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Ng WL, Hussein N, Ng CJ, Qureshi N, Lee YK, Kwan Z, Kee BP, Then SM, Abdul Malik TF, Mohd Zaidan FZ, Azmi SUF. Implementing HLA-B*58:01 testing prior to allopurinol initiation in Malaysian primary care setting: A qualitative study from doctors' and patients' perspective. PLoS One 2024; 19:e0296498. [PMID: 38206925 PMCID: PMC10783771 DOI: 10.1371/journal.pone.0296498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Allopurinol, the first-line treatment for chronic gout, is a common causative drug for severe cutaneous adverse reactions (SCAR). HLA-B*58:01 allele was strongly associated with allopurinol-induced SCAR in Asian countries such as Taiwan, Japan, Thailand and Malaysia. HLA-B*58:01 screening before allopurinol initiation is conditionally recommended in the Southeast-Asian population, but the uptake of this screening is slow in primary care settings, including Malaysia. This study aimed to explore the views and experiences of primary care doctors and patients with gout on implementing HLA-B*58:01 testing in Malaysia as part of a more extensive study exploring the feasibility of implementing it routinely. METHODS This qualitative study used in-depth interviews and focus group discussions to obtain information from patients with gout under follow-up in primary care and doctors who cared for them. Patients and doctors shared their gout management experiences and views on implementing HLA-B*58:01 screening in primary care. Data were coded and analysed using thematic analysis. RESULTS 18 patients and 18 doctors from three different healthcare settings (university hospital, public health clinics, private general practitioner clinics) participated. The acceptability to HLA-B*58:01 screening was good among the doctors and patients. We discovered inadequate disclosure of severe side effects of allopurinol by doctors due to concerns about medication refusal by patients, which could potentially be improved by introducing HLA-B*58:01 testing. Barriers to implementation included out-of-pocket costs for patients, the cost-effectiveness of this implementation, lack of established alternative treatment pathway besides allopurinol, counselling burden and concern about genetic data security. Our participants preferred targeted screening for high-risk populations instead of universal screening. CONCLUSION Implementing HLA-B*58:01 testing in primary care is potentially feasible if a cost-effective, targeted screening policy on high-risk groups can be developed. A clear treatment pathway for patients who test positive should be made available.
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Affiliation(s)
- Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Norita Hussein
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Nadeem Qureshi
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Boon Pin Kee
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sue-Mian Then
- Division of Biomedical Science, School of Pharmacy, Faculty of Science and Engineering, University of Nottingham, Selangor, Malaysia
| | - Tun Firzara Abdul Malik
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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David SP, Dunnenberger HM, Choi S, DePersia A, Ilbawi N, Ward C, Wake DT, Khandekar JD, Shannon Y, Hughes K, Miller N, Mangold KA, Sabatini LM, Helseth DL, Xu J, Sanders A, Kaul KL, Hulick PJ. Personalized medicine in a community health system: the NorthShore experience. Front Genet 2023; 14:1308738. [PMID: 38090148 PMCID: PMC10713750 DOI: 10.3389/fgene.2023.1308738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 02/01/2024] Open
Abstract
Genomic and personalized medicine implementation efforts have largely centered on specialty care in tertiary health systems. There are few examples of fully integrated care systems that span the healthcare continuum. In 2014, NorthShore University HealthSystem launched the Center for Personalized Medicine to catalyze the delivery of personalized medicine. Successful implementation required the development of a scalable family history collection tool, the Genetic and Wellness Assessment (GWA) and Breast Health Assessment (BHA) tools; integrated pharmacogenomics programming; educational programming; electronic medical record integration; and robust clinical decision support tools. To date, more than 225,000 patients have been screened for increased hereditary conditions, such as cancer risk, through these tools in primary care. More than 35,000 patients completed clinical genetic testing following GWA or BHA completion. An innovative program trained more than 100 primary care providers in genomic medicine, activated with clinical decision support and access to patient genetic counseling services and digital healthcare tools. The development of a novel bioinformatics platform (FLYPE) enabled the incorporation of genomics data into electronic medical records. To date, over 4,000 patients have been identified to have a pathogenic or likely pathogenic variant in a gene with medical management implications. Over 33,000 patients have clinical pharmacogenomics data incorporated into the electronic health record supported by clinical decision support tools. This manuscript describes the evolution, strategy, and successful multispecialty partnerships aligned with health system leadership that enabled the implementation of a comprehensive personalized medicine program with measurable patient outcomes through a genomics-enabled learning health system model that utilizes implementation science frameworks.
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Affiliation(s)
- Sean P. David
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Henry M. Dunnenberger
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Sarah Choi
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Allison DePersia
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Nadim Ilbawi
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Christopher Ward
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Dyson T. Wake
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Janardan D. Khandekar
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Kellogg Cancer Center, NorthShore University HealthSystem, Evanston, IL, United States
| | - Yvette Shannon
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Kristen Hughes
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Nicholas Miller
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Kathy A. Mangold
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Linda M. Sabatini
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Donald L. Helseth
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Jianfeng Xu
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Alan Sanders
- Center for Psychiatric Genetics, Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem, Evanston, IL, United States
- Departments of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Karen L. Kaul
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
- Department of Pathology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Peter J. Hulick
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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Shue SA, Rowe E, Bell LA, Damush T, DeLong A, Gowan T, Skaar T, Haggstrom D. Pharmacogenomics implementation across multiple clinic settings: a qualitative evaluation. Pharmacogenomics 2023; 24:881-893. [PMID: 37975236 DOI: 10.2217/pgs-2023-0179] [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] [Indexed: 11/19/2023] Open
Abstract
Aim: To advance clinical adoption and implementation of pharmacogenomics (PGx) testing, barriers and facilitators to these efforts must be understood. This study identified and examined barriers and facilitators to active implementation of a PGx program across multiple clinic settings in an academic healthcare system. Materials & methods: 28 contributors to the PGx implementation (e.g., clinical providers, informatics specialists) completed an interview to elicit their perceptions of the implementation. Results: Qualitative analysis identified several barriers and facilitators that spanned different stages of the implementation process. Specifically, unclear test payment mechanisms, decision support tool development, rigid workflows and provider education were noted as barriers to the PGx implementation. A multidisciplinary implementation team and leadership support emerged as key facilitators. Furthermore, participants also suggested strategies to overcome or maintain these factors. Conclusion: Assessing real-world implementation perceptions and suggested strategies from a range of implementation contributors facilitates a more comprehensive framework and best-practice guidelines for PGx implementation.
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Affiliation(s)
- Sarah A Shue
- VA HSR&D Center for Health Information & Communication, Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Elizabeth Rowe
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lauren A Bell
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Teresa Damush
- VA HSR&D Center for Health Information & Communication, Roudebush VA Medical Center, Indianapolis, IN 46202, USA
- Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Alexis DeLong
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Tayler Gowan
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Todd Skaar
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - David Haggstrom
- VA HSR&D Center for Health Information & Communication, Roudebush VA Medical Center, Indianapolis, IN 46202, USA
- Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
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Patterson WG, Tribble LM, Hopkins CS, Fasolino TK, Ward LD. Workforce survey of PAs' genetic-genomic knowledge, attitudes, and application in practice. JAAPA 2023; 36:34-40. [PMID: 37561671 DOI: 10.1097/01.jaa.0000947044.74047.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This study surveyed practicing physician associates/assistants (PAs) about their genetics-genomics knowledge, attitudes, and application in practice. METHODS A 25-question electronic survey was emailed to each constituent organization of the American Academy of Physician Associates (AAPA) with a description of the study and a request to forward to their members. Additionally, a posting was displayed in the bulletin board section of the online AAPA Huddle. RESULTS Of the 420 PAs who completed the survey, few are knowledgeable (25%) about or confident (13%) in applying a genomic approach to patient care, although most (61%) think genetics-genomics is important to delivering high-quality care. Remarkably, 97% of PAs surveyed are interested in genetics-genomics continuing medical education. CONCLUSIONS PAs lack knowledge and confidence in integrating genetics-genomics into patient care; however, they have a positive attitude toward genetics-genomics and want to improve their knowledge and confidence through education.
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Affiliation(s)
- Wesley G Patterson
- At Greenwood (S.C.) Genetic Center, Wesley G. Patterson is a PA in genetics and Leta M. Tribble is director of the Division of Education. At Clemson (S.C.) University's School of Nursing, Casey S. Hopkins is an assistant professor and Tracy K. Fasolino and Linda D. Ward are associate professors. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Lapointe J, Côté JM, Mbuya-Bienge C, Dorval M, Pashayan N, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Brooks JD, Walker MJ, Blackmore KM, Joly Y, Knoppers BM, Chiarelli AM, Simard J, Nabi H. Canadian Healthcare Professionals' Views and Attitudes toward Risk-Stratified Breast Cancer Screening. J Pers Med 2023; 13:1027. [PMID: 37511640 PMCID: PMC10381377 DOI: 10.3390/jpm13071027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Given the controversy over the effectiveness of age-based breast cancer (BC) screening, offering risk-stratified screening to women may be a way to improve patient outcomes with detection of earlier-stage disease. While this approach seems promising, its integration requires the buy-in of many stakeholders. In this cross-sectional study, we surveyed Canadian healthcare professionals about their views and attitudes toward a risk-stratified BC screening approach. An anonymous online questionnaire was disseminated through Canadian healthcare professional associations between November 2020 and May 2021. Information collected included attitudes toward BC screening recommendations based on individual risk, comfort and perceived readiness related to the possible implementation of this approach. Close to 90% of the 593 respondents agreed with increased frequency and earlier initiation of BC screening for women at high risk. However, only 9% agreed with the idea of not offering BC screening to women at very low risk. Respondents indicated that primary care physicians and nurse practitioners should play a leading role in the risk-stratified BC screening approach. This survey identifies health services and policy enhancements that would be needed to support future implementation of a risk-stratified BC screening approach in healthcare systems in Canada and other countries.
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Affiliation(s)
- Julie Lapointe
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Jean-Martin Côté
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Cynthia Mbuya-Bienge
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, Av de la Médecine, Québec City, QC G1V 0A6, Canada
| | - Michel Dorval
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Faculty of Pharmacy, Université Laval, 1050, Av de la Médecine, Québec City, QC G1V 0A6, Canada
- CISSS de Chaudière-Appalaches Research Center, 143 Rue Wolfe, Lévis, QC G6V 3Z1, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, Gower Street, London WC1E 6BT, UK
| | - Jocelyne Chiquette
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- CHU de Québec-Université Laval, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Laurence Eloy
- Programme Québécois de Cancérologie, Ministère de la Santé et des Services Sociaux, 1075, Chemin Sainte-Foy, Québec City, QC G1S 2M1, Canada
| | - Annie Turgeon
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Laurence Lambert-Côté
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, 155, College Street, Toronto, ON M5T 3M7, Canada
| | - Meghan J Walker
- Dalla Lana School of Public Health, University of Toronto, 155, College Street, Toronto, ON M5T 3M7, Canada
- Cancer Care Ontario, Ontario Health, 525, University Avenue, Toronto, ON M5G 2L3, Canada
| | | | - Yann Joly
- Centre of Genomics and Policy, McGill University, 740, Ave Penfield, Montreal, QC H3A 0G1, Canada
- Human Genetics Department and Bioethics Unit, Faculty of Medicine, McGill University, 3647, Peel Street, Montreal, QC G1V 0A6, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, McGill University, 740, Ave Penfield, Montreal, QC H3A 0G1, Canada
| | - Anna Maria Chiarelli
- Dalla Lana School of Public Health, University of Toronto, 155, College Street, Toronto, ON M5T 3M7, Canada
- Cancer Care Ontario, Ontario Health, 525, University Avenue, Toronto, ON M5G 2L3, Canada
| | - Jacques Simard
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, 1050, Avenue de la Médecine, Québec City, QC G1V 0A6, Canada
| | - Hermann Nabi
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, Av de la Médecine, Québec City, QC G1V 0A6, Canada
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Jia T, Wu C, Hu X, Li S, Zhang X, Cai Y, Chen J, Shi L, Lu CY, Nie X. Physicians' Knowledge, Attitude, and Experience of Pharmacogenomic Testing in China. J Pers Med 2022; 12:jpm12122021. [PMID: 36556242 PMCID: PMC9783535 DOI: 10.3390/jpm12122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: As prescribers, physicians play a decisive role in applying and promoting pharmacogenomic (PGx) testing in clinical practices. So far, little is known about physicians' perspectives on PGx testing in China. The aim of this study was to assess physicians' knowledge of, attitude towards, and experience of PGx testing in China. (2) Methods: A 39-question online survey was developed. Participants were physicians recruited through two platforms, MEDLINKER and "Dazhuanjia". (3) Results: A total of 450 respondents completed the survey and 366 questionnaires were eligible for analysis based on the inclusion criteria. Among all included physicians, 275 (75.1%) had heard of PGx testing before. More than half rated their knowledge of PGx testing as "Fair" (61.5%) while 20.0% chose "Excellent" or "Good" and 18.6% chose "Poor" or "Terrible". "Guidelines, consensus, and treatment paths for disease diagnosis and treatment" (72.7%) were the most preferred sources of information about PGx testing. Respondents were confident in their personal capacity to conduct PGx, with an average score of 3.30 ± 0.09 (out of 5.00). Most respondents (75.6%) believed that PGx could "help to improve efficacy and reduce the incidence of adverse reactions". Targeted cancer therapy (score 78.95 ± 1.26 out of 100) was considered the field where PGx testing had its highest value. Lack of professionals and knowledge (n = 186, 67.6%), high costs of testing (n = 170, 61.8%), and lack of hospitals to offer PGx testing (n = 166, 60.4%) were identified as the primary obstacles to increasing the uptake of PGx testing in China. Academic conference (n = 213, 72.4%) was considered the most efficient way for physicians to obtain information about PGx testing. (4) Conclusions: Physicians in China have poor knowledge about PGx testing; nonetheless, they generally had confidence in their capacity to order PGx testing and positive attitudes towards the use of PGx testing in routine clinical practices. Future efforts to promote the uptake of PGx testing should focus on foundational education and practical training.
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Affiliation(s)
- Tong Jia
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Caiying Wu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Xiaowen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Sicong Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Xinyi Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Yuchun Cai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Jing Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
- Correspondence: ; Tel.: +86-10-8280-5880
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O'Shea J, Ryan C, Gallagher J, O'Brien C, Morris C, Dwyer E, Laughlin JM, Fitzpatrick L, O'Meara M, Kelly S, Knox S, Ledwidge M. Public perceptions of pharmacogenomic services in Ireland - Are people with chronic disease more likely to want service availability than those without? A questionnaire study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100182. [PMID: 36200068 PMCID: PMC9529536 DOI: 10.1016/j.rcsop.2022.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background As pharmacogenomic services begin to emerge in primary care, the insight of the public is crucial for its integration into clinical practice. Objectives To establish perceptions of pharmacogenomics (awareness, understanding, openness to availability, perceived benefits and concerns, willingness to pay, and service setting) and investigate if they differ between those with and without chronic disease(s). Methods An anonymous, online questionnaire generated using Qualtrics® and circulated via social media and posters placed in eight participating community pharmacies was conducted with Irish adults. The questions were designed to consider existing literature on patient perceptions of pharmacogenomics. Descriptive statistics were used to summarize questionnaire responses. Chi-square test was used to compare categorical variables, while independent sample t-test and one-way ANOVA were used to compare the mean values of two (with and without chronic disease) and three groups (multimorbidity (two or more chronic conditions) and polypharmacy (prescribed four or more regular medicines) (MMPP), a single chronic disease, and those without existing medical conditions) respectively Logistic regression was used to evaluate age and gender adjusted associations of chronic disease(s) with responses. A p-value <0.05 was considered statistically significant. Results A total of 421 responses were received, 30% (n = 120) of whom reported having a chronic disease. Overall, respondents reported low awareness (44%, n = 166) and poor knowledge (55%, n = 212) of pharmacogenomics. After explaining pharmacogenomics to respondents, patients with chronic disease(s) were 2.17 times more likely (p < 0.001) to want pharmacogenomic services availability than those without existing conditions, adjusted for age and gender (driven by preferences of those with MMPP than those with single chronic disease). Respondents demonstrated a high level of interest and noted both the potential benefits and downsides of pharmacogenomic testing. Willingness-to-pay was not associated with having a chronic disease and respondents were more positive about primary care (community pharmacy or general practice) rather than hospital-based pharmacogenomics implementation. Conclusion The Irish public in general and those with chronic disease in particular are strongly supportive of pharmacogenomic testing, highlighting an unmet need for its incorporation in medicines optimization. These data underline the need for more research on the implementation of community-based pharmacogenomics services for MMPP patients and ubiquitous pharmacogenomics education programs.
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Lehmann LS, Snyder Sulmasy L, Burke W. Ethical Considerations in Precision Medicine and Genetic Testing in Internal Medicine Practice: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1322-1323. [PMID: 35878403 DOI: 10.7326/m22-0743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This American College of Physicians position paper aims to inform ethical decision making for the integration of precision medicine and genetic testing into clinical care. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and can also inform how health care systems, professional schools, and residency programs integrate genomics into educational and clinical settings. Addressing the challenges of precision medicine and genetic testing will guide ethical and responsible implementation to improve health outcomes.
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Affiliation(s)
- Lisa Soleymani Lehmann
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Google Health, Mountain View, California (L.S.L.)
| | | | - Wylie Burke
- University of Washington, Seattle, Washington (W.B.)
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Gates RW, Hudgins L, Huffman LC. Medical genetics education for pediatrics residents: A brief report. Genet Med 2022; 24:2408-2412. [PMID: 36029300 DOI: 10.1016/j.gim.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Genetic testing is ubiquitous in the field of medicine and is often ordered or requested by primary care providers, nongenetics subspecialists, and patients themselves. Other studies have shown that providers are often not comfortable ordering genetic testing. There have been initiatives to teach these concepts via continuing medical education; however, there is not a standardized training program for teaching resident physicians about genetic testing. METHODS During September to October 2020, we recruited all the pediatrics residents at our institution via email (N = 102). Residents were invited to complete a Qualtrics electronic survey that addressed self-perceived level of knowledge about core concepts of genetic testing, as well as self-perceived confidence discussing these concepts with families. RESULTS Response rate was 46 to 102 (45%). Proportions of respondents reporting they felt insufficiently knowledgeable ranged from 28% (basic concepts of genetics) to 80% (Genetic Information Nondiscrimination Act). Most pediatrics residents agreed that a curriculum teaching basics of genetic testing would be helpful to them. Desired curricular topics included indications and limitations of genetic testing, testing procedures, and counseling families. CONCLUSION Despite its expanding importance across medicine, genetics education is lacking in pediatrics residency programs and residents would benefit from a curriculum teaching basic concepts of genetic testing.
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Affiliation(s)
- Ryan W Gates
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
| | - Louanne Hudgins
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lynne C Huffman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Stanford Medicine, Stanford, CA
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Clinicians' Perceptions towards Precision Medicine Tools for Cardiovascular Disease Risk Stratification in South Africa. J Pers Med 2022; 12:jpm12091360. [PMID: 36143145 PMCID: PMC9505828 DOI: 10.3390/jpm12091360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of mortality and morbidity in South Africa. Risk stratification is the preferred approach to disease prevention, but identifying patients at high risk for CVD remains challenging. Assessing genetic risk could improve stratification and inform a clinically relevant precision medicine (PM) approach. Clinicians are critical to PM adoption, thus, this study explores practicing clinicians’ perceptions of PM-based CVD risk stratification in South Africa’s public health setting. Practicing clinicians (n = 109) at four teaching hospitals in Johannesburg, South Africa, completed an electronic self-administered survey. The effect of demographic and professional characteristics on PM-based CVD risk stratification perceptions was assessed. Fewer than 25% of respondents used clinical genetic testing, and 14% had formal genetics training. 78% had a low mean knowledge score, with higher scores associated with genetic training (p < 0.0005) and research involvement (p < 0.05). Despite limited knowledge and resources, 84% perceived PM approaches positively. 57% felt confident in applying the PM-based approach, with those already undertaking CVD risk stratification more confident (p < 0.001). High cost and limited access to genetics services are key barriers. Integrating genetic information into established clinical tools will likely increase confidence in using PM approaches. Addressing the genetics training gap and investment into the country’s genomics capacity is needed to advance PM in South Africa.
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11
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Bobo WV, Van Ommeren B, Athreya AP. Machine learning, pharmacogenomics, and clinical psychiatry: predicting antidepressant response in patients with major depressive disorder. Expert Rev Clin Pharmacol 2022; 15:927-944. [DOI: 10.1080/17512433.2022.2112949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- William V. Bobo
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN & Jacksonville, FL, USA
| | | | - Arjun P. Athreya
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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12
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Eadon MT, Cavanaugh KL, Orlando LA, Christian D, Chakraborty H, Steen-Burrell KA, Merrill P, Seo J, Hauser D, Singh R, Beasley CM, Fuloria J, Kitzman H, Parker AS, Ramos M, Ong HH, Elwood EN, Lynch SE, Clermont S, Cicali EJ, Starostik P, Pratt VM, Nguyen KA, Rosenman MB, Calman NS, Robinson M, Nadkarni GN, Madden EB, Kucher N, Volpi S, Dexter PR, Skaar TC, Johnson JA, Cooper-DeHoff RM, Horowitz CR. Design and rationale of GUARDD-US: A pragmatic, randomized trial of genetic testing for APOL1 and pharmacogenomic predictors of antihypertensive efficacy in patients with hypertension. Contemp Clin Trials 2022; 119:106813. [PMID: 35660539 PMCID: PMC9928488 DOI: 10.1016/j.cct.2022.106813] [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: 02/16/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVE APOL1 risk alleles are associated with increased cardiovascular and chronic kidney disease (CKD) risk. It is unknown whether knowledge of APOL1 risk status motivates patients and providers to attain recommended blood pressure (BP) targets to reduce cardiovascular disease. STUDY DESIGN Multicenter, pragmatic, randomized controlled clinical trial. SETTING AND PARTICIPANTS 6650 individuals with African ancestry and hypertension from 13 health systems. INTERVENTION APOL1 genotyping with clinical decision support (CDS) results are returned to participants and providers immediately (intervention) or at 6 months (control). A subset of participants are re-randomized to pharmacogenomic testing for relevant antihypertensive medications (pharmacogenomic sub-study). CDS alerts encourage appropriate CKD screening and antihypertensive agent use. OUTCOMES Blood pressure and surveys are assessed at baseline, 3 and 6 months. The primary outcome is change in systolic BP from enrollment to 3 months in individuals with two APOL1 risk alleles. Secondary outcomes include new diagnoses of CKD, systolic blood pressure at 6 months, diastolic BP, and survey results. The pharmacogenomic sub-study will evaluate the relationship of pharmacogenomic genotype and change in systolic BP between baseline and 3 months. RESULTS To date, the trial has enrolled 3423 participants. CONCLUSIONS The effect of patient and provider knowledge of APOL1 genotype on systolic blood pressure has not been well-studied. GUARDD-US addresses whether blood pressure improves when patients and providers have this information. GUARDD-US provides a CDS framework for primary care and specialty clinics to incorporate APOL1 genetic risk and pharmacogenomic prescribing in the electronic health record. TRIAL REGISTRATION ClinicalTrials.govNCT04191824.
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Affiliation(s)
- Michael T Eadon
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Lori A Orlando
- Duke University School of Medicine, Durham, NC 27720, USA
| | - David Christian
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hrishikesh Chakraborty
- Duke University School of Medicine, Durham, NC 27720, USA; Duke Clinical Research Institute, Durham, NC 27720, USA
| | | | - Peter Merrill
- Duke Clinical Research Institute, Durham, NC 27720, USA
| | - Janet Seo
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Diane Hauser
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Family Health, New York, NY 10029, USA
| | - Rajbir Singh
- Meharry Medical College, Nashville, TN 37208, USA
| | - Cherry Maynor Beasley
- McKenzie-Elliott School of Nursing, University of North Carolina at Pembroke, Pembroke, NC 28372, USA
| | - Jyotsna Fuloria
- Office of Research, University Medical Center New Orleans, New Orleans, LA 70112, USA
| | - Heather Kitzman
- Baylor Scott & White Health, Baylor University, Robbins Institute for Health Policy & Leadership, Dallas, TX 75246, USA
| | - Alexander S Parker
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL 32209, USA
| | - Michelle Ramos
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Henry H Ong
- Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Erica N Elwood
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | - Sheryl E Lynch
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sabrina Clermont
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Emily J Cicali
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | - Petr Starostik
- University of Florida, College of Medicine, Gainesville, FL 32610, USA
| | - Victoria M Pratt
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Khoa A Nguyen
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | - Marc B Rosenman
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Neil S Calman
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Family Health, New York, NY 10029, USA
| | | | - Girish N Nadkarni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ebony B Madden
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Natalie Kucher
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Simona Volpi
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Paul R Dexter
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Julie A Johnson
- University of Florida, College of Pharmacy, Gainesville, FL 32610, USA
| | | | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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13
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Langfelder-Schwind E, Raraigh KS, Parad RB. Genetic counseling access for parents of newborns who screen positive for cystic fibrosis: Consensus guidelines. Pediatr Pulmonol 2022; 57:894-902. [PMID: 34964558 DOI: 10.1002/ppul.25806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A risk associated with cystic fibrosis newborn screening (CFNBS) is parental misunderstanding of genetic information generated by the over 6600 positive screens reported annually in the United States. CFNBS algorithms incorporating DNA analysis can generate genetic information that requires clinical interpretation and has significance for the newborn, parents, and other relatives. Engagement between CF care centers and trained genetic counseling providers, such as licensed and/or certified genetic counselors (GCs), is variable and limited in providing information to CFNBS positive (CFNBS+) families. METHODS Using a modified Delphi process, a workgroup of CFNBS experts developed recommendation statements for engagement of genetic counseling services in CF care centers where CFNBS + diagnostic evaluations are performed. Statements were assessed over three rounds of surveys, one face-to-face meeting, and through public feedback. RESULTS Seventeen statements achieved >80% consensus (range: 82%-100%). The workgroup affirmed prior CFF policy statements recommending genetic counseling for parents of infants with CFNBS+. The remaining statements addressed infrastructure and logistics of genetic counseling services, including defining appropriate training for genetic counseling providers and counseling content, establishing a path to equal access to genetic counseling providers across CF care centers, and setting a standard for client-centered CFNBS genetic counseling that is respectful of diverse patient needs and autonomy. CONCLUSIONS Implementation of client-centered genetic counseling for CFNBS+ families in CF care centers by providers with expertise in both CF and genetic counseling will require efforts to further define core concepts, enhance the education of providers, and develop opportunities for access via telemedicine.
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Affiliation(s)
- Elinor Langfelder-Schwind
- Department of Pulmonary, Critical Care, and Sleep Medicine, The Cystic Fibrosis Center, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karen S Raraigh
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Richard B Parad
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
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14
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Pearce A, Terrill B, Alffenaar JW, Patanwala S, Kummerfeld S, Day R, Young MA, Stocker S. Pharmacogenomic testing: perception of clinical utility, enablers and barriers to adoption in Australian hospitals. Intern Med J 2022; 52:1135-1143. [PMID: 35191159 PMCID: PMC9541847 DOI: 10.1111/imj.15719] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
Background Despite healthcare professionals (HCP) endorsing the clinical utility of pharmacogenomics testing, use in clinical practice is limited. Aims To assess HCP' perceptions of pharmacogenomic testing and identify barriers to implementation. Methods HCP involved in prescribing decisions at three hospitals in Sydney, Australia, were invited to participate. The online survey assessed perceptions of pharmacogenomic testing, including: (i) demographic and practice variables; (ii) use, knowledge and confidence; (iii) perceived benefits; (iv) barriers to implementation; and (v) operational and/or system changes and personnel required to implement on site. Results HCP were predominantly medical practitioners (75/107) and pharmacists (25/107). HCP perceived pharmacogenomic testing was beneficial to identify reasons for drug intolerance (85/95) and risk of side‐effects (86/95). Although testing was considered relevant to their practice (79/100), few HCP (23/100) reported past or intended future use (26/100). Few HCP reported confidence in their ability to identify indications for pharmacogenomic testing (14/107), order tests (19/106) and communicate results with patients (16/107). Lack of clinical practice guidelines (62/79) and knowledge (54/77) were identified as major barriers to implementation of pharmacogenomics. Comprehensive reimbursement for testing and clinical practice guidelines, alongside models‐of‐care involving multidisciplinary teams and local clinical champions were suggested as strategies to facilitate implementation of pharmacogenomic testing into practice. Conclusions Pharmacogenomic testing was considered important to guide drug selection and dosing decisions. However, limited knowledge, low confidence and an absence of guidelines impede the use of pharmacogenomic testing. Establishment of local resources including multidisciplinary models‐of‐care was suggested to facilitate implementation of pharmacogenomics.
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Affiliation(s)
- Angela Pearce
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia
| | - Bronwyn Terrill
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Jan-Willem Alffenaar
- Sydney Pharmacy School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | - Sid Patanwala
- Sydney Pharmacy School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Sarah Kummerfeld
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Richard Day
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Sophie Stocker
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Sydney Pharmacy School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
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Abstract
PURPOSE In this ongoing case series, 33 genetic testing cases are documented in which tests were recommended, ordered, interpreted, or used incorrectly and/or in which clinicians faced challenges related to history/reports provided by patients or laboratories. METHODS An invitation to submit cases of challenges or errors in genetic testing was issued to the general National Society of Genetic Counselors Listserv, the National Society of Genetic Counselors Cancer Special Interest Group members, as part of a case series with Precision Oncology News, and via social media (i.e., Facebook, Twitter, LinkedIn). Deidentified clinical documentation was requested and reviewed when available. Thirty-three cases were submitted, reviewed, and accepted. A thematic analysis was performed. Submitters were asked to approve cases before submission. RESULTS All cases took place in the United States, involved hereditary cancer testing and/or findings in cancer predisposition genes, and involved medical-grade genetic testing, direct-to-consumer testing, or research genetic testing. In 9 cases, test results were misinterpreted, leading to incorrect screening or risk-reducing procedures being performed/recommended. In 5 cases, incorrect or unnecessary testing was ordered/recommended. In 3 cases, incorrect clinical diagnoses were made, or opportunities for diagnoses were delayed. In 3 cases, errors or challenges arose related to medical intervention after testing or reported genetic diagnosis. In 2 cases, physicians provided incorrect information related to the inheritance pattern of a syndrome. In 2 cases, there were challenges related to the interpretation of genetic variants. In 2 cases, challenges arose after direct-to-consumer testing. One case involved test results that should never have been reported based on sample quality. In 1 case, a patient presented a falsified test result. In 5 cases, multiple errors were made. DISCUSSION As genetic testing continues to become more complicated and common, it is critical that patients and nongenetics providers have access to accurate and timely genetic counseling information. Even as multiple medical bodies highlight the value of genetic counselors (GCs), tension exists in the genomics community as GCs work toward licensure and Medicare provider status. It is critical that health care communities leverage, rather than restrict, the expertise and experience of GCs so that patients can benefit from, and not be harmed by, genetic testing. In order to responsibly democratize genomics, it will be important for genetics and nongenetic health care providers to collaborate and use alternative service delivery models and technology solutions at point of care. To deliver on the promise of precision medicine, accurate resources and tools must be utilized.
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16
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Hansen JM, Nørgaard JDSV, Kälvemark Sporrong S. A systematic review of pharmacogenetic testing in primary care: Attitudes of patients, general practitioners, and pharmacists. Res Social Adm Pharm 2021; 18:3230-3238. [PMID: 34996718 DOI: 10.1016/j.sapharm.2021.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharmacogenetic testing enhances patient safety by improving medical treatment and reducing side effects. It has shown potential in both primary and secondary care. However, implementation in healthcare, particularly in primary care, is slow. OBJECTIVE The objective was to review articles published on the attitudes towards, and knowledge on pharmacogenetic testing in primary care, among general practitioners, pharmacists, and patients. METHODS The review was performed according to the PRISMA checklist. A systemized literature search was followed by a 2-step screening process. Apart from the content of articles being within the scope of the review, inclusion criteria included: articles in English; primary research articles; qualitative, quantitative, or mixed methods. Content analysis was conducted as a qualitative meta-synthesis. The methodological rigor of included articles was assessed. RESULTS Fifteen studies were included. The analysis resulted in the following main themes: i) benefits of pharmacogenetic testing, ii) barriers to pharmacogenetic testing, iii) pharmacists' role in pharmacogenetic counselling, and iv) pharmacists' knowledge on pharmacogenetics. Methodological rigor was generally medium/high. CONCLUSIONS More studies are needed in this area, and there is a need for more education on pharmacogenetic testing for healthcare professionals. Issues like patient autonomy, economy, and access to tests also need to be addressed.
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Affiliation(s)
- Johanne Mølby Hansen
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, København Ø, Denmark.
| | - Josefine D S V Nørgaard
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, København Ø, Denmark; Capital Region Hospital Pharmacy, North Zealand Hospitals, Denmark.
| | - Sofia Kälvemark Sporrong
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, København Ø, Denmark; Department of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden.
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17
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Truong TK, Kenneson A, Rosen AR, Singh RH. Genetic Referral Patterns and Responses to Clinical Scenarios: A Survey of Primary Care Providers and Clinical Geneticists. J Prim Care Community Health 2021; 12:21501327211046734. [PMID: 34583568 PMCID: PMC8485275 DOI: 10.1177/21501327211046734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary care physicians (PCPs) are considered the gatekeepers of genetic services, but they often underutilize or inappropriately utilize such services, leading to lack of early treatment, incorrect diagnoses, and unnecessary procedures. This study aims to delineate PCP referral patterns, including the frequency of, motivators for, and barriers to genetic referrals and testing in the present landscape of genomics. Methods: A 34-item online survey was distributed to PCPs in the United States (US). PCP demographics, practice characteristics, and referral patterns, motivators, and barriers were analyzed. Six hypothetical clinical scenarios included in the survey also were presented to a cohort of clinical geneticists. We calculated PCPs’ rates of ordering genetic tests and of referral to genetics services in the past year. Rates and responses to clinical scenarios were compared based on respondents’ personal and practice characteristics. Results: A total of 95 PCPs and 25 clinical geneticists participated. Among the PCPs, 79% reported referring and 50% reported ordering genetic testing in the last year. PCPs with genetic counselors (GCs) in their clinic referred at significantly higher rates than those without (P = .008). White PCPs referred at significantly higher rates compared to Black or African American PCPs (P = .009). The most commonly reported motivators for referring patients to genetic services were preference for specialist coordination, lack of knowledge, and family’s desire for risk information. The most commonly reported barriers were patient refusal, provider concerns about costs to patients, and uncertainty of when a genetic referral is appropriate. In response to clinical scenarios, clinical geneticists were in agreement about the need for genetic testing or referral for 2 of the scenarios. For these 2 scenarios, only 48% and 71% of PCPs indicated that they would offer genetic testing or referral, respectively. Conclusions: Responses to clinical scenarios suggest that it is not clear to PCPs when referrals or testing are needed. Collaboration with GCs is one approach to reducing barriers to and improving PCPs’ utilization of genetic services. Clear guidelines from clinical geneticists may help facilitate appropriate use of genetics services by PCPs. Additional research is needed to further describe barriers that PCPs face in genetic testing/referrals.
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Affiliation(s)
- Tina K Truong
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ami R Rosen
- Emory University School of Medicine, Atlanta, GA, USA
| | - Rani H Singh
- Emory University School of Medicine, Atlanta, GA, USA
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18
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Sharma Y, Cox L, Kruger L, Channamsetty V, Haga SB. Evaluating Primary Care Providers' Readiness for Delivering Genetic and Genomic Services to Underserved Populations. Public Health Genomics 2021; 25:1-10. [PMID: 34515218 DOI: 10.1159/000518415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Increased genomics knowledge and access are advancing precision medicine and care delivery. With the translation of precision medicine across health care, genetics and genomics will play a greater role in primary care services. Health disparities and inadequate representation of racial and ethnically diverse groups threaten equitable access for those historically underserved. Health provider awareness, knowledge, and perceived importance are important determinants of the utilization of genomic applications. METHODS We evaluated the readiness of primary care providers at a Federally Qualified Health Center, the Community Health Center, Inc. (CHCI) for delivering genetic and genomic testing to underserved populations. Online survey questions focused on providers' education and training in basic and clinical genetics, familiarity with current genetic tests, and needs for incorporating genetics and genomics into their current practice. RESULTS Fifty of 77 (65%) primary care providers responded to the survey. Less than half received any training in basic or clinical genetics (40%), were familiar with specific genetic tests (36%), or felt confident with collecting family health history (44%), and 70% believed patients would benefit from genetic testing. CONCLUSION Despite knowledge gaps, respondents recognized the value and need to bring these services to their patients, though would like more education on applying genetics and genomics into their practice, and more training about discussing risk factors associated with race or ethnicity. We provide further evidence of the need for educational resources and standardized guidelines for providers caring for underserved populations to optimize appropriate use and referral of genetic and genomic services and to reduce disparities in care.
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Affiliation(s)
- Yashoda Sharma
- Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut, USA
| | - Livia Cox
- Wesleyan University, Middletown, Connecticut, USA
| | - Lucie Kruger
- Wesleyan University, Middletown, Connecticut, USA
| | - Veena Channamsetty
- Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut, USA
| | - Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Dive L, Archibald AD, Newson AJ. Ethical considerations in gene selection for reproductive carrier screening. Hum Genet 2021; 141:1003-1012. [PMID: 34426854 PMCID: PMC9160090 DOI: 10.1007/s00439-021-02341-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022]
Abstract
Genetic carrier screening for reproductive purposes has existed for half a century. It was originally offered to particular ethnic groups with a higher prevalence of certain severe recessive or X-linked genetic conditions, or (as carrier testing) to those with a family history of a particular genetic condition. Commercial providers are increasingly offering carrier screening on a user-pays basis. Some countries are also trialing or offering public reproductive genetic carrier screening with whole populations, rather than only to those known to have a higher chance of having a child with an inherited genetic condition. Such programs broaden the ethical and practical challenges that arise in clinical carrier testing. In this paper we consider three aspects of selecting genes for population reproductive genetic carrier screening panels that give rise to important ethical considerations: severity, variable penetrance and expressivity, and scalability; we also draw on three exemplar genes to illustrate the ethical issues raised: CFTR, GALT and SERPINA1. We argue that such issues are important to attend to at the point of gene selection for RGCS. These factors warrant a cautious approach to screening panel design, one that takes into account the likely value of the information generated by screening and the feasibility of implementation in large and diverse populations. Given the highly complex and uncertain nature of some genetic variants, careful consideration needs to be given to the balance between delivering potentially burdensome or harmful information, and providing valuable information to inform reproductive decisions.
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Affiliation(s)
- Lisa Dive
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Level 1, Edward Ford Building A27, Sydney, NSW, 2006, Australia
| | - Alison Dalton Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Level 1, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
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20
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Nisselle A, King EA, McClaren B, Janinski M, Metcalfe S, Gaff C. Measuring physician practice, preparedness and preferences for genomic medicine: a national survey. BMJ Open 2021; 11:e044408. [PMID: 34244249 PMCID: PMC8273463 DOI: 10.1136/bmjopen-2020-044408] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Even as genomic medicine is implemented globally, there remains a lack of rigorous, national assessments of physicians' current genomic practice and continuing genomics education needs. The aim of this study was to address this gap. DESIGN A cross-sectional survey, informed by qualitative data and behaviour change theory, to assess the current landscape of Australian physicians' genomic medicine practice, perceptions of proximity and individual preparedness, and preferred models of practice and continuing education. The survey was advertised nationally through 10 medical colleges, 24 societies, 62 hospitals, social media, professional networks and snowballing. RESULTS 409 medical specialists across Australia responded, representing 30 specialties (majority paediatricians, 20%), from mainly public hospitals (70%) in metropolitan areas (75%). Half (53%) had contacted their local genetics services and half (54%) had ordered or referred for a gene panel or exome/genome sequencing test in the last year. Two-thirds (67%) think genomics will soon impact their practice, with a significant preference for models that involved genetics services (p<0.0001). Currently, respondents mainly perform tasks associated with pretest family history taking and counselling, but more respondents expect to perform tasks at all stages of testing in the future, including tasks related to the test itself, and reporting results. While one-third (34%) recently completed education in genomics, only a quarter (25%) felt prepared to practise. Specialists would like (more) education, particularly on genomic technologies and clinical utility, and prefer this to be through varied educational strategies. CONCLUSIONS This survey provides data from a breadth of physician specialties that can inform models of genetic service delivery and genomics education. The findings support education providers designing and delivering education that best meet learner needs to build a competent, genomic-literate workforce. Further analyses are underway to characterise early adopters of genomic medicine to inform strategies to increase engagement.
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Affiliation(s)
- Amy Nisselle
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Emily A King
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Belinda McClaren
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Monika Janinski
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sylvia Metcalfe
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Clara Gaff
- Australian Genomics, Genomics in Society, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Parkville, Victoria, Australia
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21
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Pediatric Oncologists' Experiences Returning and Incorporating Genomic Sequencing Results into Cancer Care. J Pers Med 2021; 11:jpm11060570. [PMID: 34207141 PMCID: PMC8235493 DOI: 10.3390/jpm11060570] [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: 05/15/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric oncologists’ perspectives around returning and incorporating tumor and germline genomic sequencing (GS) results into cancer care are not well-described. To inform optimization of cancer genomics communication, we assessed oncologists’ experiences with return of genomic results (ROR), including their preparation/readiness for ROR, collaboration with genetic counselors (GCs) during ROR, and perceived challenges. The BASIC3 study paired pediatric oncologists with GCs to return results to patients’ families. We thematically analyzed 24 interviews with 12 oncologists at two post-ROR time points. Oncologists found pre-ROR meetings with GCs and geneticists essential to interpreting patients’ reports and communicating results to families. Most oncologists took a collaborative ROR approach where they discussed tumor findings and GCs discussed germline findings. Oncologists perceived many roles for GCs during ROR, including answering families’ questions and describing information in lay language. Challenges identified included conveying uncertain information in accessible language, limits of oncologists’ genetics expertise, and navigating families’ emotional responses. Oncologists emphasized how GCs’ and geneticists’ support was essential to ROR, especially for germline findings. GS can be successfully integrated into cancer care, but to account for the GC shortage, alternative ROR models and access to genetics resources will be needed to better support families and avoid burdening oncologists.
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22
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McDermott JH, Mahood R, Stoddard D, Mahaveer A, Turner MA, Corry R, Garlick J, Miele G, Ainsworth S, Kemp L, Bruce I, Body R, Ulph F, Macleod R, Harvey K, Booth N, Roberts P, Wilson P, Newman WG. Pharmacogenetics to Avoid Loss of Hearing (PALOH) trial: a protocol for a prospective observational implementation trial. BMJ Open 2021; 11:e044457. [PMID: 34135034 PMCID: PMC8211036 DOI: 10.1136/bmjopen-2020-044457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In conjunction with a beta-lactam, aminoglycosides are the first-choice antibiotic for empirical treatment of sepsis in the neonatal period. The m.1555A>G variant predisposes to ototoxicity after aminoglycoside administration and has a prevalence of 1 in 500. Current genetic testing can take over 24 hours, an unacceptable delay in the acute setting. This prospective-observational trial will implement a rapid point of care test (POCT), facilitating tailored antibiotic prescribing to avoid hearing loss. METHODS AND ANALYSIS The genedrive POCT can detect the m.1555A>G variant in 26 min from buccal swab. This system will be integrated into the clinical pathways at two large UK neonatal centres over a minimum 6-month period. The primary outcome is the number of neonates successfully tested for the variant out of all babies prescribed antibiotics. As a secondary outcome, clinical timings will be compared with data collected prior to implementation, measuring the impact on routine practice. ETHICS AND DISSEMINATION Approval for the trial was granted by the Research Ethics Committee (REC) and Human Research Authority in August 2019. Results will be published in full on completion of the study. TRIAL REGISTRATION NUMBER ISRCTN13704894. PROTOCOL VERSION V 1.3.
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Affiliation(s)
- John Henry McDermott
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK
| | - Rachel Mahood
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Duncan Stoddard
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- DS Analytics and Machine Learning Ltd, London, UK
| | - Ajit Mahaveer
- Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mark A Turner
- Neonatal Intensive Care Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Rachel Corry
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Julia Garlick
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Iain Bruce
- Paediatric ENT Department, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Richard Body
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, Manchester, UK
| | - Fiona Ulph
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Rhona Macleod
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen Harvey
- Neonatal Intensive Care Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Nicola Booth
- Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Roberts
- Market Access & Reimbursement Solutions, Manchester, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK
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23
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Galbraith LN, Preys CL, Rehm HL, Scheuner MT, Hajek C, Green RC, Christensen KD. Primary care providers' responses to unsolicited Lynch syndrome secondary findings of varying clinical significance. Genet Med 2021; 23:1977-1983. [PMID: 34113000 PMCID: PMC8487923 DOI: 10.1038/s41436-021-01225-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: How primary care providers (PCPs) respond to genomic secondary findings (SFs) of varying clinical significance (pathogenic, uncertain significance (VUS), or benign) is unknown. Methods: We randomized 148 American Academy of Family Physicians members to review three reports with varying significance for Lynch syndrome. Participants provided open-ended responses about the follow-up they would address and organized the SF reports and five other topics in the order they would prioritize responding to them (1=highest priority, 6=lowest priority). Results: PCPs suggested referrals more often for pathogenic variants or VUSs than benign variants (72% vs 16%, p<0.001). PCPs were also more likely to address further workup, like a colonoscopy or EGD, in response to pathogenic variants or VUSs than benign variants (43% vs 4%, p<0.001). The likelihoods of addressing referrals or further workup were similar when PCPs reviewed pathogenic variants and VUSs (both p>0.46). SF reports were prioritized highest for pathogenic variants (2.7 for pathogenic variants, 3.6 for VUSs, 4.3 for benign variants, all p≤0.014). Conclusions: Results suggest that while PCPs appreciated the differences in clinical significance, disclosure of VUSs as SFs would substantially increase downstream health care utilization.
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Affiliation(s)
- Lauren N Galbraith
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Charlene L Preys
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Heidi L Rehm
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Maren T Scheuner
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Division of Medical Genetics, Department of Pediatrics, and Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Catherine Hajek
- Sanford Health Imagenetics, Sioux Falls, SD, USA.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Ariadne Labs, Boston, MA, USA
| | - Kurt D Christensen
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA. .,Broad Institute of Harvard and MIT, Cambridge, MA, USA. .,Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
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24
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Kittikoon S, Pithukpakorn M, Pramyothin P. Physician awareness, preparedness, and opinions toward consumer-initiated genetic testing in Thailand: Views from a changing landscape. J Genet Couns 2021; 30:1535-1543. [PMID: 33931918 DOI: 10.1002/jgc4.1420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/25/2021] [Accepted: 02/20/2021] [Indexed: 12/19/2022]
Abstract
Consumer-initiated genetic tests have captured public interest in recent years, including in low-to-middle-income countries (LMICs) such as Thailand. Due to limited resources and personnel, physicians will most likely bear the burden of increasing service needs from the public as consumer-initiated genetic tests become popularized. The primary objective of this study was to describe (a) awareness, (b) preparedness to provide counseling about the consumer-initiated genetic test, and (c) opinions on the usefulness of consumer-initiated genetic tests among physicians at an academic hospital in Bangkok, Thailand. The secondary objective was to describe factors that were associated with the awareness, preparedness, and opinion of the participants. Paper questionnaires were sent out to participants which included internal medicine residents, fellows, and faculty staff members. The questionnaires assessed awareness, preparedness to discuss consumer-initiated genetic test results, and opinion on the usefulness of consumer-initiated genetic tests and included both closed- and open-ended questions. Responses were anonymous. Among 308 participants, there were 223 (72.4%) residents, 14 (4.5%) fellows, and 71 (23.1%) staff members. Only 15% of participants were aware of consumer-initiated genetic tests, mostly from the internet, and only 7% were prepared to provide counseling regarding consumer-initiated genetic tests. However, 60% agreed that consumer-initiated genetic tests may be clinically useful. Many participants, including trainees, expressed concerns about the interpretation of consumer-initiated genetic test results, application into clinical practice, appropriate counseling, and patient referral to geneticists. Multivariate logistic regression revealed that years of work experience was independently associated with awareness of consumer-initiated genetic tests, while male gender and less work experience were independently associated with favorable opinion toward the usefulness of consumer-initiated genetic tests. Our results pointed to an urgent need for genetic counselors in Thailand. Also, physicians, particularly trainees, need appropriate training to prepare them for a rapidly evolving environment where consumer-initiated genetic tests become commonplace.
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Affiliation(s)
- Siraphob Kittikoon
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manop Pithukpakorn
- Division of Medical Genetics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpoj Pramyothin
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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25
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Abstract
Neurodevelopmental disorders are the most prevalent chronic medical conditions encountered in pediatric primary care. In addition to identifying appropriate descriptive diagnoses and guiding families to evidence-based treatments and supports, comprehensive care for individuals with neurodevelopmental disorders includes a search for an underlying etiologic diagnosis, primarily through a genetic evaluation. Identification of an underlying genetic etiology can inform prognosis, clarify recurrence risk, shape clinical management, and direct patients and families to condition-specific resources and supports. Here we review the utility of genetic testing in patients with neurodevelopmental disorders and describe the three major testing modalities and their yields - chromosomal microarray, exome sequencing (with/without copy number variant calling), and FMR1 CGG repeat analysis for fragile X syndrome. Given the diagnostic yield of genetic testing and the potential for clinical and personal utility, there is consensus that genetic testing should be offered to all patients with global developmental delay, intellectual disability, and/or autism spectrum disorder. Despite this recommendation, data suggest that a minority of children with autism spectrum disorder and intellectual disability have undergone genetic testing. To address this gap in care, we describe a structured but flexible approach to facilitate integration of genetic testing into clinical practice across pediatric specialties and discuss future considerations for genetic testing in neurodevelopmental disorders to prepare pediatric providers to care for patients with such diagnoses today and tomorrow.
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Affiliation(s)
- Juliann M. Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
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26
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Odgis JA, Gallagher KM, Suckiel SA, Donohue KE, Ramos MA, Kelly NR, Bertier G, Blackburn C, Brown K, Fielding L, Lopez J, Aguiniga KL, Maria E, Rodriguez JE, Sebastin M, Teitelman N, Watnick D, Yelton NM, Abhyankar A, Abul-Husn NS, Baum A, Bauman LJ, Beal JC, Bloom T, Cunningham-Rundles C, Diaz GA, Dolan S, Ferket BS, Jobanputra V, Kovatch P, McDonald TV, McGoldrick PE, Rhodes R, Rinke ML, Robinson M, Rubinstein A, Shulman LH, Stolte C, Wolf SM, Yozawitz E, Zinberg RE, Greally JM, Gelb BD, Horowitz CR, Wasserstein MP, Kenny EE. The NYCKidSeq project: study protocol for a randomized controlled trial incorporating genomics into the clinical care of diverse New York City children. Trials 2021; 22:56. [PMID: 33446240 PMCID: PMC7807444 DOI: 10.1186/s13063-020-04953-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasingly, genomics is informing clinical practice, but challenges remain for medical professionals lacking genetics expertise, and in access to and clinical utility of genomic testing for minority and underrepresented populations. The latter is a particularly pernicious problem due to the historical lack of inclusion of racially and ethnically diverse populations in genomic research and genomic medicine. A further challenge is the rapidly changing landscape of genetic tests and considerations of cost, interpretation, and diagnostic yield for emerging modalities like whole-genome sequencing. METHODS The NYCKidSeq project is a randomized controlled trial recruiting 1130 children and young adults predominantly from Harlem and the Bronx with suspected genetic disorders in three disease categories: neurologic, cardiovascular, and immunologic. Two clinical genetic tests will be performed for each participant, either proband, duo, or trio whole-genome sequencing (depending on sample availability) and proband targeted gene panels. Clinical utility, cost, and diagnostic yield of both testing modalities will be assessed. This study will evaluate the use of a novel, digital platform (GUÍA) to digitize the return of genomic results experience and improve participant understanding for English- and Spanish-speaking families. Surveys will collect data at three study visits: baseline (0 months), result disclosure visit (ROR1, + 3 months), and follow-up visit (ROR2, + 9 months). Outcomes will assess parental understanding of and attitudes toward receiving genomic results for their child and behavioral, psychological, and social impact of results. We will also conduct a pilot study to assess a digital tool called GenomeDiver designed to enhance communication between clinicians and genetic testing labs. We will evaluate GenomeDiver's ability to increase the diagnostic yield compared to standard practices, improve clinician's ability to perform targeted reverse phenotyping, and increase the efficiency of genetic testing lab personnel. DISCUSSION The NYCKidSeq project will contribute to the innovations and best practices in communicating genomic test results to diverse populations. This work will inform strategies for implementing genomic medicine in health systems serving diverse populations using methods that are clinically useful, technologically savvy, culturally sensitive, and ethically sound. TRIAL REGISTRATION ClinicalTrials.gov NCT03738098 . Registered on November 13, 2018 Trial Sponsor: Icahn School of Medicine at Mount Sinai Contact Name: Eimear Kenny, PhD (Principal Investigator) Address: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1003, New York, NY 10029 Email: eimear.kenny@mssm.edu.
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Affiliation(s)
- Jacqueline A Odgis
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie M Gallagher
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sabrina A Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine E Donohue
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle A Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole R Kelly
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gabrielle Bertier
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Blackburn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kaitlyn Brown
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lena Fielding
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Jessenia Lopez
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karla Lopez Aguiniga
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Estefany Maria
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica E Rodriguez
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monisha Sebastin
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nehama Teitelman
- Department of Pediatrics, Division of Pediatric Academic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dana Watnick
- Department of Pediatrics, Division of Pediatric Academic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole M Yelton
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Noura S Abul-Husn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Baum
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie J Bauman
- Department of Pediatrics, Division of Pediatric Academic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jules C Beal
- Department of Pediatrics, Division of Child Neurology, Weill Cornell Medical, New York, NY, USA
| | - Toby Bloom
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Charlotte Cunningham-Rundles
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George A Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Siobhan Dolan
- Department of Obstetrics and Gynecology and Women's Health (Reproductive and Medical Genetics), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vaidehi Jobanputra
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Patricia Kovatch
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Scientific Computing and Data Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas V McDonald
- Department of Medicine (Cardiology), Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia E McGoldrick
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | - Rosamond Rhodes
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael L Rinke
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Arye Rubinstein
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa H Shulman
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christian Stolte
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Steven M Wolf
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | - Elissa Yozawitz
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eimear E Kenny
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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27
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Snir M, Nazareth S, Simmons E, Hayward L, Ashcraft K, Bristow SL, Esplin ED, Aradhya S. Democratizing genomics: Leveraging software to make genetics an integral part of routine care. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2020; 187:14-27. [PMID: 33296144 DOI: 10.1002/ajmg.c.31866] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022]
Abstract
Genetic testing can provide definitive molecular diagnoses and guide clinical management decisions from preconception through adulthood. Innovative solutions for scaling clinical genomics services are necessary if they are to transition from a niche specialty to a routine part of patient care. The expertise of specialists, like genetic counselors and medical geneticists, has traditionally been relied upon to facilitate testing and follow-up, and while ideal, this approach is limited in its ability to integrate genetics into primary care. As individuals, payors, and providers increasingly realize the value of genetics in mainstream medicine, several implementation challenges need to be overcome. These include electronic health record integration, patient and provider education, tools to stay abreast of guidelines, and simplification of the test ordering process. Currently, no single platform offers a holistic view of genetic testing that streamlines the entire process across specialties that begins with identifying at-risk patients in mainstream care settings, providing pretest education, facilitating consent and test ordering, and following up as a "genetic companion" for ongoing management. We describe our vision for using software that includes clinical-grade chatbots and decision support tools, with direct access to genetic counselors and pharmacists within a modular, integrated, end-to-end testing journey.
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28
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Stenner SP, Rice W, Nelson SD. A Viewpoint on the Information Sharing Paradox. Appl Clin Inform 2020; 11:460-463. [PMID: 32643779 DOI: 10.1055/s-0040-1713413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Shane P Stenner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - William Rice
- Vanderbilt Health Affiliated Network, Nashville, Tennessee, United States
| | - Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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29
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Frigon MP, Blackburn MÈ, Dubois-Bouchard C, Gagnon AL, Tardif S, Tremblay K. Pharmacogenetic testing in primary care practice: opinions of physicians, pharmacists and patients. Pharmacogenomics 2020; 20:589-598. [PMID: 31190623 DOI: 10.2217/pgs-2019-0004] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Although health authorities have set pharmacogenetic (PGx) markers on labels of hundreds of drugs, the use of PGx in clinical care remains infrequent. The adoption of PGx will depend on the opinions of physicians, pharmacists and patients. Materials & methods: Qualitative focus group interviews were performed with 23 physicians, 11 pharmacists and 30 patients. Results: Majority of the participants showed enthusiasm toward the implementation of PGx in clinics. Lack of knowledge on PGx, roles of healthcare providers, factors in favor and challenges of PGx implementation, ethical and insurance issues, educational and tools needs were the key themes that emerged from the interviews. Conclusion: Several barriers impede the uptake of PGx in clinics, however, opinions of physicians, pharmacists and patients are mostly favorable.
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Affiliation(s)
- Marie-Pier Frigon
- Community Genomic Medicine Centre & biocluster ECOGENE-21, Department of Medicine, Université de Montréal, Saguenay, QC, Canada
| | | | | | - Ann-Lorie Gagnon
- Community Genomic Medicine Centre & biocluster ECOGENE-21, Department of Medicine, Université de Montréal, Saguenay, QC, Canada
| | - Suzie Tardif
- ÉCOBES-Research & Transfer Center, Cégep de Jonquière, QC, Canada
| | - Karine Tremblay
- Community Genomic Medicine Centre & biocluster ECOGENE-21, Department of Medicine, Université de Montréal, Saguenay, QC, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada
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30
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Rashkin MD, Bowes J, Dunaway K, Dhaliwal J, Loomis E, Riffle S, Washington NL, Ziegler C, Lu J, Levin E. Genetic counseling, 2030: An on-demand service tailored to the needs of a price conscious, genetically literate, and busy world. J Genet Couns 2020; 28:456-465. [PMID: 30964579 DOI: 10.1002/jgc4.1123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
Abstract
The practice of genetic counseling is going to be impacted by the public's expectation that goods, services, information, and experiences happen on demand, wherever and whenever people want them. Building from trends that are currently taking shape, this article looks just over a decade into the future-to 2030-to provide a description of how the field of genetics and genetic counseling will be changed, as well as advice for genetic counselors for how to prepare. We build from the prediction that a large portion of the general public will have access to their digitized whole genome sequence anytime, any place, on any device. We focus on five topics downstream of this prediction: public health, personal autonomy, polygenic scores (PGS), evolving clinical practices, and genetic privacy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - James Lu
- Helix Opco, LLC, San Carlos, California
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Rosso A, Pitini E, D’Andrea E, Di Marco M, Unim B, Baccolini V, De Vito C, Marzuillo C, Barnhoorn F, Zeegers Paget D, Villari P. Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey. PLoS One 2020; 15:e0230749. [PMID: 32240206 PMCID: PMC7117699 DOI: 10.1371/journal.pone.0230749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services. Methods EUPHA members were invited via monthly newsletter and e-mail to take part in an online survey from February 2017 to January 2018. A descriptive analysis of knowledge and attitudes was conducted, along with a univariate and multivariate analysis of their determinants. Results Five hundred and two people completed the questionnaire, 17.9% were involved in PHG activities. Only 28.9% correctly identified all medical conditions for which there is (or not) evidence for implementing genetic testing; over 60% thought that investing in genomics may divert economic resources from social and environmental determinants of health. The majority agreed that PH professionals may play different roles in incorporating genomics into their activities. Better knowledge was associated with positive attitudes towards the use of genetic testing and the delivery of genetic services in PH (OR = 1.48; 95% CI 1.01–2.18). Conclusions Our study revealed quite positive attitudes, but also a need to increase awareness on genomics among European PH professionals. Those directly involved in PHG activities tend to have a more positive attitude and better knowledge; however, gaps are also evident in this group, suggesting the need to harmonize practice and encourage greater exchange of knowledge among professionals.
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Affiliation(s)
- Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit-Azienda Sanitaria Locale Roma 2, Rome, Italy
- * E-mail:
| | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Elvira D’Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Marco Di Marco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Floris Barnhoorn
- European Public Health Association (EUPHA), Utrecht, the Netherlands
| | | | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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32
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Asiedu GB, Finney Rutten LJ, Agunwamba A, Bielinski SJ, St. Sauver JL, Olson JE, Rohrer Vitek CR. An assessment of patient perspectives on pharmacogenomics educational materials. Pharmacogenomics 2020; 21:347-358. [PMID: 32292118 PMCID: PMC7197106 DOI: 10.2217/pgs-2019-0175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
Aim: Pharmacogenomics (PGx) holds potential to improve patient treatment; yet, effective patient educational materials are limited. Materials & methods: Using a 'think aloud' technique, we sought to understand comprehension and perceptions of a multimedia PGx results packet including a cover letter with QR code to an educational video, brochure and prototype report in the context of PGx case vignettes. Results: The cover letter and video components were viewed less favorably due to excess detail, complex jargon and technology challenges. Recommendations were to enhance comprehension and utility and to customize materials to each patient's medications or disease conditions. Conclusion: Educational materials were revised to improve comprehension and usability, and diminish concerns to better prepare patients to understand the importance of discussing test results with their provider.
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Affiliation(s)
- Gladys B Asiedu
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Lila J Finney Rutten
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Amenah Agunwamba
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jennifer L St. Sauver
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Kim WY, Kim HS, Oh M, Shin JG. Survey of physicians' views on the clinical implementation of pharmacogenomics-based personalized therapy. Transl Clin Pharmacol 2020; 28:34-42. [PMID: 32274379 PMCID: PMC7136078 DOI: 10.12793/tcp.2020.28.e6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Despite quantitative increases and qualitative advances in pharmacogenomics (PGx) research, the clinical implementation of PGx-based personalized therapy has still been limited. The objective of this study was to assess physicians' self-reported knowledge of PGx-based personalized therapy, and to explore the most problematic and highest priority barriers preventing physicians from applying PGx into clinical practice under the Korean healthcare system. A 36-question survey was distributed to 53 physicians with various specialties in Korea. In the physicians' self-perceived knowledge, twenty-eight physicians (53%) reported a lack sufficient knowledge about PGx. The perceived largest barrier to clinical implementation of PGx was the high cost of PGx testing, followed by a lack of PGx education for healthcare providers or lack of clinical PGx experts. Physicians without clinical PGx experience or with indirect experience reported that the largest barrier to clinical implementation of PGx was the high cost of PGx testing, while physicians with clinical PGx experience pointed out that a lack of patients' education was the major concern, followed by a lack of PGx education for healthcare providers or lack of clinical PGx experts. The highest priority problem was reported to be a lack of actionable guidelines for drug selection and dosing using PGx. In conclusion, we should increase and expand extensive educational programs for healthcare providers and patients, and to develop and establish a clinical decision support systems for PGx-based personalized therapy in Korea.
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Affiliation(s)
- Woo-Young Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Korea
| | - Ho-Sook Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Korea
| | - Minkyung Oh
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Korea
| | - Jae-Gook Shin
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Korea.,Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Korea
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34
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Riggan KA, Close S, Allyse MA. Family experiences and attitudes about receiving the diagnosis of sex chromosome aneuploidy in a child. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:404-413. [PMID: 32181570 DOI: 10.1002/ajmg.c.31781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 01/03/2023]
Abstract
The most common sex chromosome aneuploidies (SCA) (47, XXY; 47, XYY; 47, XXX) frequently result in a milder phenotype than autosomal aneuploidies. Nevertheless, these conditions are highly variable and more symptomatic phenotypes may require significant clinical involvement, including specialty care. While historically most individuals with mild phenotypes remained undiagnosed during their lifetime, the increasing use of genetic testing in clinical care has increased the prenatal and postnatal diagnosis of SCAs. These genetic tests are frequently ordered by nongenetic providers who are also responsible for delivering the diagnosis. We surveyed parents of children (n = 308) to evaluate their experience of receiving a diagnosis and their support needs. The majority (73.3%) received the diagnosis from a nongenetic medical provider. Following a prenatal diagnosis parents reported experiencing depression, anxiety, and less optimism than those receiving a postnatal diagnosis. Few parents reported receiving materials explaining their child's condition that they found to be up-to-date, accurate, and unbiased. The frequently negative reported experiences of parents at time of diagnosis suggests more educational opportunities should be provided for nongenetic providers in order to become more informed about these conditions and communicate the diagnosis in a way parents experience as supportive.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
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McClaren BJ, King EA, Crellin E, Gaff C, Metcalfe SA, Nisselle A. Development of an Evidence-Based, Theory-Informed National Survey of Physician Preparedness for Genomic Medicine and Preferences for Genomics Continuing Education. Front Genet 2020; 11:59. [PMID: 32194615 PMCID: PMC7063665 DOI: 10.3389/fgene.2020.00059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/17/2020] [Indexed: 01/31/2023] Open
Abstract
Despite some early implementation of genomic medicine globally, there is a lack of rigorous, large-scale assessments of medical specialists' current practice and continuing education needs. As a first step to addressing this gap, we describe the development of a robust, expert-reviewed, survey using a mixed-methods sequential study design. We conducted semi-structured qualitative interviews with 32 education providers and 86 non-genetic medical specialists about current genomic medicine practice and need for continuing education. Key concepts were identified and used as an initial framework for the survey. These were: personal characteristics (medical specialty, years of practice); current practice of genomics in clinical and research settings; perception of how proximal genomic medicine is to practice; perception of preparedness (competence and confidence); and, preferences for future roles and models of care in genomic medicine and for continuing education. Potential survey questions that related to at least one of these concepts were identified from the literature or were created if no suitable question existed. Using a modified, reactive Delphi approach, questions were reviewed by a panel of 22 experts. Experts were selected purposefully representing four areas of expertise: non-genetic medical specialties; clinical genetics; genetic/genomic education and evaluation; and implementation science. Three Delphi rounds assessed relevance, clarity and importance of each question. The questions were also mapped to the behaviour change wheel theoretical framework which encompasses capability, opportunity and motivation (COM-B). The survey (included as supplementary material) was then tested with a small group of non-genetic medical specialists and feedback was written or verbal in 'talk-aloud', cognitive interviews. The final survey was then piloted with a further 29 specialists. We describe the methodology to create a robust, data- and theory-informed survey. The final survey captures not only levels of experience, practice of genomics and preferences for education but also the challenges around engaging with education. Survey data will provide evidence for education providers to inform development of education which meets learner needs and contributes to a medical workforce that is literate in genomics and more confident to competently practice genomic medicine.
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Affiliation(s)
- Belinda J. McClaren
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily A. King
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Erin Crellin
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Sylvia A. Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
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36
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Simpson S, Seller A, Bishop M. Using the Findings of a National Survey to Inform the Work of England's Genomics Education Programme. Front Genet 2019; 10:1265. [PMID: 31921303 PMCID: PMC6927929 DOI: 10.3389/fgene.2019.01265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/18/2019] [Indexed: 01/24/2023] Open
Abstract
A national coordinated approach to workforce education and training in genomics is essential for the successful implementation of whole genome sequencing and, more broadly, genomic medicine within the National Health Service (NHS) in England. However, there have been no workforce wide assessments of genomics education and training needs that can be used to inform the strategic approach to be taken. In order to assess these needs the Genomics Education Programme (GEP) undertook a cross-professional training needs analysis. Responses from 2,814 individuals allowed the identification of four themes related to NHS staff's perceived education and training needs in genomics, those who: a) have a role in genomics and are competent; b) have a role in genomics but identified a specific learning need; c) could not identify whether genomics is relevant, but want to know more, and; d) do not see genomics as relevant to their role and do not believe they need to learn about it. Individuals are motivated to undertake training for their own continuing professional development and if they perceive training to have a direct impact on patient care. Overall, online learning is the preferred mode of delivery, but there are still many individuals who value face-to-face teaching. This paper demonstrates how the GEP has used these findings to provide an evidence base to inform the ongoing strategy for genomics education and training in the NHS, including the development of competency frameworks and a range of resources to address the diverse genomics learning needs of the healthcare workforce.
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Affiliation(s)
- Siobhan Simpson
- Genomics Education Programme, Health Education England, Birmingham, United Kingdom
| | - Anneke Seller
- Genomics Education Programme, Health Education England, Birmingham, United Kingdom
| | - Michelle Bishop
- Genomics Education Programme, Health Education England, Birmingham, United Kingdom
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37
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Gray SW, Gagan J, Cerami E, Cronin AM, Uno H, Oliver N, Lowenstein C, Lederman R, Revette A, Suarez A, Lee C, Bryan J, Sholl L, Van Allen EM. Interactive or static reports to guide clinical interpretation of cancer genomics. J Am Med Inform Assoc 2019; 25:458-464. [PMID: 29315417 PMCID: PMC6018970 DOI: 10.1093/jamia/ocx150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022] Open
Abstract
Objective Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation. Materials and Methods We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians’ genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0–18 and 1–4, respectively, higher score corresponding with improved endpoints). Results One hundred and five physicians at a tertiary cancer center participated (29% participation rate): 67% medical, 20% pediatric, 7% radiation, and 7% surgical oncology; 37% female. Prior to viewing the case-based vignettes, 34% of the physicians reported difficulty making treatment recommendations based on the standard static report. After vignette/report exposure, physicians’ overall comprehension scores did not differ by report type (mean score: interactive 11.6 vs static 10.5, difference = 1.1, 95% CI, −0.3, 2.5, P = .13). However, physicians exposed to the interactive report were more likely to correctly assess sequencing quality (P < .001) and understand when reports needed to be interpreted with caution (eg, low tumor purity; P = .02). Overall satisfaction scores were higher in the interactive group (mean score 2.5 vs 2.1, difference = 0.4, 95% CI, 0.2-0.7, P = .001). Discussion and Conclusion Interactive genomic reports may improve physicians’ ability to accurately assess genomic data and increase report-related satisfaction. Additional research in users’ genomic needs and efforts to integrate interactive reports into electronic health records may facilitate the implementation of precision oncology.
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Affiliation(s)
- Stacy W Gray
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA.,Beckman Research Institute, Duarte, CA, USA
| | - Jeffrey Gagan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ethan Cerami
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Angel M Cronin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hajime Uno
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nelly Oliver
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Carol Lowenstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ruth Lederman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna Revette
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Lynette Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Eliezer M Van Allen
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,The Broad Institute, Cambridge, MA, USA
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Veilleux S, Bouffard M. Knowledge and understanding of pharmacogenomic testing among patients and health care professionals: A scoping review. PATIENT EDUCATION AND COUNSELING 2019; 102:2001-2009. [PMID: 31229328 DOI: 10.1016/j.pec.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To support the introduction of pharmacogenomic tests in current practice, this study identifies the factors associated with a better understanding of the information related to genetic, genomic and/or pharmacogenomic tests by patients and health care professionals. METHODS Following a scoping review methodology, a search for literature was conducted with keywords related to health literacy and knowledge translation in the context of pharmacogenomic tests. Since only 6 articles were identified, the context of genetic or genomic testing were added to the inclusion criteria, leading to 24 articles. RESULTS Fourteen of the studies analyzed focused on genetic predictive, diagnostic or carrier tests, or concerned genetics in general, while ten addressed or included the use of pharmacogenomic tests. Demographic, individual, experiential and contextual factors were associated with a better understanding of the information related to genetic, genomic and/or pharmacogenomic tests among the targeted populations. RESEARCH IMPLICATIONS Our review shows that there is currently little empirical research available to identify the factors to consider in order to develop educational tools and resources specific to pharmacogenomics. CONCLUSION Expanding our review to include genetic and genomic testing factors can serve as a starting point for the evidence to be validated in future empirical research.
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Affiliation(s)
- Sophie Veilleux
- Department of Management, FSA ULaval - Business School, 2325, rue de la Terrasse, Pavillon Palasis-Prince, office 0533, Université Laval, Québec, Québec, G1V 0A6, Canada.
| | - Maud Bouffard
- FSA ULaval - Business School, 2325, rue de la Terrasse, Pavillon Palasis-Prince, Université Laval, Québec, Québec, G1V 0A6, Canada.
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39
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Haga SB. Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:273-285. [PMID: 31686893 PMCID: PMC6800463 DOI: 10.2147/pgpm.s179172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022]
Abstract
For the past several years, the implementation of pharmacogenetic (PGx) testing has become widespread in several centers and clinical practice settings. PGx testing may be ordered at the point-of-care when treatment is needed or in advance of treatment for future use. The potential benefits of PGx testing are not limited to adult patients, as children are increasingly using medications more often and at earlier ages. This review provides some background on the use of PGx testing in children as well as mothers (prenatally and post-natally) and discusses the challenges, benefits, and the ethical, legal, and social implications of providing PGx testing to children.
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Affiliation(s)
- Susanne B Haga
- Department of Medicine, Division of General Internal Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
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40
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Wu AC, Kiley JP, Noel PJ, Amur S, Burchard EG, Clancy JP, Galanter J, Inada M, Jones TK, Kropski JA, Loyd JE, Nogee LM, Raby BA, Rogers AJ, Schwartz DA, Sin DD, Spira A, Weiss ST, Young LR, Himes BE. Current Status and Future Opportunities in Lung Precision Medicine Research with a Focus on Biomarkers. An American Thoracic Society/National Heart, Lung, and Blood Institute Research Statement. Am J Respir Crit Care Med 2019; 198:e116-e136. [PMID: 30640517 DOI: 10.1164/rccm.201810-1895st] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Thousands of biomarker tests are either available or under development for lung diseases. In many cases, adoption of these tests into clinical practice is outpacing the generation and evaluation of sufficient data to determine clinical utility and ability to improve health outcomes. There is a need for a systematically organized report that provides guidance on how to understand and evaluate use of biomarker tests for lung diseases. METHODS We assembled a diverse group of clinicians and researchers from the American Thoracic Society and leaders from the National Heart, Lung, and Blood Institute with expertise in various aspects of precision medicine to review the current status of biomarker tests in lung diseases. Experts summarized existing biomarker tests that are available for lung cancer, pulmonary arterial hypertension, idiopathic pulmonary fibrosis, asthma, chronic obstructive pulmonary disease, sepsis, acute respiratory distress syndrome, cystic fibrosis, and other rare lung diseases. The group identified knowledge gaps that future research studies can address to efficiently translate biomarker tests into clinical practice, assess their cost-effectiveness, and ensure they apply to diverse, real-life populations. RESULTS We found that the status of biomarker tests in lung diseases is highly variable depending on the disease. Nevertheless, biomarker tests in lung diseases show great promise in improving clinical care. To efficiently translate biomarkers into tests used widely in clinical practice, researchers need to address specific clinical unmet needs, secure support for biomarker discovery efforts, conduct analytical and clinical validation studies, ensure tests have clinical utility, and facilitate appropriate adoption into routine clinical practice. CONCLUSIONS Although progress has been made toward implementation of precision medicine for lung diseases in clinical practice in certain settings, additional studies focused on addressing specific unmet clinical needs are required to evaluate the clinical utility of biomarkers; ensure their generalizability to diverse, real-life populations; and determine their cost-effectiveness.
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41
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Crellin E, McClaren B, Nisselle A, Best S, Gaff C, Metcalfe S. Preparing Medical Specialists to Practice Genomic Medicine: Education an Essential Part of a Broader Strategy. Front Genet 2019; 10:789. [PMID: 31572433 PMCID: PMC6749815 DOI: 10.3389/fgene.2019.00789] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Abstract
Developing a competent workforce will be crucial to realizing the promise of genomic medicine. The preparedness of medical specialists without specific genetic qualifications to play a role in this workforce has long been questioned, prompting widespread calls for education across the spectrum of medical training. Adult learning theory indicates that for education to be effective, a perceived need to learn must first be established. Medical specialists have to perceive genomic medicine as relevant to their clinical practice. Here, we review what is currently known about medical specialists’ perceptions of genomics, compare these findings to those from the genetics era, and identify areas for future research. Previous studies reveal that medical specialists’ views on the clinical utility of genomic medicine are mixed and are often tempered by several concerns. Specialists generally perceive their confidence and understanding to be lacking; subsequently, they welcome additional educational support, although specific needs are rarely detailed. Similar findings from the genetics era suggest that these challenges are not necessarily new but on a different scale and relevant to more specialties as genomic applications expand. While existing strategies developed for genetic education and training may be suitable for genomic education and training, investigating the educational needs of a wider range of specialties is critically necessary to determine if tailored approaches are needed and, if so, to facilitate these. Other interventions are also required to address some of the additional challenges identified in this review, and we encourage readers to see education as part of a broader implementation strategy.
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Affiliation(s)
- Erin Crellin
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Belinda McClaren
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Attitudes of Australian health professionals towards rapid genomic testing in neonatal and paediatric intensive care. Eur J Hum Genet 2019; 27:1493-1501. [PMID: 31148592 DOI: 10.1038/s41431-019-0429-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/10/2019] [Accepted: 04/30/2019] [Indexed: 11/08/2022] Open
Abstract
We investigated the attitudes of intensive care physicians and genetics professionals towards rapid genomic testing in neonatal and paediatric intensive care units (NICU/PICU). A mixed-methods study (surveys and interviews) was conducted at 13 Australian hospitals and three laboratories involved in multi-center implementation of rapid genomic testing. We investigated experience and confidence with genomic tests among intensivists; perceived usefulness of genomic diagnostic results; preferences for service delivery models; and implementation readiness among genetic services. The overall survey response rate was 59%, 47% for intensivists (80/170), and 75% (91/121) for genetics professionals. Intensivists reported moderate confidence with microarray tests and lower confidence with genomic tests. The majority of intensivists (77%), clinical geneticists (87%) and genetic counsellors (82%) favoured a clinical genetics-led service delivery model of genomic testing. Perceived clinical utility of genomic results was lower in the intensivist group compared to the genetics professionals group (20 v 50%, p < 0.001). Interviews (n = 6 intensivists; n = 11 genetic counselors) demonstrated support for implementation, with concerns relating to implementation environment and organizational readiness. Overall, our findings support initial implementation of genomic testing in NICU/PICU as part of an interdisciplinary service delivery model that promotes gradual adoption of genomics by the intensive care workforce while ensuring safety, sustainability, and efficiency.
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Primary Care Physicians' Knowledge, Attitudes, and Experience with Personal Genetic Testing. J Pers Med 2019; 9:jpm9020029. [PMID: 31137623 PMCID: PMC6617198 DOI: 10.3390/jpm9020029] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023] Open
Abstract
Primary care providers (PCPs) will play an important role in precision medicine. However, their lack of training and knowledge about genetics and genomics may limit their ability to advise patients or interpret or utilize test results. We evaluated PCPs’ awareness of the role of genetics/genomics in health, knowledge about key concepts in genomic medicine, perception/attitudes towards direct-to-consumer (DTC) genetic testing, and their level of confidence/comfort in discussing testing with patients prior to and after undergoing DTC testing through the 23andMe Health + Ancestry Service. A total of 130 PCPs completed the study. Sixty-three percent were board-certified in family practice, 32% graduated between 1991 and 2000, and 88% had heard of 23andMe prior to the study. Seventy-two percent decided to participate in the study to gain a better understanding about testing. At baseline, 23% of respondents indicated comfort discussing genetics as a risk factor for common diseases, increasing to 59% after undergoing personal genetic testing (PGT) (p < 0.01). In summary, we find that undergoing PGT augments physicians’ confidence, comfort, and interest in DTC testing.
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Ta R, Cayabyab MA, Coloso R. Precision medicine: a call for increased pharmacogenomic education. Per Med 2019; 16:233-245. [PMID: 31025601 DOI: 10.2217/pme-2018-0107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Precision medicine is an emerging model of care where providers consider patients' genetic profiles, lifestyles and environments to offer more precise therapy. The potential of precision medicine is boundless as interdisciplinary teams utilize genetic technologies to improve patient outcomes. The integration of precision medicine into healthcare faces many barriers, including a lack of standardization and reimbursement concerns. This article argues that increased pharmacogenetics education and system-wide implementation is necessary to overcome some of these challenges. Extensive expansion of pharmacogenomics education is a step toward producing knowledgeable clinicians who are poised to apply its methodology and champion for patient-centered care.
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Affiliation(s)
- Richard Ta
- University of California, San Francisco, School of Pharmacy, Class of 2020; San Francisco, CA, 94143, USA
| | - Mari As Cayabyab
- University of California, San Francisco, School of Pharmacy, Class of 2020; San Francisco, CA, 94143, USA
| | - Rodolfo Coloso
- University of California, San Francisco, School of Pharmacy, Class of 2021P; San Francisco, CA, 94143, USA
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45
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Personal genome testing on physicians improves attitudes on pharmacogenomic approaches. PLoS One 2019; 14:e0213860. [PMID: 30921347 PMCID: PMC6438681 DOI: 10.1371/journal.pone.0213860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/01/2019] [Indexed: 01/17/2023] Open
Abstract
In this era of clinical genomics, the accumulation of knowledge of pharmacogenomics (PGx) is rising dramatically and attempts to utilize it in clinical practice are also increasing. However, this advanced knowledge and information have not yet been sufficiently utilized in the clinical field due to various barriers including physician factors. This study was conducted to evaluate the attitudes of physicians to PGx services by providing them their own genomic data analysis report focusing on PGx. We also tried to evaluate the clinical applicability of whole exome sequencing (WES)-based functional PGx test. In total 88 physicians participated in the study from September 2015 to August 2016. Physicians who agreed to participate in the study were asked to complete a pre-test survey evaluating their knowledge of and attitude toward clinical genomics including PGx. Only those who completed the pre-test survey proceeded to WES and were provided with a personal PGx analysis report in an offline group meeting. Physicians who received these PGx reports were asked to complete a follow-up survey within two weeks. We then analyzed changes in their knowledge and attitude after reviewing their own PGx analysis results through differences in their pre-test and post-test survey responses. In total, 70 physicians (79.5%) completed the pre-test and post-test surveys and attended an off-line seminar to review their personal PGx reports. After physicians reviewed the report, their perception of and attitude towards the PGx domain and genomics significantly changed. Physician’ awareness of the likelihood of occurrence of adverse drug reactions and genetic contribution was also changed significantly. Overall, physicians were very positive about the value and potential of the PGx test but maintained a conservative stance on its actual clinical use. Results revealed that physicians’ perception and attitude to the utility of PGx testing was significantly changed after reviewing their own WES results.
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Zoltick ES, Linderman MD, McGinniss MA, Ramos E, Ball MP, Church GM, Leonard DGB, Pereira S, McGuire AL, Caskey CT, Sanderson SC, Schadt EE, Nielsen DE, Crawford SD, Green RC. Predispositional genome sequencing in healthy adults: design, participant characteristics, and early outcomes of the PeopleSeq Consortium. Genome Med 2019; 11:10. [PMID: 30808425 PMCID: PMC6391825 DOI: 10.1186/s13073-019-0619-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/05/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Increasing numbers of healthy individuals are undergoing predispositional personal genome sequencing. Here we describe the design and early outcomes of the PeopleSeq Consortium, a multi-cohort collaboration of predispositional genome sequencing projects, which is examining the medical, behavioral, and economic outcomes of returning genomic sequencing information to healthy individuals. METHODS Apparently healthy adults who participated in four of the sequencing projects in the Consortium were included. Web-based surveys were administered before and after genomic results disclosure, or in some cases only after results disclosure. Surveys inquired about sociodemographic characteristics, motivations and concerns, behavioral and medical responses to sequencing results, and perceived utility. RESULTS Among 1395 eligible individuals, 658 enrolled in the Consortium when contacted and 543 have completed a survey after receiving their genomic results thus far (mean age 53.0 years, 61.4% male, 91.7% white, 95.5% college graduates). Most participants (98.1%) were motivated to undergo sequencing because of curiosity about their genetic make-up. The most commonly reported concerns prior to pursuing sequencing included how well the results would predict future risk (59.2%) and the complexity of genetic variant interpretation (56.8%), while 47.8% of participants were concerned about the privacy of their genetic information. Half of participants reported discussing their genomic results with a healthcare provider during a median of 8.0 months after receiving the results; 13.5% reported making an additional appointment with a healthcare provider specifically because of their results. Few participants (< 10%) reported making changes to their diet, exercise habits, or insurance coverage because of their results. Many participants (39.5%) reported learning something new to improve their health that they did not know before. Reporting regret or harm from the decision to undergo sequencing was rare (< 3.0%). CONCLUSIONS Healthy individuals who underwent predispositional sequencing expressed some concern around privacy prior to pursuing sequencing, but were enthusiastic about their experience and not distressed by their results. While reporting value in their health-related results, few participants reported making medical or lifestyle changes.
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Affiliation(s)
- Emilie S Zoltick
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, Suite 301, Boston, MA, 02115, USA.,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA, 02118, USA
| | - Michael D Linderman
- Department of Computer Science, Middlebury College, McCardell Bicentennial Hall, Middlebury, VT, 05753, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, 10029, USA
| | | | - Erica Ramos
- Geisinger National Precision Health, Geisinger, 6101 Executive Blvd, Suite 110, North Bethesda, MD, 20852, USA
| | | | - George M Church
- Open Humans Foundation, Boston, MA, USA.,Harvard Personal Genome Project, Harvard Medical School, Boston, MA, USA.,Department of Genetics, Harvard Medical School, 77 Avenue Louis Pasteur, Room 238, Boston, MA, 02115, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Debra G B Leonard
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D, College of Medicine of the University of Vermont, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, 05405, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA
| | - C Thomas Caskey
- Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Mail Stop BCM225, Houston, TX, 77030, USA
| | - Saskia C Sanderson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, 10029, USA.,Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Eric E Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1498, New York, NY, 10029, USA
| | - Daiva E Nielsen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, Suite 301, Boston, MA, 02115, USA.,School of Human Nutrition, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Scott D Crawford
- SoundRocket, 950 Victors Way, Suite 50, Ann Arbor, MI, 48108, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, Suite 301, Boston, MA, 02115, USA. .,The Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA, 02142, USA. .,Harvard Medical School, Boston, MA, USA. .,Partners HealthCare Personalized Medicine, Boston, MA, 02115, USA.
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Kim K, Magness JW, Nelson R, Baron V, Brixner DI. Clinical Utility of Pharmacogenetic Testing and a Clinical Decision Support Tool to Enhance the Identification of Drug Therapy Problems Through Medication Therapy Management in Polypharmacy Patients. J Manag Care Spec Pharm 2019; 24:1250-1259. [PMID: 30479202 PMCID: PMC10397798 DOI: 10.18553/jmcp.2018.24.12.1250] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In polypharmacy patients, medication therapy management (MTM) services provide a comprehensive review of current medications and future treatment goals. Pharmacogenetics (PGx) may further optimize the identification of potential drug therapy problems (DTPs); however, the clinical utility of PGx information with a clinical decision support tool (CDST) in an MTM setting in identifying DTPs has not been systematically assessed. OBJECTIVE To assess the clinical utility of an MTM service enhanced by pharmacogenetic test results and a clinical decision support tool. METHODS This study was a post hoc analysis of the data obtained from an open-label, randomized, observational trial. Polypharmacy patients eligible for MTM service were randomly assigned to 3 intervention arms: standard MTM (SMTM), MTM incorporating CDST (CMTM), and CMTM further enhanced by PGx test results of CYP450 and VKORC1 enzymes (PGxMTM). Allocation for this post hoc analysis was based on patient adherence to the research protocol and completion of a PGx test. The number of DTPs per patient was compared across the 3 arms using analysis of variance. In addition, the frequency of serious DTPs as a categorical variable (grade 3 or above vs. lower grade) was compared across the 3 arms between PGx driven and non-PGx driven DTP recommendations. Statistical significance was tested using the chi-square test. The level of agreement between the DTP seriousness and the acceptance made by prescribers was presented as Cohen's kappa coefficient. RESULTS Numbers of patients after cohort reallocation based on completion of PGx testing were 104, 180, and 58 for the SMTM, CMTM, and PGxMTM arms, respectively. On average, 3.08 DTPs were identified for each patient, which was nearly identical across all 3 arms. Blinded clinical pharmacists considered seriousness (grade 3 or 4) in 31% of the PGx-related DTPs in comparison with 4.9% of the non-PGx DTPs (P < 0.001). The more serious (i.e., grade 3 or above) DTP recommendations were more likely to be accepted by prescribers with the odds ratios of 1.95 (P = 0.05) and 2.39 (P = 0.15), when the analysis was performed for all DTPs and DTPs from the PGxMTM arm only, respectively. CONCLUSIONS MTM enhanced by PGx testing and the clinical decision support tool did not increase the number of DTPs identified. However, PGx testing and the decision support software helps pharmacists determine more serious DTPs, and resulting subsequent recommendations were more readily accepted by a prescriber. Future study of the patient safety outcomes and overall health care costs associated with the utility of the decision support is warranted. DISCLOSURES No funding was received for conducting the post hoc analysis presented in this study. Magness is employed by Magellan Health, which received funding from Genelex for costs to administrate the medication management program. The open-label randomized trial was sponsored by Genelex (Clinicaltrials.gov ID number NCT02428660). PGx tests were provided and laboratory analysis was performed by Genelex. Valerie Baron is an employee of YouScript, which created the clinical decision support tool used in this study and formerly was part of Genelex. The other authors have nothing to disclose.
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Affiliation(s)
- Kibum Kim
- 1 Pharmacotherapy Outcomes Research Center and Department of Pathology, University of Utah, Salt Lake City
| | | | - Ryan Nelson
- 3 Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | | | - Diana I Brixner
- 5 Pharmacotherapy Outcomes Research Center and Department of Pharmacotherapy, University of Utah, Salt Lake City, and Program in Personalized Health Care, University Health, Salt Lake City, Utah
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Dotters-Katz SK, Vora N, Kuller J. Genetics for the Women's Health Trainee: A Five-Module Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10797. [PMID: 30800997 PMCID: PMC6376891 DOI: 10.15766/mep_2374-8265.10797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
Introduction Genetics is ubiquitous in OB-GYN. However, data suggest that trainees feel underprepared to counsel patients about genetic testing, the nuances of which are becoming increasingly complicated. We sought to develop and implement a genetics curriculum for OB-GYN residents. Methods This five-module (screening for fetal aneuploidy, prenatal diagnostic testing, prenatal carrier screening, pedigrees, and cancer genetics), interactive, case-based curriculum is linked to Council on Resident Education in Obstetrics and Gynecology objectives and can stand alone or work as part of an ultrasound or obstetrics rotation. Each module, containing objectives, assigned readings, and cases with answers, is used in a small-group format and can be completed in 20-30 minutes prior to the start of a clinical day. Modules were implemented at two academic centers with first-year OB-GYN residents. Qualitative real-time feedback and summative quantitative feedback from OB-GYN residents were obtained. Results Twenty-one OB-GYN residents completed the curriculum, which was well received by trainees and program directors. All residents (100%) felt the curriculum increased knowledge of prenatal genetics and felt more comfortable counseling patients after completion. Seventy-three percent enjoyed the discussion/case-based format; associated articles were found helpful by 100% of trainees. Facilitators enjoyed teaching the curriculum and felt learner knowledge improved dramatically. Discussion These low-cost modules were easy to implement and resulted in increased knowledge and confidence in prenatal and cancer genetics. Designed to stand alone and take as little as 20 minutes, the modules provide a helpful adjunct to a women's health rotation or didactic curriculum.
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Affiliation(s)
- Sarah K. Dotters-Katz
- Assistant Professor, Department of Obstetrics and Gynecology, Duke University School of Medicine
| | - Neeta Vora
- Associate Professor, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine
| | - Jeffrey Kuller
- Professor, Department of Obstetrics and Gynecology, Duke University School of Medicine
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Rubanovich CK, Cheung C, Torkamani A, Bloss CS. Physician Communication of Genomic Results in a Diagnostic Odyssey Case Series. Pediatrics 2019; 143:S44-S53. [PMID: 30600271 DOI: 10.1542/peds.2018-1099i] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The availability of whole genome sequencing (WGS) is increasing in clinical care, and WGS is a promising tool in diagnostic odyssey cases. Physicians' ability to effectively communicate genomic information with patients, however, is unclear. In this multiperspective study, we assessed physicians' communication of patient genome sequencing information in a diagnostic odyssey case series. METHODS We evaluated physician communication of genome sequencing results in the context of an ongoing study of the utility of WGS for the diagnosis of rare and idiopathic diseases. A modified version of the Medical Communication Competence Scale was used to compare patients' ratings of their physicians' communication of general medical information to communication of genome sequencing information. Physician self-ratings were also compared with patient ratings. RESULTS A total of 47 patients, parents, and physicians across 11 diagnostic odyssey cases participated. In 6 of 11 cases (54%), the patient respondent rated the physician's communication of genome sequencing information as worse than that of general medical information. In 9 of 11 cases (82%), physician self-ratings of communication of genome sequencing information were worse than the patient respondent's rating. Identification of a diagnosis via WGS was positively associated with physician self-ratings (P = .021) but was not associated with patient respondent ratings (P = .959). CONCLUSIONS These findings reveal that even in diagnostic odyssey cases, in which genome sequencing may be clinically beneficial, physicians may not be well-equipped to communicate genomic information to patients. Future studies may benefit from multiperspective approaches to assessing and understanding physician-patient communication of genome-sequencing information.
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Affiliation(s)
- Caryn Kseniya Rubanovich
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | - Ali Torkamani
- Scripps Genomic Medicine Division, Scripps Translational Science Institute, Scripps Health, La Jolla, CA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA; and
| | - Cinnamon S Bloss
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
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50
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Vassy JL, Brunette CA, Majahalme N, Advani S, MacMullen L, Hau C, Zimolzak AJ, Miller SJ. The Integrating Pharmacogenetics in Clinical Care (I-PICC) Study: Protocol for a point-of-care randomized controlled trial of statin pharmacogenetics in primary care. Contemp Clin Trials 2018; 75:40-50. [PMID: 30367991 PMCID: PMC8119226 DOI: 10.1016/j.cct.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The association between the SLCO1B1 rs4149056 variant and statin-associated muscle symptoms (SAMS) is well validated, but the clinical utility of its implementation in patient care is unknown. DESIGN The Integrating Pharmacogenetics in Clinical Care (I-PICC) Study is a pseudo-cluster randomized controlled trial of SLCO1B1 genotyping among statin-naïve primary care and women's health patients across the Veteran Affairs Boston Healthcare System. Eligible patients of enrolled primary care providers are aged 40-75 and have elevated risk of cardiovascular disease by American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Patients give consent by telephone in advance of an upcoming appointment, but they are enrolled only if and when their provider co-signs an order for SLCO1B1 testing, performed on a blood sample already collected in clinical care. Enrolled patients are randomly allocated to have their providers receive results through the electronic health record at baseline (PGx + arm) versus after 12 months (PGx- arm). The primary outcome is the change in low-density lipoprotein cholesterol (LDL-C) after one year. Secondary outcomes are concordance with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for simvastatin prescribing, concordance with ACC/AHA guidelines for statin use, and incidence of SAMS. With 408 patients, the study has >80% power to exclude a between-group LDL-C difference of 10 mg/dL (non-inferiority design) and to detect between-group differences of 15% in CPIC guideline concordance (superiority design). CONCLUSION The outcomes of the I-PICC Study will inform the clinical utility of preemptive SLCO1B1 testing in the routine practice of medicine, including its proposed benefits and unforeseen risks.
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Affiliation(s)
- Jason L Vassy
- VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
| | | | | | | | | | - Cynthia Hau
- VA Boston Healthcare System, Boston, MA, USA
| | - Andrew J Zimolzak
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
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