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Pearce A, Mitchell LA, Best S, Young MA, Terrill B. Publics' knowledge of, attitude to and motivation towards health-related genomics: a scoping review. Eur J Hum Genet 2024; 32:747-758. [PMID: 38316954 PMCID: PMC11220043 DOI: 10.1038/s41431-024-01547-5] [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: 07/27/2023] [Revised: 11/12/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
The use of genomic data in research and genomic information in clinical care is increasing as technologies advance and sequencing costs decrease. Using Rogers' Diffusion of Innovation (DOI) theory as a framework we reviewed recent literature examining publics' current knowledge of, attitude to, and motivation towards health-related genomics in clinical and research settings. The population of interest was described as 'publics' to denote the heterogeneity of 'the public'. Eligible studies were published in English between 2016-2022. We retrieved 1657 records, with 278 full-text reviewed against the eligibility criteria and concept definitions. In total, 99 articles were included in the review and descriptive numerical summaries were collated. Knowledge literature was categorized using deductive thematic analysis. For attitude and motivation, literature was coded using an analytic framework developed by the authors. There was wide variability in concept definition and measurement across studies. Overall, there was general positivity about genomics, with high awareness but little familiarity or factual knowledge. Publics had high expectations of genomics and perceived that it could provide them with information for their future. Only a few key attitudes were found to be important as motivators or barriers for participation in genomics; these were related to personal and clinical utility of the information. Context was often missing from studies, decreasing the utility of findings for implementation or public engagement. Future research would benefit by using theory-driven approaches to assess relevant publics' knowledge and attitudes of specific contexts or applications to support genomic implementation and informed decision-making.
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Affiliation(s)
- Angela Pearce
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia.
| | - Lucas A Mitchell
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
| | - Mary-Anne Young
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
| | - Bronwyn Terrill
- Clinical Translation & Engagement, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, NSW, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
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2
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Abitbol A, Lee NM, VanDyke MS, Meneses C, Wallace K. The Role of Human Voice in Direct-To-Consumer Health Communication. HEALTH COMMUNICATION 2024:1-7. [PMID: 38591185 DOI: 10.1080/10410236.2024.2338669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Despite overall positive perceptions, many customers distrust direct-to-consumer genetic testing companies in regard to privacy and aftercare. Prior research suggests companies can assuage mistrust by personalizing communication when discussing sensitive health information. This content analysis of customer e-mails (N = 338) investigates the purpose, personalization, and use of the human voice strategy by direct-to-consumer genetic testing companies to gain trust. Results reveal that companies rarely use human voice when communicating with customers, most of the information provided is promotional, and they invite dialogue less over time. Theoretical and practical implications are provided.
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Affiliation(s)
- Alan Abitbol
- Department of Communication, University of Dayton
| | - Nicole M Lee
- School of Social and Behavioral Sciences, Arizona State University
| | - Matthew S VanDyke
- Department of Advertising & Public Relations, The University of Alabama
| | | | - Kaylynne Wallace
- School of Social and Behavioral Sciences, Arizona State University
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3
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Horton R, Boyle L, Weller S, Lucassen A. Glowing gels and pipettes aplenty: how do commercial stock image banks portray genetic tests? Eur J Hum Genet 2024; 32:456-460. [PMID: 38066171 PMCID: PMC10999410 DOI: 10.1038/s41431-023-01508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024] Open
Abstract
News stories and patient-facing material about genetic tests are often illustrated by images, but the content of such images and the messages they propagate are rarely scrutinised. Stock image banks were searched to identify a hundred images relating to genetic tests and analysed using a multimodal critical discourse approach, aiming to identify what the images featured, how they were composed, and what they communicated about genetic testing. We found that images tended to focus on technical aspects of sample processing (for example, pipetting) and drew on older technologies (for example slab gel electrophoresis) when representing data arising from genetic tests. Composition choices like focussing images around pipette tips, or emphasising colour or brightness of electrophoretic bands, represented genetic testing as precise, unambiguous and illuminating. Only 7% of images featured a person having a genetic test, and only one image alluded to communication of genetic results. Current popular visual representations of genetic testing rarely highlight the possibility of uncertain or non-diagnostic outcomes, and may contribute to high public expectations of informativeness and certainty from such tests.
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Affiliation(s)
- Rachel Horton
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Leah Boyle
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Susie Weller
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK
| | - Anneke Lucassen
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK.
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK.
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Nabi RL, Dobmeier CM, Robbins CL, Pérez Torres D, Walter N. Effects of Scanning Health News Headlines on Trust in Science: An Emotional Framing Perspective. HEALTH COMMUNICATION 2024:1-13. [PMID: 38453692 DOI: 10.1080/10410236.2024.2321404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Rooted in the emotions-as-frames model (EFM), this research examines how hope, fear, and annoyance are evoked through health news headline scanning, and how these emotions influence perceptions of news and medical science institutions as well as health behavioral intentions. A sample of U.S. adults (N = 327) were assigned to one of four headline framing conditions expected to associate with different emotions (positive future frame-hope; threat frame-fear/anxiety; reversal frame-annoyance; and control-neutral) and then asked about their emotional states, trust in science and news, and health-related behavioral intentions. Overall, health news headlines generated more hope than any other emotion across all conditions, and positive future-framed headlines evoked more hope than other framed headlines. Felt hope, in turn, generated greater trust in news and science, higher expectations of medical breakthroughs and cures, and greater intention to engage in preventative health behaviors. Felt anxiety had marginal positive benefits whereas felt annoyance negatively impacted the outcomes of interest. Notably, felt emotion mediated the headline frame-outcome relationships in the positive future/hope condition. These findings offer some support for the EFM and demonstrate that scanning headlines imbued with specific emotional frames can influence important health-related outcomes through the emotions they evoke. We discuss both the theoretical and practical implication of these findings.
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Affiliation(s)
- Robin L Nabi
- Department of Communication, University of California Santa Barbara
| | | | - Chris L Robbins
- Department of Medical Social Sciences, Northwestern University
| | | | - Nathan Walter
- Department of Communication Studies, Northwestern University
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5
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Batheja S, Schopp EM, Pappas S, Ravuri S, Persky S. Characterizing Precision Nutrition Discourse on Twitter: Quantitative Content Analysis. J Med Internet Res 2023; 25:e43701. [PMID: 37824190 PMCID: PMC10603558 DOI: 10.2196/43701] [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: 10/20/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND It is possible that tailoring dietary approaches to an individual's genomic profile could provide optimal dietary inputs for biological functioning and support adherence to dietary management protocols. The science required for such nutrigenetic and nutrigenomic profiling is not yet considered ready for broad application by the scientific and medical communities; however, many personalized nutrition products are available in the marketplace, creating the potential for hype and misleading information on social media. Twitter provides a unique big data source that provides real-time information. Therefore, it has the potential to disseminate evidence-based health information, as well as misinformation. OBJECTIVE We sought to characterize the landscape of precision nutrition content on Twitter, with a specific focus on nutrigenetics and nutrigenomics. We focused on tweet authors, types of content, and presence of misinformation. METHODS Twitter Archiver was used to capture tweets from September 1, 2020, to December 1, 2020, using keywords related to nutrition and genetics. A random sample of tweets was coded using quantitative content analysis by 4 trained coders. Codebook-driven, quantified information about tweet authors, content details, information quality, and engagement metrics were compiled and analyzed. RESULTS The most common categories of tweets were precision nutrition products and nutrigenomic concepts. About a quarter (132/504, 26.2%) of tweet authors presented themselves as science experts, medicine experts, or both. Nutrigenetics concepts most frequently came from authors with science and medicine expertise, and tweets about the influence of genes on weight were more likely to come from authors with neither type of expertise. A total of 14.9% (75/504) of the tweets were noted to contain untrue information; these were most likely to occur in the nutrigenomics concepts topic category. CONCLUSIONS By evaluating social media discourse on precision nutrition on Twitter, we made several observations about the content available in the information environment through which individuals can learn about related concepts and products. Tweet content was consistent with the indicators of medical hype, and the inclusion of potentially misleading and untrue information was common. We identified a contingent of users with scientific and medical expertise who were active in discussing nutrigenomics concepts and products and who may be encouraged to share credible expert advice on precision nutrition and tackle false information as this technology develops.
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Affiliation(s)
- Sapna Batheja
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States
| | - Emma M Schopp
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Samantha Pappas
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States
| | - Siri Ravuri
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
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Meitern M, Hansson S. Persuasive Appeals in Genetic Biobank Recruitment Campaigns: Social and Ethical Implications. J Empir Res Hum Res Ethics 2023; 18:284-295. [PMID: 37337739 PMCID: PMC10496419 DOI: 10.1177/15562646231181028] [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: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 06/21/2023]
Abstract
The social and ethical implications of large-scale biobank donor recruitment campaigns have remained understudied. We use two recent campaigns of the population-based genetic biobank in Estonia as an example to demonstrate how campaign spokespersons try to persuade potential donors by appealing to (1) gaining self-knowledge, (2) gaining control over one's health, (3) fear of illness, (4) contributing to healthcare, (5) contributing to science, and (6) contributing to one's country. While these campaigns succeeded in recruiting 15 percent of the country's adult population as donors, we explain how the use of some of these appeals may (a) create unrealistic expectations regarding the benefits donors could receive and (b) conceal the risks regarding health data. The study lays a necessary groundwork for future empirical research on the ethics of biobank recruitment campaigns.
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Baird A, Westphalen C, Blum S, Nafria B, Knott T, Sargeant I, Harnik H, Brooke N, Wicki N, Wong‐Rieger D. How can we deliver on the promise of precision medicine in oncology and beyond? A practical roadmap for action. Health Sci Rep 2023; 6:e1349. [PMID: 37359405 PMCID: PMC10286856 DOI: 10.1002/hsr2.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Background Precision medicine (PM) is a form of personalized medicine that recognizes that individuals with the same condition may have different underlying factors and uses molecular information to provide tailored treatments. This approach can improve treatment outcomes and transform lives through favorable risk/benefit ratios, avoidance of ineffective interventions, and possible cost savings, as evidenced in the field of lung cancer and other oncology/therapeutic settings, including cardiac disease, diabetes, and rare diseases. However, the potential benefits of PM have yet to be fully realized. Discussion There are many barriers to the implementation of PM in clinical practice, including fragmentation of the PM landscape, siloed approaches to address shared challenges, unwarranted variation in availability and access to PM, lack of standardization, and limited understanding of patients' experience and needs throughout the PM pathway. We believe that a diverse, intersectoral multistakeholder collaboration, with three main pillars of activity: generation of data to demonstrate the benefit of PM, education to support informed decision-making, and addressing barriers across the patient pathway, is necessary to reach the shared goal of making PM an accessible and sustainable reality. Besides healthcare providers, researchers, policymakers/regulators/payers, and industry representatives, patients in particular must be equal partners and should be central to the PM approach-from early research through to clinical trials and approval of new treatments-to ensure it represents their entire experience and identifies barriers, solutions, and opportunities at the point of delivery. Conclusion We propose a practical and iterative roadmap to advance PM and call for all stakeholders across the healthcare system to employ a collaborative, cocreated, patient-centered methodology to close gaps and fully realize the potential of PM.
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Affiliation(s)
- Anne‐Marie Baird
- Lung Cancer Europe (LuCE)BernSwitzerland
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
| | - C. Benedikt Westphalen
- Comprehensive Cancer Center Munich and Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
| | - Sandra Blum
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- RocheBaselSwitzerland
| | - Begonya Nafria
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- Institut de Recerca Sant Joan de DéuBarcelonaSpain
- Innovation and Research Department, Hospital Sant Joan de Déu PgBarcelonaSpain
| | - Tanya Knott
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- Sarah Jennifer Knott (SJK) FoundationDublinRepublic of Ireland
| | | | - Helena Harnik
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- The SynergistBrusselsBelgium
| | - Nicholas Brooke
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- The SynergistBrusselsBelgium
| | - Nicole Wicki
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- The SynergistBrusselsBelgium
| | - Durhane Wong‐Rieger
- From Testing to Targeted Treatments (FT3) Program Team, The SynergistBrusselsBelgium
- Canadian Organization for Rare DisordersTorontoOntarioCanada
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8
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Ratcliff CL, Wicke R. How the public evaluates media representations of uncertain science: An integrated explanatory framework. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2023; 32:410-427. [PMID: 36196654 DOI: 10.1177/09636625221122960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Understanding how to portray uncertain science to the public is a pressing goal for science communication. This study compared US public audience reactions to a news article depicting a novel discovery in neurogenomics as certain or uncertain, with statements of (un)certainty attributed to either affiliated or unaffiliated scientists. The uncertainty disclosure had no main effect on perceived news article credibility, scientist trustworthiness, objectivity of the scientists' depiction, or willingness to participate in genomic research. However, news credibility and scientist objectivity ratings were higher for uncertainty disclosure attributed to the affiliated scientists. Participants with greater preference for information about uncertainty found the scientists more trustworthy, their depictions more balanced, and the news article more credible when the research was described as uncertain, and these effects were stronger for affiliated scientist attribution. Findings underscore the important roles of disclosure source and audience characteristics in public reactions to media representations of scientific uncertainty.
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Ayoub A, Lapointe J, Nabi H, Pashayan N. Risk-Stratified Breast Cancer Screening Incorporating a Polygenic Risk Score: A Survey of UK General Practitioners’ Knowledge and Attitudes. Genes (Basel) 2023; 14:genes14030732. [PMID: 36981003 PMCID: PMC10048009 DOI: 10.3390/genes14030732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
A polygenic risk score (PRS) quantifies the aggregated effects of common genetic variants in an individual. A ‘personalised breast cancer risk assessment’ combines PRS with other genetic and nongenetic risk factors to offer risk-stratified screening and interventions. Large-scale studies are evaluating the clinical utility and feasibility of implementing risk-stratified screening; however, General Practitioners’ (GPs) views remain largely unknown. This study aimed to explore GPs’: (i) knowledge of risk-stratified screening; (ii) attitudes towards risk-stratified screening; and (iii) preferences for continuing professional development. A cross-sectional online survey of UK GPs was conducted between July–August 2022. The survey was distributed by the Royal College of General Practitioners and via other mailing lists and social media. In total, 109 GPs completed the survey; 49% were not familiar with the concept of PRS. Regarding risk-stratified screening pathways, 75% agreed with earlier and more frequent screening for women at high risk, 43% neither agreed nor disagreed with later and less screening for women at lower-than-average risk, and 55% disagreed with completely removing screening for women at much lower risk. In total, 81% felt positive about the potential impact of risk-stratified screening towards patients and 62% felt positive about the potential impact on their practice. GPs selected training of healthcare professionals as the priority for future risk-stratified screening implementation, preferring online formats for learning. The results suggest limited knowledge of PRS and risk-stratified screening amongst GPs. Training—preferably using online learning formats—was identified as the top priority for future implementation. GPs felt positive about the potential impact of risk-stratified screening; however, there was hesitance and disagreement towards a low-risk screening pathway.
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Affiliation(s)
- Aya Ayoub
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
- Correspondence:
| | - Julie Lapointe
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC G1R 3S3, Canada
| | - Hermann Nabi
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC G1R 3S3, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Nora Pashayan
- Department of Applied Health Research, University College London (UCL), London WC1E 7HB, UK
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Lapointe J, Buron AC, Mbuya-Bienge C, Dorval M, Pashayan N, Brooks JD, Walker MJ, Chiquette J, Eloy L, Blackmore K, Turgeon A, Lambert-Côté L, Leclerc L, Dalpé G, Joly Y, Knoppers BM, Chiarelli AM, Simard J, Nabi H. Polygenic risk scores and risk-stratified breast cancer screening: Familiarity and perspectives of health care professionals. Genet Med 2022; 24:2380-2388. [PMID: 36057905 DOI: 10.1016/j.gim.2022.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Health care professionals are expected to take on an active role in the implementation of risk-based cancer prevention strategies. This study aimed to explore health care professionals' (1) self-reported familiarity with the concept of polygenic risk score (PRS), (2) perceived level of knowledge regarding risk-stratified breast cancer (BC) screening, and (3) preferences for continuing professional development. METHODS A cross-sectional survey was conducted using a bilingual-English/French-online questionnaire disseminated by health care professional associations across Canada between November 2020 and May 2021. RESULTS A total of 593 professionals completed more than 2 items and 453 responded to all questions. A total of 432 (94%) participants were female, 103 (22%) were physicians, and 323 (70%) were nurses. Participants reported to be unfamiliar with (20%), very unfamiliar (32%) with, or did not know (41%) the concept of PRS. Most participants reported not having enough knowledge about risk-stratified BC screening (61%) and that they would require more training (77%). Online courses and webinar conferences were the preferred continuing professional development modalities. CONCLUSION The study indicates that health care professionals are currently not familiar with the concept of PRS or a risk-stratified approach for BC screening. Online information and training seem to be an essential knowledge transfer modality.
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Affiliation(s)
- Julie Lapointe
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Anne-Catherine Buron
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Cynthia Mbuya-Bienge
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Michel Dorval
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada; CISSS de Chaudière-Appalaches Research Center, Lévis, Québec, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, United Kingdom
| | - Jennifer D Brooks
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, Ontario, Canada
| | - Meghan J Walker
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, Ontario, Canada; Cancer Care Ontario, Ontario Health, Toronto, Ontario, Canada
| | - Jocelyne Chiquette
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada; CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Laurence Eloy
- Programme Québécois de Cancérologie, Ministère de la Santé et des Services Sociaux, Québec City, Québec, Canada
| | | | - Annie Turgeon
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Laurence Lambert-Côté
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Lucas Leclerc
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montréal, Québec, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montréal, Québec, Canada; Human Genetics Department and Bioethics Unit, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Anna Maria Chiarelli
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, Ontario, Canada; Cancer Care Ontario, Ontario Health, Toronto, Ontario, Canada
| | - Jacques Simard
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada; Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Hermann Nabi
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
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Targeted RNAseq Improves Clinical Diagnosis of Very Early-Onset Pediatric Immune Dysregulation. J Pers Med 2022; 12:jpm12060919. [PMID: 35743704 PMCID: PMC9224647 DOI: 10.3390/jpm12060919] [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: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023] Open
Abstract
Despite increased use of whole exome sequencing (WES) for the clinical analysis of rare disease, overall diagnostic yield for most disorders hovers around 30%. Previous studies of mRNA have succeeded in increasing diagnoses for clearly defined disorders of monogenic inheritance. We asked if targeted RNA sequencing could provide similar benefits for primary immunodeficiencies (PIDs) and very early-onset inflammatory bowel disease (VEOIBD), both of which are difficult to diagnose due to high heterogeneity and variable severity. We performed targeted RNA sequencing of a panel of 260 immune-related genes for a cohort of 13 patients (seven suspected PID cases and six VEOIBD) and analyzed variants, splicing, and exon usage. Exonic variants were identified in seven cases, some of which had been previously prioritized by exome sequencing. For four cases, allele specific expression or lack thereof provided additional insights into possible disease mechanisms. In addition, we identified five instances of aberrant splicing associated with four variants. Three of these variants had been previously classified as benign in ClinVar based on population frequency. Digenic or oligogenic inheritance is suggested for at least two patients. In addition to validating the use of targeted RNA sequencing, our results show that rare disease research will benefit from incorporating contributing genetic factors into the diagnostic approach.
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Kickbusch I, Piselli D, Agrawal A, Balicer R, Banner O, Adelhardt M, Capobianco E, Fabian C, Singh Gill A, Lupton D, Medhora RP, Ndili N, Ryś A, Sambuli N, Settle D, Swaminathan S, Morales JV, Wolpert M, Wyckoff AW, Xue L. The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world. Lancet 2021; 398:1727-1776. [PMID: 34706260 DOI: 10.1016/s0140-6736(21)01824-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Ilona Kickbusch
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Dario Piselli
- Centre for International Environmental Studies, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Anurag Agrawal
- CSIR Institute of Genomics and Integrative Biology, Delhi, India; Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Olivia Banner
- School of Arts, Technology and Emerging Communication, The University of Texas at Dallas, Richardson, TX, USA
| | - Michael Adelhardt
- Competence Centre Health and Social Protection, Deutsche Gesellschaft für Internationale Zusammenarbeit, Bonn, Germany
| | - Emanuele Capobianco
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Amandeep Singh Gill
- International Digital Health & AI Research Collaborative, Geneva, Switzerland
| | - Deborah Lupton
- Centre for Social Research in Health, Social Policy Research Centre, Australian Research Council for Automated Decision-Making and Society, University of New South Wales, Sydney, NSW, Australia
| | | | - Njide Ndili
- PharmAccess Foundation Nigeria, Lagos, Nigeria
| | - Andrzej Ryś
- Health Systems, Medical Products and Innovation, European Commission, Brussels, Belgium
| | | | | | | | | | | | - Andrew W Wyckoff
- Directorate for Science, Technology and Innovation, Organisation for Economic Co-operation and Development, Paris, France
| | - Lan Xue
- The Schwarzman College, Tsinghua University, China
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13
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Hamilton JG, Banerjee SC, Carlsson SV, Vera J, Lynch KA, Sar-Graycar L, Martin CM, Parker PA, Hay JL. Clinician perspectives on communication and implementation challenges in precision oncology. Per Med 2021; 18:559-572. [PMID: 34674550 DOI: 10.2217/pme-2021-0048] [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] [Indexed: 11/21/2022]
Abstract
Aim: To describe patient communication challenges encountered by oncology clinicians, which represent a fundamental barrier to implementing precision oncology. Materials & methods: We conducted three focus groups including breast, melanoma and thoracic oncology clinicians regarding their precision oncology communication experiences. Transcripts were reviewed and coded using inductive thematic text analysis. Results: We identified four themes: varied definitions of precision oncology exist, clinicians and patients face unique challenges to precision oncology implementation, patient communication challenges engendered or heightened by precision oncology implementation and clinician communication solutions and training needs. Conclusion: This study elucidated clinicians' perspectives on implementing precision oncology and related communication challenges. Understanding these challenges and developing strategies to help clinicians navigate these discussions are critical for ensuring that patients reap the full benefits of precision oncology.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Weill Cornell Medical College, New York, NY 10065, USA
| | - Smita C Banerjee
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Weill Cornell Medical College, New York, NY 10065, USA
| | - Sigrid V Carlsson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Jacqueline Vera
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Kathleen A Lynch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Lili Sar-Graycar
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Chloé M Martin
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Patricia A Parker
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Weill Cornell Medical College, New York, NY 10065, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.,Weill Cornell Medical College, New York, NY 10065, USA
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14
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Suraj V, Del Vecchio Fitz C, Kleiman LB, Bhavnani SK, Jani C, Shah S, Mckay R, Warner J, Alterovitz G. SMART COVID Navigator: A Clinical Decision Support for COVID-19. J Med Internet Res 2021; 24:e29279. [PMID: 34932493 PMCID: PMC8862760 DOI: 10.2196/29279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/07/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background COVID-19 caused by SARS-CoV-2 has infected 219 million individuals at the time of writing of this paper. A large volume of research findings from observational studies about disease interactions with COVID-19 is being produced almost daily, making it difficult for physicians to keep track of the latest information on COVID-19’s effect on patients with certain pre-existing conditions. Objective In this paper, we describe the creation of a clinical decision support tool, the SMART COVID Navigator, a web application to assist clinicians in treating patients with COVID-19. Our application allows clinicians to access a patient’s electronic health records and identify disease interactions from a large set of observational research studies that affect the severity and fatality due to COVID-19. Methods The SMART COVID Navigator takes a 2-pronged approach to clinical decision support. The first part is a connection to electronic health record servers, allowing the application to access a patient’s medical conditions. The second is accessing data sets with information from various observational studies to determine the latest research findings about COVID-19 outcomes for patients with certain medical conditions. By connecting these 2 data sources, users can see how a patient’s medical history will affect their COVID-19 outcomes. Results The SMART COVID Navigator aggregates patient health information from multiple Fast Healthcare Interoperability Resources–enabled electronic health record systems. This allows physicians to see a comprehensive view of patient health records. The application accesses 2 data sets of over 1100 research studies to provide information on the fatality and severity of COVID-19 for several pre-existing conditions. We also analyzed the results of the collected studies to determine which medical conditions result in an increased chance of severity and fatality of COVID-19 progression. We found that certain conditions result in a higher likelihood of severity and fatality probabilities. We also analyze various cancer tissues and find that the probabilities for fatality vary greatly depending on the tissue being examined. Conclusions The SMART COVID Navigator allows physicians to predict the fatality and severity of COVID-19 progression given a particular patient’s medical conditions. This can allow physicians to determine how aggressively to treat patients infected with COVID-19 and to prioritize different patients for treatment considering their prior medical conditions.
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Affiliation(s)
| | | | | | - Suresh K Bhavnani
- Preventive Medicine and Population Health Institute for Translational Sciences University of Texas Medical Branch University of Texas Health Science Center in Houston, Houston, US
| | - Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital- Harvard Medical School, Cambridge, US
| | - Surbhi Shah
- Hematology, oncology and bone marrow transplantation Mayo Clinic Arizona, Phoenix, US
| | - Rana Mckay
- University of California San Diego, San Diego, US
| | - Jeremy Warner
- Vanderbilt University, 2525 West End Ave, Suite 1500, Nashville, US
| | - Gil Alterovitz
- Brigham and Women's Hospital/Harvard Medical School, Boston, US
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15
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Pagnaer T, Siermann M, Borry P, Tšuiko O. Polygenic risk scoring of human embryos: a qualitative study of media coverage. BMC Med Ethics 2021; 22:125. [PMID: 34537037 PMCID: PMC8449454 DOI: 10.1186/s12910-021-00694-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current preimplantation genetic testing (PGT) technologies enable embryo genotyping across the whole genome. This has led to the development of polygenic risk scoring of human embryos (PGT-P). Recent implementation of PGT-P, including screening for intelligence, has been extensively covered by media reports, raising major controversy. Considering the increasing demand for assisted reproduction, we evaluated how information about PGT-P is communicated in press media and explored the diversity of ethical themes present in the public debate. METHODS LexisNexis Academic database and Google News were searched to identify articles about polygenic embryo screening. This led to 535 news articles. 59 original articles met the inclusion criteria. Inductive content analysis was used to analyse these articles. RESULTS 8.8% of articles gave embryo polygenic scoring a positive portrayal, while 36.8% expressed a negative attitude. 54.4% were neutral, mostly highlighting limited practical value of the technology in in vitro fertilization settings. We identified five main ethical themes that are also present in academic literature and the broader debate on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice and societal readiness. CONCLUSIONS Implementation of embryo polygenic profiling engenders a need for specific recommendations. Current media analysis discloses important ethical themes to consider when creating future guidelines for PGT-P.
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Affiliation(s)
- Tiny Pagnaer
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Maria Siermann
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, Centre for Human Genetics, KU Leuven, Leuven, Belgium
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16
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Hicks-Courant K, Shen J, Stroupe A, Cronin A, Bair EF, Wing SE, Sosa E, Nagler RH, Gray SW. Personalized Cancer Medicine in the Media: Sensationalism or Realistic Reporting? J Pers Med 2021; 11:741. [PMID: 34442385 PMCID: PMC8399271 DOI: 10.3390/jpm11080741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Given that media coverage can shape healthcare expectations, it is essential that we understand how the media frames "personalized medicine" (PM) in oncology, and whether information about unproven technologies is widely disseminated. METHODS We conducted a content analysis of 396 news reports related to cancer and PM published between 1 January 1998 and 31 December 2011. Two coders independently coded all the reports using a pre-defined framework. Determination of coverage of "standard" and "non-standard" therapies and tests was made by comparing the media print/broadcast date to the date of Federal Drug Administration approval or incorporation into clinical guidelines. RESULTS Although the term "personalized medicine" appeared in all reports, it was clearly defined only 27% of the time. Stories more frequently reported PM benefits than challenges (96% vs. 48%, p < 0.001). Commonly reported benefits included improved treatment (89%), prediction of side effects (30%), disease risk prediction (33%), and lower cost (19%). Commonly reported challenges included high cost (28%), potential for discrimination (29%), and concerns over privacy and regulation (21%). Coverage of inherited DNA testing was more common than coverage of tumor testing (79% vs. 25%, p < 0.001). Media reports of standard tests and treatments were common; however, 8% included information about non-standard technologies, such as experimental medications and gene therapy. CONCLUSION Confusion about personalized cancer medicine may be exacerbated by media reports that fail to clearly define the term. While most media stories reported on standard tests and treatments, an emphasis on the benefits of PM may lead to unrealistic expectations for cancer genomic care.
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Affiliation(s)
| | - Jenny Shen
- Department of Psychology, The State University of New York at Stony Brook, Stony Brook, NY 11794, USA;
| | - Angela Stroupe
- Patient Reported Outcomes, Pharmerit International, Cambridge, MA 02142, USA;
| | | | - Elizabeth F. Bair
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Sam E. Wing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (S.E.W.); (E.S.)
| | - Ernesto Sosa
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (S.E.W.); (E.S.)
| | - Rebekah H. Nagler
- Hubbard School of Journalism & Mass Communication, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Stacy W. Gray
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (S.E.W.); (E.S.)
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17
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Ratcliff CL, Wong B, Jensen JD, Kaphingst KA. The Impact of Communicating Uncertainty on Public Responses to Precision Medicine Research. Ann Behav Med 2021; 55:1048-1061. [PMID: 34297059 DOI: 10.1093/abm/kaab050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Precision medicine research depends upon recruiting large and diverse participant cohorts to provide genetic, environmental, and lifestyle data. How prospective participants react to information about this research, including depictions of uncertainty, is not well understood. PURPOSE The current study examined public responses to precision medicine research, focusing on reactions toward (a) uncertainty about the scientific impact of sharing data for research, and (b) uncertainty about the privacy, security, or intended uses of participant data. METHODS U.S. adults (N = 674; 51.9% male; 50% non-Hispanic white; Mage = 42.23) participated in an online experimental survey. Participants read a manipulated news article about precision medicine research that conveyed either certainty or uncertainty of each type (scientific, data). Participants then rated their attitudes toward the research, trust in the researchers, and willingness to join a cohort. We tested direct and mediated paths between message condition and outcomes and examined individual characteristics as moderators. RESULTS Overall attitudes were positive and a majority of participants (65%) reported being somewhat or very likely to participate in precision medicine research if invited. Conveying uncertainty of either type had no overall main effect on outcomes. Instead, those who reported perceiving greater uncertainty had lower attitudes, trust, and willingness to join, while those with more tolerance for uncertainty, support for science, and scientific understanding responded favorably to the scientific uncertainty disclosure. CONCLUSIONS Findings suggest responses to precision medicine research uncertainty are nuanced and that successful cohort enrollment may be well-supported by a transparent approach to communicating with prospective participants.
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Affiliation(s)
- Chelsea L Ratcliff
- Department of Communication Studies, University of Georgia, Athens, GA, USA
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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18
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Dwyer AA, Shen H, Zeng Z, Gregas M, Zhao M. Framing Effects on Decision-Making for Diagnostic Genetic Testing: Results from a Randomized Trial. Genes (Basel) 2021; 12:genes12060941. [PMID: 34202935 PMCID: PMC8234313 DOI: 10.3390/genes12060941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Genetic testing is increasingly part of routine clinical care. However, testing decisions may be characterized by regret as findings also implicate blood relatives. It is not known if genetic testing decisions are affected by the way information is presented (i.e., framing effects). We employed a randomized factorial design to examine framing effects on hypothetical genetic testing scenarios (common, life-threatening disease and rare, life-altering disease). Participants (n = 1012) received one of six decision frames: choice, default (n = 2; opt-in, opt-out), or enhanced choice (n = 3, based on the Theory of Planned Behavior). We compared testing decision, satisfaction, regret, and decision cognitions across decision frames and between scenarios. Participants randomized to ‘choice’ were least likely to opt for genetic testing compared with default and enhanced choice frames (78% vs. 83–91%, p < 0.05). Neither satisfaction nor regret differed across frames. Perceived autonomy (behavioral control) predicted satisfaction (B = 0.085, p < 0.001) while lack of control predicted regret (B = 0.346, p < 0.001). Opting for genetic testing did not differ between disease scenarios (p = 0.23). Results suggest framing can nudge individuals towards opting for genetic testing. These findings have important implications for individual self-determination in the genomic era. Similarities between scenarios with disparate disease trajectories point to possible modular approaches for web-based decisional support.
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Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA
- Massachusetts General Hospital-Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-617-522-1711
| | - Hongjie Shen
- Department of Measurement, Evaluation, Statistics and Assessment, Lynch School of Education, Boston College, Chestnut Hill, MA 02467, USA; (H.S.); (Z.Z.)
| | - Ziwei Zeng
- Department of Measurement, Evaluation, Statistics and Assessment, Lynch School of Education, Boston College, Chestnut Hill, MA 02467, USA; (H.S.); (Z.Z.)
| | - Matt Gregas
- Department of Research Services, Boston College, Chestnut Hill, MA 02467, USA;
| | - Min Zhao
- Carroll School of Management, Boston College, Chestnut Hill, MA 02467, USA;
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19
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Allen Q, Raeymaekers B. Surface Texturing of Prosthetic Hip Implant Bearing Surfaces: A Review. JOURNAL OF TRIBOLOGY 2021; 143:040801. [PMID: 34168396 PMCID: PMC8208482 DOI: 10.1115/1.4048409] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
More than 300,000 total hip replacement surgeries are performed in the United States each year to treat degenerative joint diseases that cause pain and disability. The statistical survivorship of these implants declines significantly after 15-25 years of use because wear debris causes inflammation, osteolysis, and mechanical instability of the implant. This limited longevity has unacceptable consequences, such as revision surgery to replace a worn implant, or surgery postponement, which leaves the patient in pain. Innovations such as highly cross-linked polyethylene and new materials and coatings for the femoral head have reduced wear significantly, but longevity remains an imminent problem. Another method to reduce wear is to add a patterned microtexture composed of micro-sized texture features to the smooth bearing surfaces. We critically review the literature on textured orthopedic biomaterial surfaces in the context of prosthetic hip implants. We discuss the different functions of texture features by highlighting experimental and simulated results documented by research groups active in this area. We also discuss and compare different manufacturing techniques to create texture features on orthopedic biomaterial surfaces and emphasize the key difficulties that must be overcome to produce textured prosthetic hip implants.
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Affiliation(s)
- Quentin Allen
- Department of Mechanical Engineering, University of Utah, 1495 E. 100 S. (1550 MEK), Salt Lake City, UT 84112
| | - Bart Raeymaekers
- Department of Mechanical Engineering, University of Utah, 1495 E. 100 S. (1550 MEK), Salt Lake City, UT 84112
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20
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Hsia TY. Invited Commentary: Form and Function in Surgical Planning. World J Pediatr Congenit Heart Surg 2021; 12:244-245. [PMID: 33684006 DOI: 10.1177/2150135121990395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tain-Yen Hsia
- Pediatric Cardiac Surgery, The Heart Center at 25102Arnold Palmer Hospital for Children, Orlando, FL, USA
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21
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Næss SCK, Håland E. Between diagnostic precision and rapid decision-making: Using institutional ethnography to explore diagnostic work in the context of Cancer Patient Pathways in Norway. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:476-492. [PMID: 33636018 PMCID: PMC8248403 DOI: 10.1111/1467-9566.13235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
Alongside other Nordic countries, the Norwegian government has introduced Cancer Patient Pathways (CPPs) for faster diagnostic assessment and timely treatment to improve the quality of cancer care. A key aspect of CPPs is the introduction of time limits for each phase of the diagnostic investigation. Occurring simultaneously are ongoing advances in medical technology, complicating the process of diagnosing and treating cancer. In this article, using institutional ethnography, we examine: how does the CPP policy influence physicians' experiences of diagnostic work? Data were collected from May 2018 to May 2019, through semi-structured interviews with physicians across five hospitals in Norway (N = 27). Our findings indicate that the implementation of various strategies aimed at enhancing quality in cancer care collide, compelling physicians to negotiate between diagnostic precision and rapid decision-making. We conclude that attention to interfaces between multiple guidelines and their implications for practice is crucial for understanding and developing quality of care.
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Affiliation(s)
- Siri Christine K. Næss
- Department of Education and Lifelong LearningNorwegian University of Science and TechnologyTrondheimNorway
| | - Erna Håland
- Department of Education and Lifelong LearningNorwegian University of Science and TechnologyTrondheimNorway
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22
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Definition of Personalized Medicine and Targeted Therapies: Does Medical Familiarity Matter? J Pers Med 2021; 11:jpm11010026. [PMID: 33406631 PMCID: PMC7824594 DOI: 10.3390/jpm11010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022] Open
Abstract
Personalized medicine (PM) is increasingly becoming a topic of discussion in public health policies and media. However, there is no consensus among definitions of PM in the scientific literature and the terms used to designate it, with some definitions emphasizing patient-centered aspects and others emphasizing biomedical aspects. Furthermore, terms used to refer to PM (e.g., “pharmacogenomics” or, more often, “targeted therapies”) are diverse and differently used. To our knowledge, no study has apprehended the differences of definition and attitudes toward personalized medicine and targeted therapies according to level of familiarity with the medical field. Our cohort included 349 French students from three different academic fields, which modulated their familiarity level with the medical field. They were asked to associate words either to “personalized medicine” or “target therapies”. Then, they were asked to give an emotional valence to their associations. Results showed that nonfamiliar students perceived PM as more positive than targeted therapies (TT), whereas familiar students showed no difference. Only familiar students defined PM and TT with technical aspects such as genetics or immunology. Further studies are needed in the field in order to determine which other factors could influence the definitions of PM and TT and determine how these definitions could have an impact in a clinical setting.
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23
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Waltz M, Prince AER, O’Daniel JM, Foreman AKM, Powell BC, Berg JS. Referencing BRCA in hereditary cancer risk discussions: In search of an anchor in a sea of uncertainty. J Genet Couns 2020; 29:949-959. [PMID: 31967382 PMCID: PMC7374021 DOI: 10.1002/jgc4.1219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 01/14/2023]
Abstract
As panel testing and exome sequencing are increasingly incorporated into clinical care, clinicians must grapple with how to communicate the risks and treatment decisions surrounding breast cancer genes beyond BRCA1 and BRCA2. In this paper, we examine clinicians' practice of employing BRCA1 and BRCA2 to help contextualize less certain genetic information regarding cancer risk and the possible implications of this practice for patients within the context of an exome sequencing study, NCGENES. We audio-recorded return of results appointments for 14 women who participated in NCGENES, previously had breast cancer, and were suspected of having a hereditary cancer predisposition. These patients were also interviewed four weeks later regarding their understanding of their results. We found that BRCA1 and BRCA2 were held as the gold standard, where clinicians compared what is known about BRCA to the limited understanding of other breast cancer-related genes. BRCA1 and BRCA2 were used as anchors to shape patients' understandings of genetic knowledge, risk, and management, illustrating how the information clinicians provide to patients may work as an external anchor. Yet, presenting BRCA1 and BRCA2 as a means of scientific reassurance can run the risk of patients conflating knowledge about certainty of risk with degree of risk after receiving a result for a moderate penetrance gene. This can be further complicated by misperceptions of the precision of cancer predictability attributed to these or other described 'cancer genes' in public media.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ann Katherine M. Foreman
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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24
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Abstract
OBJECTIVE The spread of misinformation has accompanied the coronavirus pandemic, including topics such as immune boosting to prevent COVID-19. This study explores how immune boosting is portrayed on the internet during the COVID-19 pandemic. DESIGN Content analysis. METHODS We compiled a dataset of 227 webpages from Google searches in Canada and the USA using the phrase 'boost immunity' AND 'coronavirus' on 1 April 2020. We coded webpages for typology and portrayal of immune boosting and supplements. We recorded mentions of microbiome, whether the webpage was selling or advertising an immune boosting product or service, and suggested strategies for boosting immunity. RESULTS No significant differences were found between webpages that appeared in the searches in Canada and the USA. The most common types of webpages were from news (40.5%) and commercial (24.7%) websites. The concept of immune boosting was portrayed as beneficial for avoiding COVID-19 in 85.5% of webpages and supplements were portrayed as beneficial in 40% of the webpages, but commercial sites were more likely to have these portrayals. The top immune boosting strategies were vitamin C (34.8%), diet (34.4%), sleep (34.4%), exercise (30.8%) and zinc (26.9%). Less than 10% of the webpages provide any critique of the concept of immune boosting. CONCLUSIONS Pairing evidence-based advice for maintaining one's health (eg, healthy diet, exercise, sleep) with the phrase immune boosting and strategies lacking in evidence may inadvertently help to legitimise the concept, making it a powerful marketing tool. Results demonstrate how the spread of misinformation is complex and often more subtle than blatant fraudulent claims.
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Affiliation(s)
- Christen Rachul
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Benjamin Collins
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Anthropology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Timothy Caulfield
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
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25
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Shkedi-Rafid S, Horton R, Lucassen A. What is the meaning of a 'genomic result' in the context of pregnancy? Eur J Hum Genet 2020; 29:225-230. [PMID: 32929236 DOI: 10.1038/s41431-020-00722-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/21/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022] Open
Abstract
Prenatal genetic testing and analysis in the past was usually only offered when a particular fetal phenotype was noted or suspected, meaning that filtering and interpretation of genetic variants identified could be anchored in attempts to explain an existing health concern. Advanced genomic testing is now increasingly used in "low-risk" pregnancies, producing information on genotype adrift of the phenotypic data that is necessary to give it meaning, thus increasing the difficulty in predicting whether and how particular genetic variants might affect future development and health. A challenge to healthcare scientists, clinicians, and parents therefore is deciding what qualities prenatal genotypic variation should have in order to be constructed as a 'result.' At the same time, such tests are often re requested in order to make binary decisions about whether to continue a pregnancy or not. As a range of professional organizations develop guidelines on the use of advanced genomic testing during pregnancy, we highlight the particular difficulties of discovering ambiguous findings such as variants with uncertain clinical significance, susceptibility loci for neurodevelopmental problems and susceptibility to adult-onset diseases. We aim to foster international discussions about how decisions around disclosure are made and how uncertainty is communicated.
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Affiliation(s)
- Shiri Shkedi-Rafid
- Genetics Department, Hadassah Medical Center, Jerusalem, Israel.,Institute for Medical Research Israel-Canada, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Horton
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anneke Lucassen
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, Southampton, UK.
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26
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The importance of genetics and genetic counselors in the evaluation of patients with bicuspid aortic valve and aortopathy. Curr Opin Cardiol 2020; 34:73-78. [PMID: 30394908 DOI: 10.1097/hco.0000000000000586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Bicuspid aortic valve (BAV) is a common congenital heart defect, with an estimated frequency of 1-2% in the general population. BAV may occur as an isolated finding or as a feature of certain syndromes. This article discusses potential genetic causes of BAV, includes a list of current known and candidate genes associated with BAV, provides a hypothetical case demonstrating the importance of genetic testing and cascade screening, and highlights the value of genetic counselors specializing in cardiovascular genetics. RECENT FINDINGS Individuals with BAV are at significantly increased risk of progressive aortic valve disease and aortic root aneurysms. There is high heritability associated with BAV, and several specific genes have recently been associated with BAV. There is wide phenotypic variability among BAV malformations, including which cusps are involved and the degree of aortic root involvement. Genotype-phenotype correlations exist that impact treatment recommendations. Genetic testing can reduce morbidity and mortality by guiding management strategies and identifying asymptomatic relatives before significant complications occur. SUMMARY Identifying cases of BAV with an identifiable genetic cause can significantly impact patients and family members. The list of associated genes is constantly growing. Genetic counselors have an important role in the evaluation of families at risk of BAV.
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Petersen C. User-focused data sharing agreements: a foundation for the genomic future. JAMIA Open 2020; 2:402-406. [PMID: 32025634 PMCID: PMC6993993 DOI: 10.1093/jamiaopen/ooz043] [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] [Received: 03/04/2019] [Revised: 06/21/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022] Open
Abstract
Data sharing agreements that clearly describe what individuals are agreeing to and what responsibilities data stewards will undertake are crucial for the establishment, maintenance, and flourishing of genomic datasets. To optimize genomic data resources, researchers, care professionals, and informaticians must regard system design, user objectives, and environmental considerations through users' eyes, identifying fundamental values on which to build and potential barriers to success that must be avoided. Design of agreements that promote desired data sharing and protect valuable data resources as necessary begins with a review of user interests and concerns. Nontraditional approaches for informed consent (eg, abbreviated informed consent, electronic informed consent, and dynamic consent) can facilitate achievement of data donors' privacy-related goals while making data available to researchers. Transparency in individual-researcher interactions, recognition and accommodation of cultural differences, and identification of shared needs and goals create a foundation for data sharing agreements that work over short and long terms.
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Affiliation(s)
- Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Global Business Solutions, Mayo Clinic, Rochester, Minnesota, USA
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Exploring broad consent in the context of the 100,000 Genomes Project: a mixed methods study. Eur J Hum Genet 2020; 28:732-741. [PMID: 31919452 DOI: 10.1038/s41431-019-0570-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022] Open
Abstract
The 100,000 Genomes Project (100kGP)-a hybrid clinical-research initiative-was set up to analyse whole-genome sequences (WGS) from patients living with a rare disease or cancer. The project positioned participant consent as being of central importance, but consent in the context of genomic testing raises challenging issues. In this mixed method study, we surveyed 1337 100kGP participants regarding their experiences of taking part in the project and conducted in-depth interviews with 24 survey respondents to explore these findings further. Survey responses were analysed using descriptive statistics and interview data were analysed thematically. The consent approach of the 100kGP resulted in a proportion of our study's participants not understanding the complexities of the project and what types of results they might receive; for example, 20% of participants who we surveyed from the cancer arm did not recall what decisions they had made regarding additional findings. It is not surprising that a project such as this, with such diverse aims and participant groups, would throw up at least some challenges. However, participants reported being satisfied with their experience of the project to date. Our study highlights that in the context of consent for more complex endeavours, such as the 100kGP, it is important to assess (and document) an agreement to take part, but complicated decisions about what and when to communicate may need revisiting over time in response to changing contexts. We discuss the implications of our findings with reference to participants of the 100kGP and the newly formed NHS Genomic Medicine Service.
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Marcon AR, Allan D, Barber M, Murdoch B, Caulfield T. Portrayal of umbilical cord blood research in the North American popular press: promise or hype? Regen Med 2020; 15:1228-1237. [PMID: 32101099 DOI: 10.2217/rme-2019-0149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: This study examined how umbilical cord blood (UCB) use was portrayed in the English language North American popular press. Methods: Directed content analysis was conducted on 400 articles from 2007 to 2017 containing 'cord blood,' published by the most read Canadian and American news sources. Results: A total of 86.3% of the articles detailed UCB treatments and therapies, the majority of which align with clinical evidence. Some articles portrayed speculative/experimental therapies as efficacious. Public and private banking initiatives received substantial attention, and were portrayed diversely. Promotional narrative messaging was evident around private banking. Conclusion: Findings demonstrate the need for continual monitoring of the media portrayals of UCB as stem cell and transplantation research develops and as clinics continue to operate.
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Affiliation(s)
- Alessandro R Marcon
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada, T6G 2H5
| | - David Allan
- Ottawa Hospital Research Institute, Canadian Blood Services, University of Ottawa, Ottawa ON, Canada, K1Y 4E9
| | - Morgan Barber
- University of Alberta, Faculty of Law, Edmonton, AB, Canada, T6G 2H5
| | - Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada, T6G 2H5
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada, T6G 2H5
- School of Public Health, University of Alberta, Edmonton, AB, Canada, T6G 1C9
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Public Solicitation and The Canadian Media: Two Cases of Living Liver Donation, Two Different Stories. Transplant Direct 2019; 5:e508. [PMID: 32095503 PMCID: PMC7004592 DOI: 10.1097/txd.0000000000000950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background . Two stories of public solicitation for living liver donors received substantial Canadian media attention in 2015: The Wagner family, with twin toddlers, each needing transplants, and Eugene Melnyk, wealthy owner of a professional hockey team. This study compared the print media coverage of these 2 stories to understand how public solicitation was portrayed and whether coverage differed depending on the individual making the plea. Methods. We conducted a content analysis on 155 relevant Canadian newspaper articles published between January 1, 2015 and December 31, 2016. Articles were analyzed for their description of public solicitation, benefits and issues associated with public solicitation, and overall tone with respect to public solicitation. Results. The foregrounding of public solicitation and associated ethical issues featured heavily in articles focused on Melnyk but were largely absent when discussing the Wagner family. The fairness of Melnyk's solicitation was the most prominent ethical issue raised. Laws and policies surrounding public solicitation also featured in the Melnyk story but not in articles focused on the Wagners. Public solicitation was portrayed more negatively in the Melnyk articles, but overall, was portrayed positively in relation to both Melnyk and the Wagner family. Conclusions. Public solicitation was generally portrayed as a positive phenomenon in Canadian print media, yet there were stark differences in how these cases were presented. The Wagner story was largely portrayed as a human-interest piece about a family in dire circumstances, whereas Melnyk's wealth, status, and influence raised questions of the fairness of his transplant.
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Direct-to-consumer genetic testing with third party interpretation: beware of spurious results. Emerg Top Life Sci 2019; 3:669-674. [DOI: 10.1042/etls20190059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/04/2023]
Abstract
Direct-to-consumer (DTC) genetic tests aim to provide insights into issues as varied as ancestry, nutrition, athletic ability and child talent, and some also report on disease risks. DTC companies tend to present their tests as uniformly beneficial, but the quality of the information they provide can be doubtful. Tests often invite people to step between territories, from the consumer in search of ‘fun’ information to potential patient, and the boundaries between these roles become even murkier when individuals explore the raw data from their DTC tests using third-party interpretation websites. We discuss two composite cases from U.K. genetics centres where patients used third party interpretation services to analyse raw data from DTC genetic tests. They then presented to NHS clinical services requesting interventions based on the disease-associated variants found, only to find that these variants were not actually present: their ‘pathogenic results’ were spurious. We highlight the risk of false positives (as well as false negatives) from DTC genetic tests, and discuss whether these cases represent the start of a worrying trend, where publicly funded clinicians and clinical scientists increasingly need to spend time and money investigating genetic results of dubious validity.
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Affiliation(s)
- Rachel Horton
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Gillian Crawford
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Angela Fenwick
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
| | | | - Anneke Lucassen
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
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Ballard LM, Horton RH, Fenwick A, Lucassen AM. Genome sequencing in healthcare: understanding the UK general public's views and implications for clinical practice. Eur J Hum Genet 2019; 28:155-164. [PMID: 31527856 DOI: 10.1038/s41431-019-0504-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022] Open
Abstract
Technological advances have seen the offer of genome sequencing becoming part of mainstream medical practice. Research has elicited patient and health professional views on the ethical issues genome sequencing raises, however, we know little about the general public's views. These views offer an insight into people's faith in such technologies, informing discussion regarding the approach to consent in clinic. We aimed to garner public views regarding genome sequencing, incidental findings (IFs), and sharing genetic information with relatives. Participants (n = 1954) from the British general public completed a survey, distributed via email. Overall, the public had a positive view of genomic sequencing, choosing 'informative' as the most popular word (52%) and 'family legacy' as the most popular analogy (33%) representing genomic sequencing for them. Fifty-three percent agree that their relative had the right to be told about genetic information relevant to them. Fifty-four percent would expect to be told about IFs whether they had asked for them or not. Clinical practice needs to acknowledge these perspectives and expectations in order to facilitate meaningful discussion during the consent process for genomic tests. We suggest that: (a) optimistic perspectives on the usefulness of genomic tests need to be tempered by discussion in clinic about the likelihood that genomic results might be uninformative, uncertain or unexpected; (b) discussions regarding the familial nature of results are needed before testing: the majority of patients will welcome this and any concerns can be explored further; and (c) a wider discussion is required regarding the consent approach for genomic testing.
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Affiliation(s)
- Lisa M Ballard
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK.
| | - Rachel H Horton
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK
| | - Anneke M Lucassen
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK
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Crawford DC, Cooke Bailey JN, Briggs FBS. Mind the gap: resources required to receive, process and interpret research-returned whole genome data. Hum Genet 2019; 138:691-701. [PMID: 31161416 PMCID: PMC6767905 DOI: 10.1007/s00439-019-02033-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Abstract
Most genotype-phenotype studies have historically lacked population diversity, impacting the generalizability of findings and thereby limiting the ability to equitably implement precision medicine. This well-documented problem has generated much interest in the ascertainment of new cohorts with an emphasis on multiple dimensions of diversity, including race/ethnicity, gender, age, socioeconomic status, disability, and geography. The most well known of these new cohort efforts is arguably All of Us, formerly known as the Precision Medicine Cohort Initiative Program. All of Us intends to ascertain at least one million participants in the United States representative of the multiple dimensions of diversity. As an incentive to participate, All of Us is offering the return of research results, including whole genome sequencing data, as well as the opportunity to contribute to the scientific process as non-scientists. The scale and scope of the proposed return of research results are unprecedented. Here, we briefly review possible return of genetic data models, including the likely data file formats and modes of data transfer or access. We also review the resources required to access and interpret the genetic or genomic data once received by the average participant, highlighting the nuanced anticipated barriers that will challenge both the digitally, computationally literate and illiterate participant alike. This inventory of resources required to receive, process, and interpret return of research results exposes the potential for access disparities and warns the scientific community to mind the gap so that all participants have equal access and understanding of the benefits of human genetic research.
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Affiliation(s)
- Dana C Crawford
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA.
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA.
- Cleveland Institute for Computational Biology, Case Western Reserve University, 2103 Cornell Road. Wolstein Research Building, Suite 2-527, Cleveland, OH, 44106, USA.
| | - Jessica N Cooke Bailey
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
- Cleveland Institute for Computational Biology, Case Western Reserve University, 2103 Cornell Road. Wolstein Research Building, Suite 2-527, Cleveland, OH, 44106, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
- Cleveland Institute for Computational Biology, Case Western Reserve University, 2103 Cornell Road. Wolstein Research Building, Suite 2-527, Cleveland, OH, 44106, USA
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Granados Moreno P, Ali-Khan SE, Capps B, Caulfield T, Chalaud D, Edwards A, Gold ER, Rahimzadeh V, Thorogood A, Auld D, Bertier G, Breden F, Caron R, César PM, Cook-Deegan R, Doerr M, Duncan R, Issa AM, Reichman J, Simard J, So D, Vanamala S, Joly Y. Open science precision medicine in Canada: Points to consider. Facets (Ott) 2019. [DOI: 10.1139/facets-2018-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Open science can significantly influence the development and translational process of precision medicine in Canada. Precision medicine presents a unique opportunity to improve disease prevention and healthcare, as well as to reduce health-related expenditures. However, the development of precision medicine also brings about economic challenges, such as costly development, high failure rates, and reduced market size in comparison with the traditional blockbuster drug development model. Open science, characterized by principles of open data sharing, fast dissemination of knowledge, cumulative research, and cooperation, presents a unique opportunity to address these economic challenges while also promoting the public good. The Centre of Genomics and Policy at McGill University organized a stakeholders’ workshop in Montreal in March 2018. The workshop entitled “Could Open be the Yellow Brick Road to Precision Medicine?” provided a forum for stakeholders to share experiences and identify common objectives, challenges, and needs to be addressed to promote open science initiatives in precision medicine. The rich presentations and exchanges that took place during the meeting resulted in this consensus paper containing key considerations for open science precision medicine in Canada. Stakeholders would benefit from addressing these considerations as to promote a more coherent and dynamic open science ecosystem for precision medicine.
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Affiliation(s)
- Palmira Granados Moreno
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Sarah E. Ali-Khan
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Benjamin Capps
- Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB T6G 2H5, Canada
| | - Damien Chalaud
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Aled Edwards
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
- Structural Genomics Consortium, University of Toronto, Toronto, ON M5G 1L6, Canada
| | - E. Richard Gold
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Vasiliki Rahimzadeh
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Adrian Thorogood
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Daniel Auld
- McGill University and Genome Quebec Innovation Centre, Montreal, QC H3A 0G1, Canada
| | - Gabrielle Bertier
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Felix Breden
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Roxanne Caron
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Priscilla M.D.G. César
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Robert Cook-Deegan
- School for the Future of Innovation in Society, Barrett & O’Connor Washington Center, Arizona State University, Washington, DC 20006, USA
| | | | - Ross Duncan
- Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Amalia M. Issa
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada
- Personalized Medicine & Targeted Therapeutics, Philadelphia, PA 19803, USA
- Health Policy & Pharmaceutical Sciences, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA
| | | | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Quebec-Laval University, Quebec City, QC G1V 4G2, Canada
| | - Derek So
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Sandeep Vanamala
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Yann Joly
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
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Briggs S, Slade I. Evaluating the Integration of Genomics into Cancer Screening Programmes: Challenges and Opportunities. CURRENT GENETIC MEDICINE REPORTS 2019; 7:63-74. [PMID: 32117599 PMCID: PMC7019642 DOI: 10.1007/s40142-019-00162-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW As the costs of genomic testing have fallen, and our understanding of genetic susceptibility to cancers has grown, there has been increasing interest in incorporating testing for cancer susceptibility genes, and polygenic risk estimates, into population cancer screening. A growing body of evidence suggests that this would be both clinically and cost-effective. In this article, we aim to explore the frameworks used to evaluate screening programmes, evaluate whether population screening for cancer susceptibility can be assessed using these standards, and consider additional issues and outcomes of importance in this context. RECENT FINDINGS There are tensions between traditional approaches of genetic testing (utilising tests with high sensitivity and specificity) and the principles of population screening (in which the screening test typically has low specificity), as well as the frameworks used to evaluate the two. Despite the existence of many screening guidelines, including consensus papers, these often do not align fully with broader considerations of genetic test evaluation. Population screening for genetic risk in cancer shifts the focus from diagnostics to prognostication and has wider implications for personal and familial health than existing screening programmes. In addition, understanding of the prevalence and penetrance of cancer susceptibility genes, required by many screening guidelines, may only be obtainable through population-level testing; prospective multi-disciplinary research alongside implementation will be essential. SUMMARY Appropriate evaluation of genetic screening for cancer risk will require modification of existing screening frameworks to incorporate additional complexity of outcomes and population values. As evidence supporting population screening for cancer susceptibility mounts, development of an appropriate evaluative framework, and expansion of public dialogue will be key to informing policy.
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Affiliation(s)
- Sarah Briggs
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN UK
| | - Ingrid Slade
- Wellcome Centre for Ethics and Humanities and Ethox Centre, Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
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The Development of a Personalised Training Framework: Implementation of Emerging Technologies for Performance. J Funct Morphol Kinesiol 2019; 4:jfmk4020025. [PMID: 33467340 PMCID: PMC7739422 DOI: 10.3390/jfmk4020025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 02/06/2023] Open
Abstract
Over the last decade, there has been considerable interest in the individualisation of athlete training, including the use of genetic information, alongside more advanced data capture and analysis techniques. Here, we explore the evidence for, and practical use of, a number of these emerging technologies, including the measurement and quantification of epigenetic changes, microbiome analysis and the use of cell-free DNA, along with data mining and machine learning. In doing so, we develop a theoretical model for the use of these technologies in an elite sport setting, allowing the coach to better answer six key questions: (1) To what training will my athlete best respond? (2) How well is my athlete adapting to training? (3) When should I change the training stimulus (i.e., has the athlete reached their adaptive ceiling for this training modality)? (4) How long will it take for a certain adaptation to occur? (5) How well is my athlete tolerating the current training load? (6) What load can my athlete handle today? Special consideration is given to whether such an individualised training framework will outperform current methods as well as the challenges in implementing this approach.
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Abstract
PURPOSE OF REVIEW Genomic tests offer increased opportunity for diagnosis, but their outputs are often uncertain and complex; results may need to be revised and/or may not be relevant until some future time. We discuss the challenges that this presents for consent and autonomy. RECENT FINDINGS Popular discourse around genomic testing tends to be strongly deterministic and optimistic, yet many findings from genomic tests are uncertain or unclear. Clinical conversations need to anticipate and potentially challenge unrealistic expectations of what a genomic test can deliver in order to enhance autonomy and ensure that consent to genomic testing is valid. SUMMARY We conclude that 'fully informed' consent is often not possible in the context of genomic testing, but that an open-ended approach is appropriate. We consider that such broad consent can only work if located within systems or organisations that are trustworthy and that have measures in place to ensure that such open-ended agreements are not abused. We suggest that a relational concept of autonomy has benefits in encouraging focus on the networks and relationships that allow decision making to flourish.
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Affiliation(s)
- Rachel Horton
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, Centre for Cancer Immunology, Southampton General Hospital, Southampton, SO16 6YD UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, SO16 5YA UK
| | - Anneke Lucassen
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, Centre for Cancer Immunology, Southampton General Hospital, Southampton, SO16 6YD UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, SO16 5YA UK
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Abstract
PURPOSE CRISPR is often called one of the century's most important discoveries and is commonly discussed in terms of its momentous potential impacts. This study analyzed how CRISPR is discussed in the North American popular press, including how it is defined, and which benefits and risks/concerns are attributed to the technology. METHODS Using the Factiva database, we identified 228 relevant, nonduplicated articles containing either "CRISPR" or "C.R.I.S.P.R.," published in popular US and Canadian news sources between 1 January 2012 and 12 July 2017. Content analysis was performed on the articles. RESULTS CRISPR is most often discussed in the context of human health (83.8%), compared with animals (26.3%) and plants (20.6%). Nearly all articles (96.1%) presented CRISPR's potential benefits; 61.4% of articles presented CRISPR-related risks/concerns, the vast majority of which focused on the uncertainty surrounding CRISPR, specifically with respect to germline modifications. CONCLUSIONS Overall, the discourse suggests a strong promotion of CRISPR, but an element of caution is also evident. Technical as well as ethical, legal, and social risks/concerns play a prominent role. This media portrayal of CRISPR might help facilitate more sophisticated and balanced policy responses, where the scientific potential of the technology is highlighted alongside broader social considerations.
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Monaghan PJ, Bossuyt PM. Test evaluation: major challengesahead - Opportunities abound. Ann Clin Biochem 2019; 56:524-526. [PMID: 30971105 DOI: 10.1177/0004563219837301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Phillip J Monaghan
- 1 The Christie Pathology Partnership, The Christie NHS Foundation Trust, Manchester, UK.,2 Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Patrick Mm Bossuyt
- 3 Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Horton RH, Lucassen AM. Recent developments in genetic/genomic medicine. Clin Sci (Lond) 2019; 133:697-708. [PMID: 30837331 PMCID: PMC6399103 DOI: 10.1042/cs20180436] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/21/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022]
Abstract
Advances in genetic technology are having a major impact in the clinic, and mean that many perceptions of the role and scope of genetic testing are having to change. Genomic testing brings with it a greater opportunity for diagnosis, or predictions of future diagnoses, but also an increased chance of uncertain or unexpected findings, many of which may have impacts for multiple members of a person's family. In the past, genetic testing was rarely able to provide rapid results, but the increasing speed and availability of genomic testing is changing this, meaning that genomic information is increasingly influencing decisions around patient care in the acute inpatient setting. The landscape of treatment options for genetic conditions is shifting, which has evolving implications for clinical discussions around previously untreatable disorders. Furthermore, the point of access to testing is changing with increasing provision direct to the consumer outside the formal healthcare setting. This review outlines the ways in which genetic medicine is developing in light of technological advances.
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Affiliation(s)
- Rachel H Horton
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Anneke M Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Kerr A, Swallow J, Chekar CK, Cunningham-Burley S. Genomic research and the cancer clinic: uncertainty and expectations in professional accounts. NEW GENETICS AND SOCIETY 2019; 38:222-239. [PMID: 31156350 PMCID: PMC6519890 DOI: 10.1080/14636778.2019.1586525] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/15/2019] [Indexed: 05/06/2023]
Abstract
This paper explores clinicians' and scientists' accounts of genomic research in cancer care and the complexities and challenges involved with delivering this work. Contributing to the sociology of (low) expectations, we draw on sociological studies of uncertainty in medicine to explore their accounts of working with uncertainty as part of the management of patient and institutional expectations. We consider their appeals to the importance of modest inquiry and framing of the uncertainties of genomic medicine as normal and at times welcome as they sought to configure professional autonomy and jurisdictions and cultivate an experimental ethos amongst their patients. We argue that these types of uncertainty work [Star, S. L. 1985. "Scientific Work and Uncertainty." Social Studies of Science 15 (3): 391-427] are a key feature of managing expectations at the intersections of genomic research and clinical care.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Julia Swallow
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Choon Key Chekar
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Levit LA, Kim ES, McAneny BL, Nadauld LD, Levit K, Schenkel C, Schilsky RL. Implementing Precision Medicine in Community-Based Oncology Programs: Three Models. J Oncol Pract 2019; 15:325-329. [PMID: 30802151 DOI: 10.1200/jop.18.00661] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of precision medicine and the number of genomic-based treatments and immunotherapies is increasing. Nevertheless, oncology providers face challenges to implementing precision medicine, including in community practices, where most patients receive treatment. On January 31, 2018, ASCO hosted Precision Medicine: Expanding Opportunities, the inaugural event in ASCO's new State of Cancer Care in America (SOCCA) event series. This article draws from the inaugural SOCCA event and the experiences of the SOCCA event participants to summarize the opportunities and challenges of precision medicine, and to highlight three successful models of implementing precision oncology in large, multisite community practices or networks: (1) Intermountain Healthcare, (2) Levine Cancer Institute, Atrium Health, and (3) National Cancer Care Alliance. The experience of these practices suggests that practice innovations that offer clinical decision support through molecular tumor boards and clinical pathways, and administrative support for prior authorization and clinical trial matching are key to successful implementation of large-scale, community-based precision medicine programs.
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Affiliation(s)
- Laura A Levit
- 1 American Society of Clinical Oncology, Alexandria, VA
| | - Edward S Kim
- 2 Levine Cancer Institute, Atrium Health, Charlotte, NC
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Gyngell C, Newson AJ, Wilkinson D, Stark Z, Savulescu J. Rapid Challenges: Ethics and Genomic Neonatal Intensive Care. Pediatrics 2019; 143:S14-S21. [PMID: 30600266 PMCID: PMC6379057 DOI: 10.1542/peds.2018-1099d] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 12/18/2022] Open
Abstract
NICUs are a priority implementation area for genomic medicine. Rapid genomic testing in the NICU is expected to be genomic medicine's "critical application," providing such clear benefits that it drives the adoption of genomics more broadly. Studies from multiple centers worldwide have now demonstrated the clinical utility and cost-effectiveness of rapid genomic sequencing in this setting, paving the way for widespread implementation. However, the introduction of this potentially powerful tool for predicting future impairment in the NICU also raises profound ethical challenges. Developing models of good practice that incorporate the identification, exploration, and analysis of ethical issues will be critical for successful implementation. In this article, we analyze 3 such issues: (1) the value and meaning of gaining consent to a complex test in a stressful, emotionally charged environment; (2) the effect of rapid diagnosis on parent-child bonding and its implications for medical and family decisions, particularly in relation to treatment limitation; and (3) distributive justice (ie, whether the substantial cost and diversion of resources to deliver rapid genomic testing in the NICU can be justified).
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Affiliation(s)
- Christopher Gyngell
- Department of Paediatrics, University of Melbourne, Melbourne, Australia,Murdoch Children’s Research Institute, Melbourne, Australia
| | - Ainsley J. Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia
| | - Dominic Wilkinson
- John Radcliffe Hospital, Oxford, UK,Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, Oxford, United Kingdom
| | - Zornitza Stark
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; .,Murdoch Children's Research Institute, Melbourne, Australia.,Australian Genomics Health Alliance, Parkville, Australia
| | - Julian Savulescu
- Murdoch Children’s Research Institute, Melbourne, Australia,Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, Oxford, United Kingdom
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Allen CG, Andersen B, Khoury MJ, Roberts MC. Current Social Media Conversations about Genetics and Genomics in Health: A Twitter-Based Analysis. Public Health Genomics 2018; 21:93-99. [PMID: 30466105 DOI: 10.1159/000494381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The growing availability of genomic information to the public may spur discussion about genetics and genomics on social media. Sites, including Twitter, provide a unique space for the public to access and discuss health information. The objective of this study was to better understand how social media users are sharing information about genetics and genomics in health and healthcare and what information is most commonly discussed among Twitter users. METHODS We obtained tweets with specific genetics- and genomics-related keywords from Crimson Hexagon. We used Boolean logic to collect tweets containing chosen keywords within the timeframe of October 1, 2016, to October 1, 2017. Features of the software were used to identify salient themes in conversation, conduct an emergent content analysis, and gather key demographic information. RESULTS We obtained 347,196 tweets from our search. There was a monthly average volume of 28,432 tweets. The five categories of tweets included: genetic disorders/disease (45.3%), health (15.6%), genomics (8%), and genetic testing (7.3%). Top influencers in the conversation included news outlets and universities. CONCLUSIONS This content analysis provides insight about the types of conversation related to genomics and health. Conversations about genomics are occurring on Twitter, and they frequently emphasize rare genetic diseases and genetic disorders. These discussions tend to be driven by key influencers who primarily include news media outlets. Further understanding of the discussions related to genomics and health in social media may offer insight about topics of importance to the public.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA,
| | - Brittany Andersen
- Division of Emerging Media Studies, Boston University, Boston, Massachusetts, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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