The survey assessed risk analysis, counseling, and management of genetic information. FPs performed less well than GCs on each survey question and scenario (p < 0.05). Average overall survey scores for FPs were lower than GCs (62% vs. 93%, p < 0.001). Additional genetic training for FPs may help avoid potential harm.
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Affiliation(s)
- Stephanie J Skinner
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Suite 172, 1621 Albert Street, Regina, Saskatchewan, S4P 2S5, Canada
| | - Adam T Clay
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Suite 172, 1621 Albert Street, Regina, Saskatchewan, S4P 2S5, Canada
| | - Michelle C E McCarron
- Research Department, Saskatchewan Health Authority, 2180 - 23 Ave, Regina, Saskatchewan, S4S 0A5, Canada
| | - Sarah Liskowich
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Suite 172, 1621 Albert Street, Regina, Saskatchewan, S4P 2S5, Canada.
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Chen LS, Zhao S, Yeh YL, Eble TN, Dhar SU, Kwok OM. Texas health educators' practice in basic genomics education and services. Per Med 2020; 18:55-66. [PMID: 33332182 DOI: 10.2217/pme-2020-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Health educators (HEs), who are specialized in health education, can provide basic genomics education/services to the public. Such practice of HEs is unknown. We examined HEs' genomics knowledge and practice, intention, attitudes, self-efficacy and perceived barriers in providing basic genomics education/services. Materials & methods: Texas HEs (n = 662) were invited to complete the survey that was developed based on theoretical constructs (i.e., practice/behavior, intention, attitudes, self-efficacy, knowledge and perceived barriers) from various health behavior theories. Results: Among 182 HEs completed the survey, most had never/seldom provided basic genomics education/services. Participants' practice was positively associated with their intention in performing basic genomics education/services and previous genomics training. Intention to offer such education/services was positively related to HEs' self-efficacy and attitudes, which were correlated to previous genomics training. Conclusion: Texas HEs lacked basic genomics education/services practice. As previous genomics training was associated with HEs' practice, providing continuing education may enhance their practice.
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Affiliation(s)
- Lei-Shih Chen
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas
| | - Shixi Zhao
- Department of Health, Exercise & Sports Sciences, University of New Mexico, Albuquerque, New Mexico
| | - Yu-Lyu Yeh
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas
| | - Tanya N Eble
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Shweta U Dhar
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Oi-Man Kwok
- Department of Educational Psychology, Texas A&M University, College Station, Texas
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Genomics in nursing education. J Am Assoc Nurse Pract 2020; 32:785-787. [PMID: 33284197 DOI: 10.1097/jxx.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genetics/Genomics is a relatively new science. The basic principles were formally described at the end of the 19th century, the physical structure of genes were described in the middle of the 20th century, and the first gene located in the early 1990s. Later, the human genome was sequenced. More and more genes have been located and described and some are now being manipulated. All health professions are struggling to infuse genomic content into the curriculum. This article traces the roots of the undergraduate and graduate nursing competencies and provides a brief review of the literature describing nursing genetic/genomics education.
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Demeshko A, Pennisi DJ, Narayan S, Gray SW, Brown MA, McInerney-Leo AM. Factors influencing cancer genetic somatic mutation test ordering by cancer physician. J Transl Med 2020; 18:431. [PMID: 33183308 PMCID: PMC7663861 DOI: 10.1186/s12967-020-02610-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/05/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clinical whole exome sequencing was introduced in an Australian centre in 2017, as an alternative to Sanger sequencing. We aimed to identify predictors of cancer physicians' somatic mutation test ordering behaviour. METHODS A validated instrument assessed somatic mutation test ordering, genomic confidence, perceived utility of tumour molecular profiling, and percent of patients eligible for targeted therapy. A cash incentive was included in 189/244 questionnaires which were mailed to all Queensland cancer specialists in November 2018. RESULTS 110 participated (response rate 45%); 54.7% oncologists, and the remainder were surgeons, haematologists and pulmonologists. Oncologists were more likely to respond (p = 0.008), and cash incentive improved the response rate (p < 0.001). 67/102 (65.7%) of physicians ordered ≥ 5 somatic mutation tests annually. Oncologists saw 86.75 unique patients monthly and ordered 2.33 somatic mutation tests (2.2%). An average of 51/110 (46.1%) reported having little/no genomic confidence. Logistic regression identified two significant predictors of somatic mutation test ordering: being an oncologist (OR 3.557, CI 1.338-9.456; p = 0.011) and having greater confidence in interpreting somatic results (OR 5.926, CI 2.230-15.74; p < 0.0001). CONCLUSIONS Consistent with previous studies, the majority of cancer physicians ordered somatic mutation tests. However, the percentage of patients on whom tests were ordered was low. Almost half respondents reported low genomic confidence. Somatic mutation test ordering was higher amongst oncologists and those with increased confidence in interpreting somatic variants. It is unclear whether genomically confident individuals ordered more tests or whether ordering more tests increased genomic confidence. Educational interventions could improve confidence and enhance test ordering behaviour.
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Affiliation(s)
- Anastassia Demeshko
- The Dermatology Research Group, University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia
| | - David J Pennisi
- Translational Genomics Group, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia
| | - Sushil Narayan
- Translational Genomics Group, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia
| | - Stacy W Gray
- Department of Population Science, City of Hope, Duarte, CA, USA.,Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Matthew A Brown
- Guy's and St Thomas' NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, UK
| | - Aideen M McInerney-Leo
- The Dermatology Research Group, University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102, Australia.
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Kurnat-Thoma E. Educational and Ethical Considerations for Genetic Test Implementation Within Health Care Systems. NETWORK AND SYSTEMS MEDICINE 2020; 3:58-66. [PMID: 32676590 PMCID: PMC7357722 DOI: 10.1089/nsm.2019.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: The precision medicine (PM) era presents unprecedented proliferation of genetic/genomic initiatives, information, and bioinformatic tools to enhance targeted molecular diagnosis and therapeutic treatments. As of February 29, 2020, the National Institutes of Health (NIH) National Center for Biotechnology Information (NCBI) Genetic Testing Registry contained 64,860 genetic tests for 12,268 conditions and 18,686 genes from 560 laboratories, and the Food and Drug Administration had 404 entries for pharmacogeneomic biomarkers used in drug labeling. Population-based research initiatives including NIH's All of Us and Veterans Affairs' Million Veteran Program, and the UK Biobank, combine use of genomic biorepositories with electronic medical records (i.e., National Human Genome Research Institute's [NHGRI's] electronic Medical Records and Genomics [eMERGE] Network). Learning health care systems are implementing clinical genomics screening programs and precision oncology programs. However, there are insufficient medical geneticists, nurse geneticists, and genetics counselors to implement expanding number of clinical genetic tests that are required for PM implementation. Methods: A scoping review of current (2014-2019) trends in U.S. genomic medicine translation, PM health care provider workforce education and training resources, and genomic clinical decision support (CDS) implementation tools was conducted. Results: Health care delivery institutions and systems are beginning to implement genetic tests that are driving PM, particularly in the areas of oncology, pharmacogenetics, obstetrics, and prenatal diagnostics. To ensure safe adoption and clinical translation of PM, health care systems have an ethical responsibility to ensure their providers and front-line staff are adequately prepared to order, use, and interpret genetic test information. Conclusion: There are a number of high-quality evidenced-based educational resources and CDS tools available. Strong partnerships between health care system leaders, front-line providers and staff coupled with reasonable goal setting can help drive PM translation interests.
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Affiliation(s)
- Emma Kurnat-Thoma
- Department of Intramural Research, DHHS/NIH/NINR, Bethesda, Maryland, USA
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
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Points to consider for reporting of germline variation in patients undergoing tumor testing: a statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2020; 22:1142-1148. [PMID: 32321997 DOI: 10.1038/s41436-020-0783-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 02/08/2023] Open
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