1
|
Lynch JA, Idleburg MJ, Butsch Kovacic M, Childers-Buschle KE, Dufendach KR, Lipstein EA, McGowan ML, Myers MF, Prows CA. Developing video education materials for the return of genomic test results to parents and adolescents. PEC INNOVATION 2022; 1:100051. [PMID: 36532300 PMCID: PMC9757811 DOI: 10.1016/j.pecinn.2022.100051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the development, implementation, and revision of a video to provide information about genomic testing and the return of genomic research results to adolescents and parents. METHODS Formative, community-engaged research was conducted in three stages: development, implementation, and revision. Existing research participant advisory groups were used for focus groups and convenience sampling was used for interviews. Participants included parents, young adults without children, and adolescents. Transcripts of recorded sessions were used for formative analysis. RESULTS Video was the preferred format for delivering genomic testing information to adolescents during the development stage. During implementation, adolescents identified video length as an impediment to recall. During the revision stage, participants preferred the video in separate short segments, supported plan to require only one short video and leaving other short videos optional. Participants were divided on whether the required short video provided enough information, but all participants reported that watching additional videos would not have changed their decisions about receiving test results. CONCLUSION Genomic education videos should be brief (<4 mins) to improve the odds that participants will view the entirety of any required video. INNOVATION The development of participant materials should incorporate plans for monitoring implementation and plans for revising materials.
Collapse
Affiliation(s)
- John A. Lynch
- Department of Communication, College of Arts & Sciences, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Michaela J. Idleburg
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Melinda Butsch Kovacic
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Rehabilitation, Exercise, and Nutrition Science, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | | | - Kevin R. Dufendach
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ellen A. Lipstein
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Michelle L. McGowan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Women’s, Gender & Sexuality Studies, College of Arts & Sciences, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Melanie F. Myers
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Cynthia A. Prows
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| |
Collapse
|
2
|
Unselected Women's Experiences of Receiving Genetic Research Results for Hereditary Breast and Ovarian Cancer: A Qualitative Study. Genet Test Mol Biomarkers 2021; 25:741-748. [DOI: 10.1089/gtmb.2021.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
3
|
Beck AT, Sutton EJ, Chow CPY, Curtis SH, Kullo IJ, Sharp RR. "Who Doesn't Like Receiving Good News?" Perspectives of Individuals Who Received Genomic Screening Results by Mail. J Pers Med 2021; 11:jpm11050322. [PMID: 33919001 PMCID: PMC8142970 DOI: 10.3390/jpm11050322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
As genomic sequencing expands to screen larger numbers of individuals, offering genetic counseling to everyone may not be possible. One approach to managing this limitation is for a genetic counselor to communicate clinically actionable results in person or by telephone, but report other results by mail. We employed this approach in a large genomic implementation study. In this paper, we describe participants' experiences receiving genomic screening results by mail. We conducted 50 semi-structured telephone interviews with individuals who received neutral genomic screening results by mail. Most participants were satisfied receiving neutral results by mail. Participants generally had a good understanding of results; however, a few participants had misunderstandings about their genomic screening results, including mistaken beliefs about their disease risk and the comprehensiveness of the test. No one reported plans to alter health behaviors, defer medical evaluations, or take other actions that might be considered medically problematic. Reporting neutral results by mail is unlikely to cause recipients distress or generate misunderstandings that may result in reduced vigilance in following recommended preventive health strategies. Nonetheless, some individuals may benefit from additional genetic counseling support to help situate their results in the context of personal concerns and illness experiences.
Collapse
Affiliation(s)
- Annika T. Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Erica J. Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Carolyn P. Y. Chow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Susan H. Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Iftikhar J. Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA;
| | - Richard R. Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55901, USA
- Correspondence:
| |
Collapse
|
4
|
Pacyna JE, Shaibi GQ, Lee A, Byrne JO, Cuellar I, Sutton EJ, Hernandez V, Lindor NM, Singh D, Kullo IJ, Sharp RR. Increasing access to individualized medicine: a matched-cohort study examining Latino participant experiences of genomic screening. Genet Med 2021; 23:934-941. [PMID: 33500569 PMCID: PMC8495890 DOI: 10.1038/s41436-020-01079-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose: Multiple efforts are underway to increase the inclusion of racial minority participants in genomic research and new forms of individualized medicine. These efforts should include studies that characterize how individuals from minority communities experience genomic medicine in diverse healthcare settings and how they integrate genetic knowledge into their understandings of healthcare needs. Methods: As part of a large, multisite genomic sequencing study, we surveyed individuals to assess their decision to pursue genomic risk evaluation. Participants included Latino patients recruited at Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, AZ, and non-Latino patients recruited at a large academic medical center (Mayo Clinic in Rochester, MN). Both groups agreed to receive individualized genomic risk assessments. Results: Comparisons between cohorts showed that Latino respondents had lower levels of decisional conflict about pursuing genomic screening but generally scored lower on genetic knowledge. Latino respondents were also more likely to have concerns about the misuse of genomic information, despite both groups having similar views about the value of genomic risk evaluation. Conclusion: Our results highlight the importance of evaluating sociocultural factors that influence minority patient engagement with genomic medicine in diverse healthcare settings.
Collapse
Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | - Alex Lee
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jamie O Byrne
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Idali Cuellar
- Center for Individualized Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA. .,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
5
|
Finn KS, Lynch J, Aufox S, Bland S, Chung W, Halverson C, Hebbring S, Hoell C, Holm I, Jarvik G, Kullo I, Leppig K, Myers M, Prows C, Rasouly HM, Singh R, Weisner G, Williams J, Wynn J, Smith M, Sharp R. Returning negative results from
large‐scale
genomic screening: Experiences from the
eMERGE III
network. Am J Med Genet A 2020; 185:508-516. [DOI: 10.1002/ajmg.a.62002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kelsey Stuttgen Finn
- Biomedical Ethics Research Program Mayo Clinic Rochester Minnesota USA
- Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA
| | - John Lynch
- Department of Communication University of Cincinnati Cincinnati Ohio USA
| | - Sharon Aufox
- Center for Genomic Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois USA
| | - Sarah Bland
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville Tennessee USA
| | - Wendy Chung
- Department of Pediatrics Columbia University New York New York USA
| | - Colin Halverson
- School of Medicine Indiana University‐Purdue University Indianapolis Indiana USA
| | - Scott Hebbring
- Center for Human Genetics Marshfield Clinic Research Institute Marshfield Wisconsin USA
| | - Christin Hoell
- Center for Genomic Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois USA
| | - Ingrid Holm
- Department of Pediatrics Harvard Medical School Boston Massachusetts USA
- Division of Genetics and Genomics Boston Children's Hospital Boston Massachusetts USA
| | - Gail Jarvik
- Division of Medical Genetics School of Medicine, University of Washington Seattle Washington USA
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Kathleen Leppig
- Genetic Services Kaiser Permanente of Washington Seattle Washington USA
- Biomedical and Health Informatics University of Washington Seattle Washington USA
| | - Melanie Myers
- College of Medicine University of Cincinnati Cincinnati Ohio USA
- Department of Pediatrics Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati Ohio USA
| | - Cynthia Prows
- Department of Pediatrics Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati Ohio USA
| | - Hila Milo Rasouly
- Department of Medicine, Division of Nephrology Columbia University Irving Medical Center New York New York USA
| | - Rajbir Singh
- Department of Microbiology and Immunology Meharry Medical College Nashville Tennessee USA
- Department of Obstetrics and Gynecology Meharry Medical College Nashville Tennessee USA
| | - Georgia Weisner
- Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA
- Vanderbilt Clinical and Translational Hereditary Cancer Program Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical Center Nashville Tennessee USA
| | - Janet Williams
- Geisinger Genomic Medicine Institute Danville Pennsylvania USA
| | - Julia Wynn
- Department of Pediatrics Columbia University New York New York USA
| | - Maureen Smith
- Department of Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois USA
| | - Richard Sharp
- Biomedical Ethics Research Program Mayo Clinic Rochester Minnesota USA
- Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA
| |
Collapse
|
6
|
Sutton EJ, Beck AT, Gamm KO, McCormick JB, Kullo IJ, Sharp RR. "They're Not Going to Do Nothing for Me": Research Participants' Attitudes towards Elective Genetic Counseling. J Pers Med 2020; 10:jpm10040143. [PMID: 32987879 PMCID: PMC7711758 DOI: 10.3390/jpm10040143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/12/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
As applications of genomic sequencing have expanded, offering genetic counseling support to all patients is arguably no longer practical. Additionally, whether individuals desire and value genetic counseling services for genomic screening is unclear. We offered elective genetic counseling to 5110 individuals prior to undergoing sequencing and 2310 participants who received neutral results to assess demand. A total of 0.2% of the study participants accessed genetic counseling services prior to sequencing, and 0.3% reached out after receiving neutral results. We later conducted 50 interviews with participants to understand why they did not access these services. Many interviewees did not recall the availability of genetic counseling and were unfamiliar with the profession. Interviewees described not needing counseling before sequencing because they understood the study and felt that they could cope with any result. Counseling was considered equally unnecessary after learning neutral results. Although the participants had questions about their results, they did not feel that speaking with a genetic counselor would be helpful. Genomic screening efforts that employ opt-in models of genetic counseling may need to clarify the potential value of genetic counseling support from the outset and feature genetic counseling services more prominently in program materials.
Collapse
Affiliation(s)
- Erica J. Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA; (E.J.S.); (A.T.B.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Annika T. Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA; (E.J.S.); (A.T.B.)
| | - Kylie O. Gamm
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Jennifer B. McCormick
- College of Medicine, Department of Humanities, Pennsylvania State University, Hershey, PA 17033, USA;
| | - Iftikhar J. Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA;
| | - Richard R. Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA; (E.J.S.); (A.T.B.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-538-6502
| |
Collapse
|
7
|
Patient reactions to receiving negative genomic screening results by mail. Genet Med 2020; 22:1994-2002. [PMID: 32669678 DOI: 10.1038/s41436-020-0906-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE As genomic screening is incorporated into a wider array of clinical settings, it is critical that we understand how patients may respond to a various screening results. Although multiple studies have examined how patients understand positive genomic screening results, few data exist regarding patient engagement with negative screening results. METHODS An 82-item survey was administered to 1712 individuals who received negative genomic screening results by mail following evaluation of 109 medically actionable genes. Genetic counselors were available to assist with the interpretation of screening results. RESULTS One thousand four hundred forty-two participants completed the survey (84.2%). The vast majority of respondents valued the information they received, with 98% of respondents reporting that negative genomic screening results were valuable and 72% indicating they would recommend genomic screening to others. Nonetheless, many respondents had questions about their genomic screening results (28%) and would have preferred to receive their screening results in person (18%). CONCLUSION These data suggest most patients value receiving negative genomic screening results and are comfortable receiving their results by mail. Nevertheless, a significant proportion of patients also reported difficulty understanding some aspects of their results. This finding challenges the idea that communicating genomic screening results by mail alone is sufficient to meet patients' needs.
Collapse
|
8
|
Challenges in returning results in a genomic medicine implementation study: the Return of Actionable Variants Empirical (RAVE) study. NPJ Genom Med 2020; 5:19. [PMID: 32377377 PMCID: PMC7198538 DOI: 10.1038/s41525-020-0127-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/27/2020] [Indexed: 12/25/2022] Open
Abstract
To inform the process of returning results in genome sequencing studies, we conducted a quantitative and qualitative assessment of challenges encountered during the Return of Actionable Variants Empiric (RAVE) study conducted at Mayo Clinic. Participants (n = 2535, mean age 63 ± 7, 57% female) were sequenced for 68 clinically actionable genes and 14 single nucleotide variants. Of 122 actionable results detected, 118 were returnable; results were returned by a genetic counselor—86 in-person and 12 by phone. Challenges in returning actionable results were encountered in a significant proportion (38%) of the cohort and were related to sequencing and participant contact. Sequencing related challenges (n = 14), affecting 13 participants, included reports revised based on clinical presentation (n = 3); reports requiring corrections (n = 2); mosaicism requiring alternative DNA samples for confirmation (n = 3); and variant re-interpretation due to updated informatics pipelines (n = 6). Participant contact related challenges (n = 44), affecting 38 participants, included nonresponders (n = 20), decedents (n = 1), and previously known results (n = 23). These results should be helpful to investigators preparing for return of results in large-scale genomic sequencing projects.
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Although primarily designed for medical documentation and billing purposes, the electronic health record (EHR) has significant potential for translational research. In this article, we provide an overview of the use of the EHR for genomics research with a focus on heritable lipid disorders. RECENT FINDINGS Linking the EHR to genomic data enables repurposing of vast phenotype data for genomic discovery. EHR data can be used to study the genetic basis of common and rare disorders, identify subphenotypes of diseases, assess pathogenicity of novel genomic variants, investigate pleiotropy, and rapidly assemble cohorts for genomic medicine clinical trials. EHR-based discovery can inform clinical practice; examples include use of polygenic risk scores for assessing disease risk and use of phenotype data to interpret rare variants. Despite limitations such as missing data, variable use of standards and poor interoperablility between disparate systems, the EHR is a powerful resource for genomic research. SUMMARY When linked to genomic data, the EHR can be leveraged for genomic discovery, which in turn can inform clinical care, exemplifying the virtuous cycle of a learning healthcare system.
Collapse
Affiliation(s)
- Maya S Safarova
- Atherosclerosis and Lipid Genomics Laboratory and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
10
|
Effectiveness of the Genomics ADvISER decision aid for the selection of secondary findings from genomic sequencing: a randomized clinical trial. Genet Med 2019; 22:727-735. [PMID: 31822848 DOI: 10.1038/s41436-019-0702-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of the Genomics ADvISER (www.genomicsadviser.com) decision aid (DA) for selection of secondary findings (SF), compared with genetic counseling alone. METHODS A randomized controlled trial (RCT) was conducted to evaluate whether the Genomics ADvISER is superior to genetic counseling when hypothetically selecting SF. Participants were randomized to use the DA followed by discussion with a genetic counselor, or to genetic counseling alone. Surveys were administered at baseline and post-intervention. Primary outcome was decisional conflict. Secondary outcomes were knowledge, preparation for, and satisfaction with decision-making, anxiety, and length of counseling session. RESULTS Participants (n = 133) were predominantly White/European (74%), female (90%), and ≥50 years old (60%). Decisional conflict (mean difference 0.05; P = 0.60), preparation for decision-making (0.17; P = 0.95), satisfaction with decision (-2.18; P = 0.06), anxiety (0.72; P = 0.56), and knowledge of sequencing limitations (0.14; P = 0.70) did not significantly differ between groups. However, intervention participants had significantly higher knowledge of SF (0.39; P < 0.001) and sequencing benefits (0.97; P = 0.01), and significantly shorter counseling time (24.40 minutes less; P < 0.001) CONCLUSIONS: The Genomics ADvISER did not decrease decisional conflict but reduced counseling time and improved knowledge. This decision aid could serve as an educational tool, reducing in-clinic time and potentially health care costs.
Collapse
|
11
|
Pacyna JE, Radecki Breitkopf C, Jenkins SM, Sutton EJ, Horrow C, Kullo IJ, Sharp RR. Should pretest genetic counselling be required for patients pursuing genomic sequencing? Results from a survey of participants in a large genomic implementation study. J Med Genet 2018; 56:317-324. [PMID: 30580287 DOI: 10.1136/jmedgenet-2018-105577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE We assessed the decision-making of individuals pursuing genomic sequencing without a requirement for pretest genetic counselling. We sought to describe the extent to which individuals who decline genetic counselling reported decisional conflict or struggled to make a decision to pursue genomic testing. METHODS We administered a 100-item survey to 3037 individuals who consented to the Return of Actionable Variants Empirical study, a genomic medicine implementation study supported by the National Institutes of Health (USA) eMERGE consortium. The primary outcomes of interest were self-reported decisional conflict about the decision to participate in the study and time required to reach a decision. RESULTS We received 2895 completed surveys (response rate=95.3%), and of these respondents 97.8% completed the decisional conflict scale in its entirety. A majority of individuals (63%) had minimal or no decisional conflict about the pursuit of genomic sequencing and were able to reach a decision quickly (78%). Multivariable logistic regression analyses identified several characteristics associated with decisional conflict, including lower education, lower health literacy, lower self-efficacy in coping, lack of prior experience with genetic testing, not discussing study participation with a family member or friend, and being male. CONCLUSION As genomic sequencing is used more widely, genetic counselling resources may not be sufficient to meet demand. Our results challenge the notion that all individuals need genetic counselling in order to make an informed decision about genomic sequencing.
Collapse
Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sarah M Jenkins
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Horrow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
12
|
Kullo IJ, Olson J, Fan X, Jose M, Safarova M, Radecki Breitkopf C, Winkler E, Kochan DC, Snipes S, Pacyna JE, Carney M, Chute CG, Gupta J, Jose S, Venner E, Murugan M, Jiang Y, Zordok M, Farwati M, Philogene M, Smith E, Shaibi GQ, Caraballo P, Freimuth R, Lindor NM, Sharp R, Thibodeau SN. The Return of Actionable Variants Empirical (RAVE) Study, a Mayo Clinic Genomic Medicine Implementation Study: Design and Initial Results. Mayo Clin Proc 2018; 93:1600-1610. [PMID: 30392543 PMCID: PMC6652203 DOI: 10.1016/j.mayocp.2018.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/04/2018] [Accepted: 06/08/2018] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To identify clinically actionable genetic variants from targeted sequencing of 68 disease-related genes, estimate their penetrance, and assess the impact of disclosing results to participants and providers. PATIENTS AND METHODS The Return of Actionable Variants Empirical (RAVE) Study investigates outcomes following the return of pathogenic/likely pathogenic (P/LP) variants in 68 disease-related genes. The study was initiated in December 2016 and is ongoing. Targeted sequencing was performed in 2533 individuals with hyperlipidemia or colon polyps. The electronic health records (EHRs) of participants carrying P/LP variants in 36 cardiovascular disease (CVD) genes were manually reviewed to ascertain the presence of relevant traits. Clinical outcomes, health care utilization, family communication, and ethical and psychosocial implications of disclosure of genomic results are being assessed by surveys, telephone interviews, and EHR review. RESULTS Of 29,208 variants in the 68 genes, 1915 were rare (frequency <1%) and putatively functional, and 102 of these (60 in 36 CVD genes) were labeled P/LP based on the American College of Medical Genetics and Genomics framework. Manual review of the EHRs of participants (n=73 with P/LP variants in CVD genes) revealed that 33 had the expected trait(s); however, only 6 of 45 participants with non-familial hypercholesterolemia (FH) P/LP variants had the expected traits. CONCLUSION Expected traits were present in 13% of participants with P/LP variants in non-FH CVD genes, suggesting low penetrance; this estimate may change with additional testing performed as part of the clinical evaluation. Ongoing analyses of the RAVE Study will inform best practices for genomic medicine.
Collapse
Affiliation(s)
- Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Janet Olson
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | - Xiao Fan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Merin Jose
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Maya Safarova
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Erin Winkler
- Center for Individualized Medicine-Genomics, Mayo Clinic, Rochester, MN
| | - David C Kochan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sara Snipes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joel E Pacyna
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | - Meaghan Carney
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Christopher G Chute
- Johns Hopkins University, Schools of Medicine, Public Health and Nursing, Baltimore, MD
| | - Jyoti Gupta
- National Human Genome Research Institute, Bethesda, MD
| | - Sheethal Jose
- National Human Genome Research Institute, Bethesda, MD
| | - Eric Venner
- Baylor College of Medicine Human Genome Sequencing Center, Houston, TX
| | - Mullai Murugan
- Baylor College of Medicine Human Genome Sequencing Center, Houston, TX
| | - Yunyun Jiang
- Baylor College of Medicine Human Genome Sequencing Center, Houston, TX
| | - Magdi Zordok
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Erica Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | | | - Robert Freimuth
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | | | - Richard Sharp
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
13
|
Developing a conceptual, reproducible, rubric-based approach to consent and result disclosure for genetic testing by clinicians with minimal genetics background. Genet Med 2018; 21:727-735. [PMID: 29976988 PMCID: PMC6320736 DOI: 10.1038/s41436-018-0093-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose In response to genetic testing being widely ordered by non-genetics clinicians, the Consent and Disclosure Recommendations (CADRe) Workgroup of the Clinical Genome Resource (ClinGen; clinicalgenome.org) developed guidance to facilitate communication about genetic testing and efficiently improve the patient experience. Considering ethical, legal, social implications and medical factors, CADRe developed and pilot tested two rubrics addressing consent for genetic testing and results disclosure. The CADRe rubrics allow for adjusting the communication approach based on circumstances specific to patients and ordering clinicians. Methods We present results of a formative survey of 66 genetics clinicians to assess the consent rubric for 9 genes (MLH1, CDH1, TP53, GJB2, OTC; DMD, HTT, and CYP2C9/VKORC1). We also conducted interviews and focus groups with family and patient stakeholders (N=18), non-genetics specialists (N=27) and genetics clinicians (N=32) on both rubrics. Results Formative evaluation of the CADRe rubrics suggests key factors on which to make decisions about consent and disclosure discussions for a ‘typical’ patient. Conclusion We propose that the CADRe rubrics include the primary issues necessary to guide communication recommendations, and are ready for pilot testing by non-genetics clinicians. Consultation with genetics clinicians can be targeted towards more complex or intensive consent and disclosure counseling.
Collapse
|