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Young J, Jimenez A, Pruett M, Hancock L, Schruff M. A randomized controlled trial of analogue pharmacogenomic testing feedback for psychotropic medications. PEC INNOVATION 2023; 2:100119. [PMID: 37214496 PMCID: PMC10194257 DOI: 10.1016/j.pecinn.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 05/24/2023]
Abstract
Objective To examine the impact of various presentations of pharmacogenomic testing results using a published, color-coded decision support tool (DST) format as a standard stimulus to list possible medications. Methods Participants were randomly assigned to groups and asked to decide which psychotropic medication they would prefer if depressed. Three of the groups varied the color-coded category of fluoxetine and received a statement indicating that this was the most prescribed drug for depression. A fourth control condition omitted base rate information. Participants also provided detail about their decision-making processes through a qualitative interview. Results Comparison of the first three groups indicated that significantly more participants selected medications from the highest category of likely effectiveness when fluoxetine appeared in this list. Comparison of the control group to its relevant analogue suggested no significant differences in selection strategy. Qualitative interview responses indicated participant comfort with genetic testing despite awareness of having very limited understanding of these techniques and their implications. Conclusions Both DST color-coding and base rates were influential in driving drug selection decisions, despite most participants indicating they did not understand this information. Innovation Efforts to standardize pharmacogenomic stimuli may lead to advances in methods of studying quantifiable healthcare decisions. Attention to the context for presenting test results may also be a useful source of understanding patient responses, particularly regarding complex tests that are likely to be interpreted heuristically.
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Affiliation(s)
- John Young
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
| | - Aileen Jimenez
- University of North Carolina at Chapel Hill, School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599, USA
| | - Madeline Pruett
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
| | - Laken Hancock
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
| | - McCall Schruff
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
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Lubin IM, Astles JR, Bunn JD, Cornish NE, Lazaro G, Marshall AA, Stang HL, De Jesús VR. The Clinical Laboratory Is an Integral Component to Health Care Delivery : An Expanded Representation of the Total Testing Process. Am J Clin Pathol 2023; 160:124-129. [PMID: 37105541 DOI: 10.1093/ajcp/aqad038] [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: 01/20/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES Developing an expanded representation of the total testing process that includes contemporary elements of laboratory practice can be useful to understanding and optimizing testing workflows across clinical laboratory and patient care settings. METHODS Published literature and meeting reports were used by the coauthors to inform the development of the expanded representation of the total testing process and relevant examples describing its uses. RESULTS A visual representation of the total testing process was developed and contextualized to patient care scenarios using a number of examples covering the detection of blood culture contamination, use of next-generation sequencing, and pharmacogenetic testing. CONCLUSIONS The expanded representation of the total testing process can serve as a model and framework to document and improve the use of clinical testing within the broader context of health care delivery. This representation recognizes increased engagement among clinical laboratory professionals with patients and other health care providers as essential to making informed decisions. The increasing use of data is highlighted as important to ensuring quality, appropriate test utilization, and sustaining an efficient workflow across clinical laboratory and patient care settings. Maintaining a properly resourced and competent workforce is also featured as an essential component to the testing process.
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Affiliation(s)
- Ira M Lubin
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - J Rex Astles
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Jake D Bunn
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Nancy E Cornish
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Gerardo Lazaro
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Ashley A Marshall
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Heather L Stang
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Victor R De Jesús
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, US
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Gudur VY, Maheshwari S, Acharyya A, Shafik R. An FPGA Based Energy-Efficient Read Mapper With Parallel Filtering and In-Situ Verification. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2022; 19:2697-2711. [PMID: 34415836 DOI: 10.1109/tcbb.2021.3106311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the assembly pipeline of Whole Genome Sequencing (WGS), read mapping is a widely used method to re-assemble the genome. It employs approximate string matching and dynamic programming-based algorithms on a large volume of data and associated structures, making it a computationally intensive process. Currently, the state-of-the-art data centers for genome sequencing incur substantial setup and energy costs for maintaining hardware, data storage and cooling systems. To enable low-cost genomics, we propose an energy-efficient architectural methodology for read mapping using a single system-on-chip (SoC) platform. The proposed methodology is based on the q-gram lemma and designed using a novel architecture for filtering and verification. The filtering algorithm is designed using a parallel sorted q-gram lemma based method for the first time, and it is complemented by an in-situ verification routine using parallel Myers bit-vector algorithm. We have implemented our design on the Zynq Ultrascale+ XCZU9EG MPSoC platform. It is then extensively validated using real genomic data to demonstrate up to 7.8× energy reduction and up to 13.3× less resource utilization when compared with the state-of-the-art software and hardware approaches.
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Madrid SD, Blum-Barnett E, Lemke AA, Pan V, Paolino V, McGlynn EA, Burnett-Hartman AN. "A Gift to My Family for Their Future": Attitudes about Genetic Research Participation. Public Health Genomics 2022; 25:1-10. [PMID: 35545013 DOI: 10.1159/000524462] [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: 09/14/2020] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Broad participation in genetic research is needed to promote equitable advances in disease treatment and prevention. OBJECTIVES The objective of the study was to assess motivations for, and concerns about, genetic research participation. METHODS The Genetics in Research and Health Care Survey was sent in winter 2017-2018 to 57,331 adult Kaiser Permanente (KP) members from 7 US regions to assess attitudes about genetic testing in health care and research. The survey included an open-ended question on why members would or would not participate in genetic research. Open text responses to this question were coded in the qualitative analysis software Dedoose and analyzed using a thematic analysis approach. Code summaries were organized by major themes, subthemes, and exemplary quotes. RESULTS Of the 10,369 participants who completed the survey, 2,645 (25%) provided a comment describing reasons they would or would not participate in research involving genetic testing. Respondents who provided a text comment were 64% female, 49% non-Hispanic (NH) White, 17% Asian/Pacific Islander, 20% Hispanic, and 14% NH Black. The primary themes identified were (1) altruism; (2) decision-making and planning; (3) data use; and (4) data security. These major themes were consistent across each race and ethnic group. CONCLUSIONS To promote broad participation in genetic research, it is important that recruitment materials address the primary motivators for genetic research participation, including altruism and the potential use of results for personal decision-making. Study materials should also address concerns about possible misuse of genetic information and fears over potential data breaches.
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Affiliation(s)
- Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Amy A Lemke
- NorthShore University HealthSystem, Evanston, Illinois, USA
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Vivian Pan
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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Wolf SM, Ossorio PN, Berry SA, Greely HT, McGuire AL, Penny MA, Terry SF. Integrating Rules for Genomic Research, Clinical Care, Public Health Screening and DTC Testing: Creating Translational Law for Translational Genomics. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:69-86. [PMID: 32342790 PMCID: PMC7447150 DOI: 10.1177/1073110520916996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Human genomics is a translational field spanning research, clinical care, public health, and direct-to-consumer testing. However, law differs across these domains on issues including liability, consent, promoting quality of analysis and interpretation, and safeguarding privacy. Genomic activities crossing domains can thus encounter confusion and conflicts among these approaches. This paper suggests how to resolve these conflicts while protecting the rights and interests of individuals sequenced. Translational genomics requires this more translational approach to law.
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Affiliation(s)
- Susan M Wolf
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
| | - Pilar N Ossorio
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
| | - Susan A Berry
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
| | - Henry T Greely
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
| | - Amy L McGuire
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
| | - Michelle A Penny
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
| | - Sharon F Terry
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She is also Chair of the University's Consortium on Law and Values in Health, Environment & the Life Sciences. She is a Principal Investigator on an NIH-supported project on "LawSeq: Building a Sound Legal Foundation for Translating Genomics into Clinical Application" (NHGRI/NCI # R01HG008605; Wolf, Clayton, Lawrenz, PIs). Pilar N. Ossorio, Ph.D., J.D., is Professor of Law and Bioethics at the University of Wisconsin-Madison, where she is on the faculties of the Law School and the Department of Medical History and Bioethics at the Medical School. She is Ethics Scholar-in-Residence at the Morgridge Institute for Research, Co-Director of UW's Law and Neuroscience Program, a faculty member in the UW Masters in Biotechnology Studies program, and Program Faculty in the Graduate Program in Population Health. Susan A. Berry, M.D., is Division Director for Genetics and Metabolism in the Department of Pediatrics at the University of Minnesota. She is a Professor in the Departments of Pediatrics, Ophthalmology and Genetics, Cell Biology and Development. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, a Fellow of the American Academy of Pediatrics, and a Fellow of the American College of Medical Genetics. Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He chairs the California Advisory Committee on Human Stem Cell Research and the steering committee of the Stanford University Center for Biomedical Ethics, and directs the Stanford Center for Law and the Biosciences and the Stanford Program in Neuroscience and Society. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at the Baylor College of Medicine. She served on the National Advisory Council for Human Genome Research 2011-15 and is immediate past-President of the Association of Bioethics Program Directors. Michelle A. Penny, Ph.D., is Head of the Translational Genome Sciences Group at Biogen. She is Co-Chair of the National Academy Roundtable on Genomics and Precision Health and the Industry Pharmacogenomics Working Group. Sharon F. Terry, M.A., is President and Chief Executive Officer of Genetic Alliance and co-founder of the Genetic Alliance Registry and Biobank. She has served in a leadership role on organizations including the Precision Medicine Initiative Cohort Advisory Panel; Cures Acceleration Network Review Board and Advisory Council, National Center for Accelerating Translation Science, NIH; National Academy Roundtable on Genomics and Precision Health; Global Alliance for Genomics and Health; and International Rare Disease Research Consortium Executive Committee. Organizations are listed here for author identification only
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Huml AM, Sullivan C, Figueroa M, Scott K, Sehgal AR. Consistency of Direct-to-Consumer Genetic Testing Results Among Identical Twins. Am J Med 2020; 133:143-146.e2. [PMID: 31207220 PMCID: PMC6911647 DOI: 10.1016/j.amjmed.2019.04.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the consistency of 3 commonly used direct-to-consumer genetic testing kits. Genetic testing kits are widely marketed by several companies but the consistency of their results is unclear. Because identical twins share the same DNA, their genetic testing results should provide insight into test consistency. METHODS Forty-two identical twins (21 pairs) provided samples for 3 testing companies. Outcomes were concordance of ancestry results when twin pairs were tested by the same company and the same participant was tested by different companies. Concordance of 8 self-reported traits with 23andMe genetic analyses were also examined. RESULTS Concordance of ancestry results when twin pairs were tested by the same company was high, with mean percentage agreement ranging from 94.5% to 99.2%. Concordance of ancestry results when participants were tested by 2 different companies was lower, with mean percentage agreement ranging from 52.7% to 84.1%. Concordance of trait results was variable, ranging from 34.1% for deep sleep and detached earlobes to 90.2% for cleft chin. CONCLUSION The consistency of consumer genetic testing is high for ancestry results within companies but lower and more variable for ancestry results across companies and for specific traits. These results raise questions about the usefulness of such testing.
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Affiliation(s)
- Anne M Huml
- Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio; Division of Nephrology, Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Catherine Sullivan
- Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Maria Figueroa
- Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Karen Scott
- Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Ashwini R Sehgal
- Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio; Division of Nephrology, Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio; Departments of Bioethics and Population and Quantitative Health Sciences, Case Western Reserve University Cleveland, Ohio
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Carroll NM, Blum‐Barnett E, Madrid SD, Jonas C, Janes K, Alvarado M, Bedoy R, Paolino V, Aziz N, McGlynn EA, Burnett‐Hartman AN. Demographic differences in the utilization of clinical and direct‐to‐consumer genetic testing. J Genet Couns 2019; 29:634-643. [DOI: 10.1002/jgc4.1193] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Nikki M. Carroll
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | | | - Sarah D. Madrid
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Cabell Jonas
- Mid‐Atlantic Permanente Research Institute Kaiser Permanente Mid‐Atlantic States Rockville MD USA
| | - Kristen Janes
- Kaiser Permanente Care Management Institute Oakland CA USA
| | - Monica Alvarado
- Southern California Permanente Medical Group Pasadena CA USA
| | - Ruth Bedoy
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Valerie Paolino
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
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8
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Abstract
BACKGROUND The apolipoprotein E (APOE) genotype provides information about Alzheimer's disease risk, yet genotype disclosure is discouraged due to concerns about possible distress. This is the first study investigating the psychological and behavioral impacts that genetic susceptibility testing for Alzheimer's disease has in an Asian population. METHODS From March 2016 to November 2017, we ran a prospective cohort study at Duke-National University of Singapore Medical School. 280 healthy Chinese elderly filled in questionnaires that measured psychological symptoms and health behaviors, 1 week before and 6 weeks after APOE genotype disclosure. Responses from ε4-positive subjects (associated with greater Alzheimer's disease risk) were compared to responses from ε4-negative subjects. RESULTS ε4 presence was not significantly associated with anxiety (p = 0.09) or depression (p = 0.25). No associations were found for changes to diet (p = 0.36), dietary supplements consumption (p = 0.90), physical activity (p = 0.15), or cognitive activity (p = 0.18). CONCLUSION There is no evidence to suggest that disclosure of APOE to Asian populations was associated with any short-term adverse psychological or behavioral impacts.
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9
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Johnston J, Lantos JD, Goldenberg A, Chen F, Parens E, Koenig BA. Sequencing Newborns: A Call for Nuanced Use of Genomic Technologies. Hastings Cent Rep 2018; 48 Suppl 2:S2-S6. [PMID: 30133723 PMCID: PMC6901349 DOI: 10.1002/hast.874] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self-directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered. In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct-to-consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole-exome or whole-genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed. In a symptomatic newborn, targeted or genome-wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome-wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome-wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context.
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10
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Lewis MA, Bonhomme N, Bloss CS. A New Era, New Strategies: Education and Communication Strategies to Manage Greater Access to Genomic Information. Hastings Cent Rep 2018; 48 Suppl 2:S25-S27. [PMID: 30133727 PMCID: PMC6890375 DOI: 10.1002/hast.880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As next-generation genomic sequencing, including whole-genome sequencing information, becomes more common in research, clinical, and public health contexts, there is a need for comprehensive communication strategies and education approaches to prepare patients and clinicians to manage this information and make informed decisions about its use, and nowhere is that imperative more pronounced than when genomic sequencing is applied to newborns. Unfortunately, in-person counseling is unlikely to be applicable or cost-effective when parents obtain genomic risk information directly via the Internet. As a rule, communication strategies should match how people are accessing health information. Today, many people can obtain health information in a variety of settings, including through direct-to-consumer services, via websites, and through other digital channels or settings. In response to these changes, new communication strategies need to be considered. Adopting a comprehensive communication model means understanding the multiple levels of influence experienced by parents and the clinicians who serve them. In addition, applying communication-science principles can help in addressing some key challenges to effectively communicating genomic information to parents.
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11
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Hayashi M, Watanabe A, Muramatsu M, Yamashita N. Effectiveness of personal genomic testing for disease-prevention behavior when combined with careful consultation with a physician: a preliminary study. BMC Res Notes 2018; 11:223. [PMID: 29615115 PMCID: PMC5883259 DOI: 10.1186/s13104-018-3330-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/26/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives There are many direct-to-consumer (DTC)-type personal genomic testing (PGT) services commercially available to the public, providing the specific disease susceptibilities of individuals. While these services do not appear to stimulate disease-prevention behavior, few studies have addressed the methods to do so. We investigated the effectiveness of combining a consultation with a physician with the delivery of test results from a DTC-type PGT, as a preliminary study to identify the effective genomic testing for disease-prevention. A prepared physician disclosed the PGT results of twenty healthy subjects and provided a specific consultation on the high-risk diseases for each subject. The effects on the sense of health, understanding of possible future diseases, and preventive behaviors for each subject were examined pre-PGT, post-PGT, and 3, 6, and 12 months post-PGT. Results Significant increases between the pre- and post-PGT scores were observed for the awareness of lifestyle effects on developing those diseases (P < 0.05) and the awareness of the ability to influence disease onset (P < 0.01). The follow-up questionnaire results showed that over 60% of the subjects changed their lifestyles in favor of disease prevention. These results suggest that combining the DTC-PGT with a careful physician consultation may be effective at motivating people toward preventive behavior. Electronic supplementary material The online version of this article (10.1186/s13104-018-3330-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mikihiro Hayashi
- Department of General Medicine, School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | | | - Masaaki Muramatsu
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
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12
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Impact of Genetic Variants on the Individual Potential for Body Fat Loss. Nutrients 2018; 10:nu10030266. [PMID: 29495392 PMCID: PMC5872684 DOI: 10.3390/nu10030266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/09/2018] [Accepted: 02/23/2018] [Indexed: 12/21/2022] Open
Abstract
The past decade has witnessed the discovery of obesity-related genetic variants and their functions through genome-wide association studies. Combinations of risk alleles can influence obesity phenotypes with different degrees of effectiveness across various individuals by interacting with environmental factors. We examined the interaction between genetic variation and changes in dietary habits or exercise that influences body fat loss from a large Korean cohort (n = 8840). Out of 673 obesity-related SNPs, a total of 100 SNPs (37 for carbohydrate intake; 19 for fat intake; 44 for total calories intake; 25 for exercise onset) identified to have gene-environment interaction effect in generalized linear model were used to calculate genetic risk scores (GRS). Based on the GRS distribution, we divided the population into four levels, namely, “very insensitive”, “insensitive”, “sensitive”, and “very sensitive” for each of the four categories, “carbohydrate intake”, “fat intake”, “total calories intake”, and “exercise”. Overall, the mean body fat loss became larger when the sensitivity level was increased. In conclusion, genetic variants influence the effectiveness of dietary regimes for body fat loss. Based on our findings, we suggest a platform for personalized body fat management by providing the most suitable and effective nutrition or activity plan specific to an individual.
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13
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Balicza P, Terebessy A, Grosz Z, Varga NA, Gal A, Fekete BA, Molnar MJ. Implementation of personalized medicine in Central-Eastern Europe: pitfalls and potentials based on citizen's attitude. EPMA J 2018. [PMID: 29515690 DOI: 10.1007/s13167-017-0125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Next-generation sequencing is increasingly utilized worldwide as a research and diagnostic tool and is anticipated to be implemented into everyday clinical practice. Since Central-Eastern European attitude toward genetic testing, especially broad genetic testing, is not well known, we performed a survey on this issue among Hungarian participants. Methods A self-administered questionnaire was distributed among patients and patient relatives at our neurogenetic outpatient clinic. Members of the general population were also recruited via public media. We used chi-square testing and binary logistic regression to examine factors influencing attitude. Results We identified a mixed attitude toward genetic testing. Access to physician consultation positively influenced attitude. A higher self-determined genetic familiarity score associated with higher perceived genetic influence score, which in turn associated with greater willingness to participate in genetic testing. Medical professionals constituted a skeptical group. Conclusions We think that given the controversies and complexities of the next-generation sequencing field, the optimal clinical translation of NGS data should be performed in institutions which have the unique capability to provide interprofessional health education, transformative biomedical research, and crucial patient care. With optimization of the clinical translational process, improvement of genetic literacy may increase patient engagement and empowerment. Relevance of the article for predictive preventive and personalized medicine The paper highlights that in countries with relatively low-genetic literacy, a special strategy is needed to enhance the implementation of personalized medicine.
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Affiliation(s)
- Peter Balicza
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Andras Terebessy
- 2Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Grosz
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Noemi Agnes Varga
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Aniko Gal
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Balint Andras Fekete
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Maria Judit Molnar
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
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14
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Takeshima T, Okayama M, Ae R, Harada M, Kajii E. Influence of family history on the willingness of outpatients to undergo genetic testing for salt-sensitive hypertension: a cross-sectional study. BMJ Open 2017; 7:e016322. [PMID: 28716792 PMCID: PMC5541584 DOI: 10.1136/bmjopen-2017-016322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES It is unclear whether family medical history influences the willingness to undergo genetic testing. This study aimed to determine how family history affected the willingness to undergo genetic testing for salt-sensitive hypertension in patients with and without hypertension. DESIGN Cross-sectional study using a self-administered questionnaire. SETTING Six primary care clinics and hospitals in Japan. PARTICIPANTS Consecutive 1705 outpatients aged >20 years, 578 of whom had hypertension. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome variable was the willingness to undergo genetic testing to determine the risk of salt-sensitive hypertension, and the secondary variables were age, sex, education level, family history and concerns about hypertension. Factors associated with a willingness to undergo genetic testing were evaluated in patients with and without hypertension using a logistic regression model. RESULTS In the hypertension and non-hypertension groups, 323 (55.9%) and 509 patients (45.2%), respectively, were willing to undergo genetic testing. This willingness was related with a high level of education (adjusted OR (ad-OR): 1.81, 95% CI 1.12 to 2.93), family history of stroke (1.55, 1.04 to 2.31) and concerns about hypertension (2.04, 1.27 to 3.28) in the hypertension group, whereas in the non-hypertension group, it was influenced by education level (ad-OR: 1.45, 95% CI 1.13 to 1.86), family history of hypertension (1.52, 1.17 to 1.98) and concerns about hypertension (2.03, 1.53 to 2.68). CONCLUSIONS The influence of family history on the willingness to undergo genetic testing for risk of salt-sensitivity hypertension differed between participants with and without hypertension. In particular, participants without hypertension wished to know their likelihood of developing hypertension, whereas those with hypertension were interested to know the risk of stroke (a complication of hypertension). Family history could help better counsel patients about genetic testing on the basis of their medical history.
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Affiliation(s)
- Taro Takeshima
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Masanobu Okayama
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
- Division of Community Medicine and Medical Education, Kobe University, Graduate School of Medicine, Kobe, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Masanori Harada
- Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, Yamaguchi, Japan
| | - Eiji Kajii
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
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15
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Utilization of Genetic Counseling after Direct-to-Consumer Genetic Testing: Findings from the Impact of Personal Genomics (PGen) Study. J Genet Couns 2017; 26:1270-1279. [PMID: 28512697 DOI: 10.1007/s10897-017-0106-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
Direct-to-consumer personal genomic testing (DTC-PGT) results lead some individuals to seek genetic counseling (GC), but little is known about these consumers and why they seek GC services. We analyzed survey data pre- and post-PGT from 1026 23andMe and Pathway Genomics customers. Participants were mostly white (91%), female (60%), and of high socioeconomic status (80% college educated, 43% household income of ≥$100,000). After receiving PGT results, 43 participants (4%) made or planned to schedule an appointment with a genetic counselor; 390 (38%) would have used in-person GC had it been available. Compared to non-seekers, GC seekers were younger (mean age of 38 vs 46 years), more frequently had children <18 (26% vs 16%), and were more likely to report previous GC (37% vs 7%) and genetic testing (30% vs 15%). In logistic regression analysis, seeking GC was associated with previous GC use (OR = 6.5, CI = 3.1-13.8), feeling motivated to pursue DTC-PGT for health reasons (OR = 4.3, CI = 1.8-10.1), fair or poor self-reported health (OR = 3.1, CI = 1.1-8.3), and self-reported uncertainty about the results (OR = 1.8, CI = 1.1-2.7). These findings can help GC providers anticipate who might seek GC services and plan for clinical discussions of DTC-PGT results.
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16
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Sweet K, Sturm AC, Schmidlen T, McElroy J, Scheinfeldt L, Manickam K, Gordon ES, Hovick S, Scott Roberts J, Toland AE, Christman M. Outcomes of a Randomized Controlled Trial of Genomic Counseling for Patients Receiving Personalized and Actionable Complex Disease Reports. J Genet Couns 2017; 26:980-998. [PMID: 28345121 DOI: 10.1007/s10897-017-0073-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
There has been very limited study of patients with chronic disease receiving potentially actionable genomic based results or the utilization of genetic counselors in the online result delivery process. We conducted a randomized controlled trial on 199 patients with chronic disease each receiving eight personalized and actionable complex disease reports online. Primary study aims were to assess the impact of in-person genomic counseling on 1) causal attribution of disease risk, 2) personal awareness of disease risk, and 3) perceived risk of developing a particular disease. Of 98 intervention arm participants (mean age = 57.8; 39% female) randomized for in-person genomic counseling, 76 (78%) were seen. In contrast, control arm participants (n = 101; mean age = 58.5; 54% female) were initially not offered genomic counseling as part of the study protocol but were able to access in-person genomic counseling, if they requested it, 3-months post viewing of at least one test report and post-completion of the study-specific follow-up survey. A total of 64 intervention arm and 59 control arm participants completed follow-up survey measures. We found that participants receiving in-person genomic counseling had enhanced objective understanding of the genetic variant risk contribution for multiple complex diseases. Genomic counseling was associated with lowered participant causal beliefs in genetic influence across all eight diseases, compared to control participants. Our findings also illustrate that for the majority of diseases under study, intervention arm participants believed they knew their genetic risk status better than control arm subjects. Disease risk was modified for the majority during genomic counseling, due to the assessment of more comprehensive family history. In conclusion, for patients receiving personalized and actionable genomic results through a web portal, genomic counseling enhanced their objective understanding of the genetic variant risk contribution to multiple common diseases. These results support the development of additional genomic counseling interventions to ensure a high level of patient comprehension and improve patient-centered health outcomes.
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Affiliation(s)
- Kevin Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA.
- Division of Human Genetics, Ohio State University, 2001 Polaris Parkway, Columbus, OH, 43212, USA.
| | - Amy C Sturm
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Tara Schmidlen
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
| | - Joseph McElroy
- Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, 43221, USA
| | - Laura Scheinfeldt
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
- Temple University, SERC Building, 1925 N. 12th St, Philadelphia, PA, 19122-1801, USA
| | - Kandamurugu Manickam
- Geisinger Health System, Genomic Medicine Institute, Precision Health Center, 190 Welles Street, Suite 128, Forty Fort, PA, 18704, USA
| | - Erynn S Gordon
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
- Genome Medical, Monterey, CA, 93940, USA
| | - Shelly Hovick
- School of Communication, Ohio State University, Columbus, OH, 43214, USA
| | - J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Amanda Ewart Toland
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, 43420, USA
| | - Michael Christman
- Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ, 08103, USA
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17
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Hamilton JG, Abdiwahab E, Edwards HM, Fang ML, Jdayani A, Breslau ES. Primary care providers' cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda. J Gen Intern Med 2017; 32:315-324. [PMID: 27995427 PMCID: PMC5331015 DOI: 10.1007/s11606-016-3943-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/15/2016] [Accepted: 11/29/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary care providers (PCPs) can play a critical role in helping patients receive the preventive health benefits of cancer genetic risk information. Thus, the objective of this systematic review was to identify studies of US PCPs' knowledge, attitudes, and communication-related behaviors regarding genetic tests that could inform risk-stratification approaches for breast, colorectal, and prostate cancer screening in order to describe current findings and research gaps. METHODS We conducted a systematic search of six electronic databases to identify peer-reviewed empirical articles relating to US PCPs and genetic testing for breast, colorectal, or prostate cancer published in English from 2008 to 2016. We reviewed these data and used narrative synthesis methods to integrate findings into a descriptive summary and identify research needs. RESULTS We identified 27 relevant articles. Most focused on genetic testing for breast cancer (23/27) and colorectal cancer risk (12/27); only one study examined testing for prostate cancer risk. Most articles addressed descriptive research questions (24/27). Many studies (24/27) documented PCPs' knowledge, often concluding that providers' knowledge was incomplete. Studies commonly (11/27) examined PCPs' attitudes. Across studies, PCPs expressed some concerns about ethical, legal, and social implications of testing. Attitudes about the utility of clinical genetic testing, including for targeted cancer screening, were generally favorable; PCPs were more skeptical of direct-to-consumer testing. Relatively fewer studies (9/27) examined PCPs' communication practices regarding cancer genetic testing. DISCUSSION This review indicates a need for investigators to move beyond descriptive research questions related to PCPs' knowledge and attitudes about cancer genetic testing. Research is needed to address important gaps regarding the development, testing, and implementation of innovative interventions and educational programs that can improve PCPs' genetic testing knowledge, assuage concerns about the appropriateness of cancer genetic testing, and promote open and effective patient-provider communication about genetic risk and genetic testing.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ekland Abdiwahab
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Min-Lin Fang
- UCSF Library, University of California San Francisco, San Francisco, CA, USA
| | - Andrew Jdayani
- Torrance Health IPA, Torrance Memorial Health System, Torrance, CA, USA
| | - Erica S Breslau
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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18
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Shan Y, Tromp G, Kuivaniemi H, Smelser DT, Verma SS, Ritchie MD, Elmore JR, Carey DJ, Conley YP, Gorin MB, Weeks DE. Genetic risk models: Influence of model size on risk estimates and precision. Genet Epidemiol 2017; 41:282-296. [PMID: 28198095 DOI: 10.1002/gepi.22035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/08/2016] [Accepted: 12/01/2016] [Indexed: 12/11/2022]
Abstract
Disease risk estimation plays an important role in disease prevention. Many studies have found that the ability to predict risk improves as the number of risk single-nucleotide polymorphisms (SNPs) in the risk model increases. However, the width of the confidence interval of the risk estimate is often not considered in the evaluation of the risk model. Here, we explore how the risk and the confidence interval width change as more SNPs are added to the model in the order of decreasing effect size, using both simulated data and real data from studies of abdominal aortic aneurysms and age-related macular degeneration. Our results show that confidence interval width is positively correlated with model size and the majority of the bigger models have wider confidence interval widths than smaller models. Once the model size is bigger than a certain level, the risk does not shift markedly, as 100% of the risk estimates of the one-SNP-bigger models lie inside the confidence interval of the one-SNP-smaller models. We also created a confidence interval-augmented reclassification table. It shows that both more effective SNPs with larger odds ratios and less effective SNPs with smaller odds ratios contribute to the correct decision of whom to screen. The best screening strategy is selected and evaluated by the net benefit quantity and the reclassification rate. We suggest that individuals whose upper bound of their risk confidence interval is above the screening threshold, which corresponds to the population prevalence of the disease, should be screened.
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Affiliation(s)
- Ying Shan
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gerard Tromp
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America.,Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Helena Kuivaniemi
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America.,Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Diane T Smelser
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Shefali S Verma
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Marylyn D Ritchie
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - James R Elmore
- Department of Vascular and Endovascular Surgery, Geisinger Health System, Danville, PA
| | - David J Carey
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael B Gorin
- Departments of Ophthalmology and Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.,Stein Eye Institute, Los Angeles, California, United States of America
| | - Daniel E Weeks
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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19
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Gray SW, Gollust SE, Carere DA, Chen CA, Cronin A, Kalia SS, Rana HQ, Ruffin MT, Wang C, Roberts JS, Green RC. Personal Genomic Testing for Cancer Risk: Results From the Impact of Personal Genomics Study. J Clin Oncol 2016; 35:636-644. [PMID: 27937091 DOI: 10.1200/jco.2016.67.1503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Significant concerns exist regarding the potential for unwarranted behavior changes and the overuse of health care resources in response to direct-to-consumer personal genomic testing (PGT). However, little is known about customers' behaviors after PGT. Methods Longitudinal surveys were given to new customers of 23andMe (Mountain View, CA) and Pathway Genomics (San Diego, CA). Survey data were linked to individual-level PGT results through a secure data transfer process. Results Of the 1,042 customers who completed baseline and 6-month surveys (response rate, 71.2%), 762 had complete cancer-related data and were analyzed. Most customers reported that learning about their genetic risk of cancers was a motivation for testing (colorectal, 88%; prostate, 95%; breast, 94%). No customers tested positive for pathogenic mutations in highly penetrant cancer susceptibility genes. A minority of individuals received elevated single nucleotide polymorphism-based PGT cancer risk estimates (colorectal, 24%; prostate, 24%; breast, 12%). At 6 months, customers who received elevated PGT cancer risk estimates were not significantly more likely to change their diet, exercise, or advanced planning behaviors or engage in cancer screening, compared with individuals at average or reduced risk. Men who received elevated PGT prostate cancer risk estimates changed their vitamin and supplement use more than those at average or reduced risk (22% v 7.6%, respectively; adjusted odds ratio, 3.41; 95% CI, 1.44 to 8.18). Predictors of 6-month behavior include baseline behavior (exercise, vitamin or supplement use, and screening), worse health status (diet and vitamin or supplement use), and older age (advanced planning, screening). Conclusion Most adults receiving elevated direct-to-consumer PGT single nucleotide polymorphism-based cancer risk estimates did not significantly change their diet, exercise, advanced care planning, or cancer screening behaviors.
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Affiliation(s)
- Stacy W Gray
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah E Gollust
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Deanna Alexis Carere
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Clara A Chen
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Angel Cronin
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah S Kalia
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Huma Q Rana
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Mack T Ruffin
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Catharine Wang
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - J Scott Roberts
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Robert C Green
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
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Quantitative assessment of genetic testing for type 2 diabetes mellitus based on findings of genome-wide association studies. Ann Epidemiol 2016; 26:816-818.e6. [PMID: 27751632 DOI: 10.1016/j.annepidem.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/26/2016] [Accepted: 09/16/2016] [Indexed: 12/29/2022]
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O'Donovan CB, Walsh MC, Forster H, Woolhead C, Celis-Morales C, Fallaize R, Macready AL, Marsaux CFM, Navas-Carretero S, San-Cristobal R, Kolossa S, Mavrogianni C, Lambrinou CP, Moschonis G, Godlewska M, Surwillo A, Bouwman J, Grimaldi K, Traczyk I, Drevon CA, Daniel H, Manios Y, Martinez JA, Saris WHM, Lovegrove JA, Mathers JC, Gibney MJ, Brennan L, Gibney ER. The impact of MTHFR 677C → T risk knowledge on changes in folate intake: findings from the Food4Me study. GENES AND NUTRITION 2016; 11:25. [PMID: 27708721 PMCID: PMC5043523 DOI: 10.1186/s12263-016-0539-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is hypothesised that individuals with knowledge of their genetic risk are more likely to make health-promoting dietary and lifestyle changes. The present study aims to test this hypothesis using data from the Food4Me study. This was a 6-month Internet-based randomised controlled trial conducted across seven centres in Europe where individuals received either general healthy eating advice or varying levels of personalised nutrition advice. Participants who received genotype-based personalised advice were informed whether they had the risk (CT/TT) (n = 178) or non-risk (CC) (n = 141) alleles of the methylenetetrahydrofolate reductase (MTHFR) gene in relation to cardiovascular health and the importance of a sufficient intake of folate. General linear model analysis was used to assess changes in folate intake between the MTHFR risk, MTHFR non-risk and control groups from baseline to month 6 of the intervention. RESULTS There were no differences between the groups for age, gender or BMI. However, there was a significant difference in country distribution between the groups (p = 0.010). Baseline folate intakes were 412 ± 172, 391 ± 190 and 410 ± 186 μg per 10 MJ for the risk, non-risk and control groups, respectively. There were no significant differences between the three groups in terms of changes in folate intakes from baseline to month 6. Similarly, there were no changes in reported intake of food groups high in folate. CONCLUSIONS These results suggest that knowledge of MTHFR 677C → T genotype did not improve folate intake in participants with the risk variant compared with those with the non-risk variant. TRIAL REGISTRATION ClinicalTrials.gov NCT01530139.
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Affiliation(s)
- Clare B O'Donovan
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
| | - Marianne C Walsh
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
| | - Hannah Forster
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
| | - Clara Woolhead
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
| | - Carlos Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, NE4 5PL UK
| | - Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Health, University of Reading, Reading, RG6 6AR UK
| | - Anna L Macready
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Health, University of Reading, Reading, RG6 6AR UK
| | - Cyril F M Marsaux
- Department of Human Biology, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - Santiago Navas-Carretero
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain ; CIBERobn, Fisiopatología de la Obesidad y Nutrición, INstituto de Salud Carlos III, Madrid, Spain
| | - Rodrigo San-Cristobal
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain
| | - Silvia Kolossa
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | | | | | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | | | - Jildau Bouwman
- TNO, Microbiology and Systems Biology Group, Zeist, The Netherlands
| | - Keith Grimaldi
- Eurogenetica Ltd, Salisbury Road, Burnham-on-Sea, TA8 1HX UK
| | - Iwona Traczyk
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hannelore Daniel
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - J Alfredo Martinez
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain ; CIBERobn, Fisiopatología de la Obesidad y Nutrición, INstituto de Salud Carlos III, Madrid, Spain ; IDISNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Wim H M Saris
- Department of Human Biology, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Health, University of Reading, Reading, RG6 6AR UK
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, NE4 5PL UK
| | - Michael J Gibney
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
| | - Lorraine Brennan
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
| | - Eileen R Gibney
- Institute of Food & Health, University College Dublin, Dublin 4, Ireland
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Bouchard-Mercier A, Desroches S, Robitaille J, Vohl MC. Factors Associated with the Intention of Registered Dietitians to Discuss Nutrigenetics with their Patients/Clients. CAN J DIET PRACT RES 2016; 77:163-169. [PMID: 27182816 DOI: 10.3148/cjdpr-2016-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The objective of this study was to investigate factors affecting the intention of Registered Dietitians (RDs) to discuss nutrigenetics with their patients/clients. METHODS A survey based on the theory of planned behaviour (TPB; attitude, subjective norm, and perceived behavioural control) was developed and sent by email to RD members of the Ordre professionnel des diététistes du Québec. Multiple regression analyses were performed to examine the determinants of intention and behaviour. RESULTS A total of 141 RDs completed the questionnaire (5.8% response rate). On a scale from -2 to 2 (from strongly disagree to strongly agree), the intention of discussing nutrigenetics with patients/clients was neutral (mean of -0.07 ± 0.92). The TPB construct of attitude was the most strongly associated with intention (β = 0.66, P < 0.0001) followed by perceived behavioural control (β = 0.33, P < 0.0001) and subjective norm (β = 0.21, P = 0.03). Finally, 13 out of 141 RDs (~9%) actually practiced the behaviour, which was to have discussed nutrigenetics with their patients/clients in the last 3 months. Only perceived behavioural control contributed to explain the behaviour (β = 0.17, P < 0.0001). CONCLUSIONS Main determinants of the intention of RDs to discuss nutrigenetics with their patients/clients were determined. This knowledge will help inform the design of future educational content about nutrigenetics.
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Affiliation(s)
- Annie Bouchard-Mercier
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| | - Sophie Desroches
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| | - Julie Robitaille
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| | - Marie-Claude Vohl
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
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Ahmed M, Eeles R. Germline genetic profiling in prostate cancer: latest developments and potential clinical applications. Future Sci OA 2016; 2:FSO87. [PMID: 28031937 PMCID: PMC5137984 DOI: 10.4155/fso.15.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/10/2015] [Indexed: 12/16/2022] Open
Abstract
Familial and twin studies have demonstrated a significant inherited component to prostate cancer predisposition. Genome wide association studies have shown that there are 100 single nucleotide polymorphisms which have been associated with the development of prostate cancer. This review aims to discuss the scientific methods used to identify these susceptibility loci. It will also examine the current clinical utility of these loci, which include the development of risk models as well as predicting treatment efficacy and toxicity. In order to refine the clinical utility of the susceptibility loci, international consortia have been developed to combine statistical power as well as skills and knowledge to further develop models that could be used to predict risk and treatment outcomes.
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Affiliation(s)
- Mahbubl Ahmed
- The Institute of Cancer Research, London SM2 5NG, UK
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24
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Case Report: Direct Access Genetic Testing and A False-Positive Result For Long QT Syndrome. J Genet Couns 2015; 25:25-31. [DOI: 10.1007/s10897-015-9882-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022]
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Rafiq M, Ianuale C, Ricciardi W, Boccia S. Direct-to-consumer genetic testing: a systematic review of european guidelines, recommendations, and position statements. Genet Test Mol Biomarkers 2015; 19:535-47. [PMID: 26313927 DOI: 10.1089/gtmb.2015.0051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Personalized healthcare is expected to yield promising results, with a paradigm shift toward more personalization in the practice of medicine. This emerging field has wide-ranging implications for all the stakeholders. Commercial tests in the form of multiplex genetic profiles are currently being provided to consumers, without the physicians' consultation, through the Internet, referred to as direct-to-consumer genetic tests (DTC GT). OBJECTIVES The objective was to review all the existing European guidelines on DTC GT, and its associated interventions, to list all the supposed benefits and harms, issues and concerns, and recommendations. METHODS We conducted a systematic review of position statements, policies, guidelines, and recommendations, produced by professional organizations or other relevant bodies for use of DTC GT in Europe. RESULTS Seventeen documents met the inclusion criteria, which were subjected to thematic analysis, and the texts were coded for statements related to use of DTC GT. DISCUSSION AND CONCLUSIONS Professional societies and associations are currently more suggestive of potential disadvantages of DTC GT, recommending improved genetic literacy of both populations and health professionals, and implementation research on the genetic tests to integrate public health genomics into healthcare systems.
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Affiliation(s)
- Muhammad Rafiq
- 1 Medical Management Center (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet , Stockholm, Sweden .,2 SDA Bocconi School of Management , Milan, Italy
| | - Carolina Ianuale
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Ricciardi
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
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Perbal L. [A genetic ID for tomorrow?]. C R Biol 2015. [PMID: 26211982 DOI: 10.1016/j.crvi.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dozens of private companies have emerged in 2005, with the commercial purpose of offering the public a wide variety of personal genetic tests - direct-to-consumer personal genome tests. Simultaneously, a collaborative research initiative on individual sequencing - the Personal Genome Project - was born in Harvard University, then online. This text provides an analysis of the promises and limits of the proposed individual sequencing. First, the scope and quality of individual predictive genetic sequencing are still far from being acquired. Moreover, it is necessary to question the ethical standards of confidentiality and respect for privacy in the connected information era.
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Affiliation(s)
- Laurence Perbal
- Centre de recherche interdisciplinaire en bioéthique, Université libre de Bruxelles, 50, avenue Franklin-Delano-Roosevelt, CP 175/01, 1050 Bruxelles, Belgique.
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27
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Awareness, attitudes and perspectives of direct-to-consumer genetic testing in Greece: a survey of potential consumers. J Hum Genet 2015; 60:515-23. [DOI: 10.1038/jhg.2015.58] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 04/30/2015] [Indexed: 12/28/2022]
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Ryan NM, O'Donovan CB, Forster H, Woolhead C, Walsh MC. New tools for personalised nutrition: The Food4Me project. NUTR BULL 2015. [DOI: 10.1111/nbu.12143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. M. Ryan
- UCD Institute of Food and Health; University College Dublin; Republic of Ireland
| | - C. B. O'Donovan
- UCD Institute of Food and Health; University College Dublin; Republic of Ireland
| | - H. Forster
- UCD Institute of Food and Health; University College Dublin; Republic of Ireland
| | - C. Woolhead
- UCD Institute of Food and Health; University College Dublin; Republic of Ireland
| | - M. C. Walsh
- UCD Institute of Food and Health; University College Dublin; Republic of Ireland
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Barajas MR, Formea CM, McCormick JB, Abdalrhim AD, Han LC, McBane RD, Fiksdal AS, Kullo IJ. A patient-centered approach to the development and pilot of a warfarin pharmacogenomics patient education tool for health professionals. CURRENTS IN PHARMACY TEACHING & LEARNING 2015; 7:249-255. [PMID: 25729462 PMCID: PMC4339072 DOI: 10.1016/j.cptl.2014.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe an exploratory project to develop and pilot a novel patient educational tool that explains the concept of pharmacogenomics and its impact on warfarin dosing that can be utilized by health professionals providing patient counseling. METHODS A pharmacogenomics educational tool prototype was developed by an interdisciplinary team. During the pilot of the tool, focus group methodology was used to elicit input from patients based upon their perspectives and experiences with warfarin. Focus group sessions were audio-recorded and transcribed, and the data was analyzed through consensus coding in NVivo. RESULTS The focus group participants were generally unfamiliar with the concept of pharmacogenomics but were receptive to the information. They thought the patient education tool was informative and would provide the most benefit to patients newly initiated on warfarin therapy. CONCLUSIONS Preliminary results from this exploratory project suggest that implementation and further feasibility testing of this pharmacogenomics patient education tool should be performed in a population of newly initiated patients taking warfarin.
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Affiliation(s)
- Megan R Barajas
- Hospital Pharmacy Services, Mayo Clinic Hospital-St. Marys Campus, 200 First Street SW, Rochester, MN 55905,
| | - Christine M Formea
- Hospital Pharmacy Services, Mayo Clinic Hospital-St. Marys Campus, 200 First Street SW, Rochester, MN 55905, 1-507-255-7552,
| | - Jennifer B McCormick
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Ahmed D Abdalrhim
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Leona C Han
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Robert D McBane
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Alexander S Fiksdal
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Iftikhar J Kullo
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
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Affiliation(s)
- Alfred L George
- From the Department of Pharmacology and Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL.
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31
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Design and implementation of a randomized controlled trial of genomic counseling for patients with chronic disease. J Pers Med 2015; 4:1-19. [PMID: 24926413 PMCID: PMC4051230 DOI: 10.3390/jpm4010001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We describe the development and implementation of a randomized controlled trial to investigate the impact of genomic counseling on a cohort of patients with heart failure (HF) or hypertension (HTN), managed at a large academic medical center, the Ohio State University Wexner Medical Center (OSUWMC). Our study is built upon the existing Coriell Personalized Medicine Collaborative (CPMC®). OSUWMC patient participants with chronic disease (CD) receive eight actionable complex disease and one pharmacogenomic test report through the CPMC® web portal. Participants are randomized to either the in-person post-test genomic counseling—active arm, versus web-based only return of results—control arm. Study-specific surveys measure: (1) change in risk perception; (2) knowledge retention; (3) perceived personal control; (4) health behavior change; and, for the active arm (5), overall satisfaction with genomic counseling. This ongoing partnership has spurred creation of both infrastructure and procedures necessary for the implementation of genomics and genomic counseling in clinical care and clinical research. This included creation of a comprehensive informed consent document and processes for prospective return of actionable results for multiple complex diseases and pharmacogenomics (PGx) through a web portal, and integration of genomic data files and clinical decision support into an EPIC-based electronic medical record. We present this partnership, the infrastructure, genomic counseling approach, and the challenges that arose in the design and conduct of this ongoing trial to inform subsequent collaborative efforts and best genomic counseling practices.
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Vrecar I, Peterlin B, Teran N, Lovrecic L. Direct-to-consumer genetic testing in Slovenia: availability, ethical dilemmas and legislation. Biochem Med (Zagreb) 2015; 25:84-9. [PMID: 25672471 PMCID: PMC4401315 DOI: 10.11613/bm.2015.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/15/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Over the last few years, many private companies are advertising direct-to-consumer genetic testing (DTC GT), mostly with no or only minor clinical utility and validity of tests and without genetic counselling. International professional community does not approve provision of DTC GT and situation in some EU countries has been analysed already. The aim of our study was to analyse current situation in the field of DTC GT in Slovenia and related legal and ethical issues. MATERIALS AND METHODS Information was retrieved through internet search, performed independently by two authors, structured according to individual private company and the types of offered genetic testing. RESULTS Five private companies and three Health Insurance Companies offer DTC GT and it is provided without genetic counselling. Available tests include testing for breast cancer, tests with other health-related information (complex diseases, drug responses) and other tests (nutrigenetic, ancestry, paternity). National legislation is currently being developed and Council of Experts in Medical Genetics has issued an opinion about Genetic Testing and Commercialization of Genetic Tests in Slovenia. CONCLUSIONS Despite the fact that Slovenia has signed the Additional protocol to the convention on human rights and biomedicine, concerning genetic testing for health purposes, DTC GT in Slovenia is present and against all international recommendations. There is lack of or no medical supervision, clinical validity and utility of tests and inappropriate genetic testing of minors is available. There is urgent need for regulation of ethical, legal, and social aspects. National legislation on DTC GT is being prepared.
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Affiliation(s)
- Irena Vrecar
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Peterlin
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Natasa Teran
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luca Lovrecic
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Abstract
PURPOSE OF REVIEW To discuss the risks, benefits and value of genetic testing for ocular genetic disease. RECENT FINDINGS Testing for ocular genetics diseases is becoming more available and successful gene therapy is being reported. Clinicians must prepare for this trend by considering diagnostic genetic testing for their patients. SUMMARY As advances continually occur in genetic testing for ocular genetic disorders, clinicians must develop an understanding of the potential risks and benefits for their patients.
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Savard J, Mooney-Somers J, Newson AJ, Kerridge I. Australians' knowledge and perceptions of direct-to-consumer personal genome testing. Intern Med J 2014; 44:27-31. [PMID: 24450520 DOI: 10.1111/imj.12289] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND As direct-to-consumer personal genome testing (DTC-PGT) is increasingly available in Australia, knowledge of Australians' perceptions and attitudes towards this technology is needed in order to assess the (potential) impact it might have on the Australian public and healthcare system. AIMS To explore the knowledge and perceptions of DTC-PGT in an Australian sample. METHODS An online survey asking about knowledge and perceptions of DTC-PGT, undertaken between October 2011 and April 2012, of 270 Australian residents. Results were analysed using SAS. RESULTS Our study found limited consumer knowledge of, and interest in, pursuing DTC-PGT in Australia. Ninety-three per cent of respondents correctly identified DTC-PGT as available to consumers directly, but only 40% correctly identified its availability in Australia. When asked about the content and value of the information DTC-PGT provides, the majority of respondents indentified that DTC-PGT could provide information about one's health and/or ancestry (82% and 74%). Additionally, respondents indicated they believed this information to be equally important as non-genetic information about one's ancestry and health. CONCLUSION While a minority of respondents expressed an intention to pursue DTC-PGT (27%), the majority of respondents, irrespective of whether they wished to pursue it or not, believed that genetic information was as important as non-genetic information in regards to their health and their ancestry. The value ascribed to genetic information suggests that genetics plays a role in people's lives, and that further qualitative research could explore the ways in which people might use and understand the genetic information provided by DTC-PGT.
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Affiliation(s)
- J Savard
- Centre for Values, Ethics and the Law in Medicine (VELiM), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Pastore LM, Johnson J. The FMR1 gene, infertility, and reproductive decision-making: a review. Front Genet 2014; 5:195. [PMID: 25071825 PMCID: PMC4083559 DOI: 10.3389/fgene.2014.00195] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/12/2014] [Indexed: 12/15/2022] Open
Abstract
The strongest association between FMR1 and the ovary in humans is the increased risk of premature ovarian failure (POF) in women who carry the premutation level of CGG repeats (55–199 CGGs). Research on the FMR1 gene has extended to other endpoints of relevance in the OB/GYN setting for women, including infertility and ovarian hormones. After reviewing the nomenclature changes that have occurred in recent years, this article reviews the evidence linking the length of the FMR1 repeat length to fertility and ovarian hormones (follicle stimulating hormone and anti-mullerian hormone as the primary methods to assess ovarian reserve in clinical settings). The literature is inconsistent on the association between the FMR1 trinucleotide repeat length and infertility. Elevated levels of follicle stimulating hormone have been found in women who carry the premutation; however the literature on the relationship between anti-mullerian hormone and the CGG repeat length are too disparate in design to make a summary statement. This article considers the implications of two transgenic mouse models (FXPM 130R and YAC90R) for theories on pathogenesis related to ovarian endpoints. Given the current screening/testing recommendations for reproductive age females and the variability of screening protocols in clinics, future research is recommended on pretest and posttest genetic counseling needs. Future research is also needed on ovarian health measurements across a range of CGG repeat lengths in order to interpret FMR1 test results in reproductive age women; the inconsistencies in the literature make it quite challenging to advise women on their risks related to FMR1 repeat length.
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Affiliation(s)
- Lisa M Pastore
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia Charlottesville, VA, USA
| | - Joshua Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University New Haven, CT, USA
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Hamilton JG, Edwards HM, Khoury MJ, Taplin SH. Cancer screening and genetics: a tale of two paradigms. Cancer Epidemiol Biomarkers Prev 2014; 23:909-16. [PMID: 24706727 PMCID: PMC4047129 DOI: 10.1158/1055-9965.epi-13-1016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The long-standing medical tradition to "first do no harm" is reflected in population-wide evidence-based recommendations for cancer screening tests that focus primarily on reducing morbidity and mortality. The conventional cancer screening process is predicated on finding early-stage disease that can be treated effectively; yet emerging genetic and genomic testing technologies have moved the target earlier in the disease development process to identify a probabilistic predisposition to disease. Genetic risk information can have varying implications for the health and well-being of patients and their relatives, and has raised important questions about the evaluation and value of risk information. This article explores the paradigms that are being applied to the evaluation of conventional cancer screening tests and emerging genetic and genomic tests of cancer susceptibility, and how these perspectives are shifting and evolving in response to advances in our ability to detect cancer risks. We consider several challenges germane to the evaluation of both categories of tests, including defining benefits and harms in terms of personal and clinical utility, addressing healthcare consumers' information preferences, and managing scientific uncertainty. We encourage research and dialogue aimed at developing a better understanding of the value of all risk information, nongenetic and genetic, to people's lives. Cancer Epidemiol Biomarkers Prev; 23(6); 909-16. ©2014 AACR.
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Affiliation(s)
- Jada G Hamilton
- Authors' Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick; Epidemiology and Genomics Research Program, Process of Care Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland; and Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather M Edwards
- Authors' Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick; Epidemiology and Genomics Research Program, Process of Care Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland; and Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Muin J Khoury
- Authors' Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick; Epidemiology and Genomics Research Program, Process of Care Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland; and Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GeorgiaAuthors' Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick; Epidemiology and Genomics Research Program, Process of Care Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland; and Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen H Taplin
- Authors' Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick; Epidemiology and Genomics Research Program, Process of Care Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland; and Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
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Li A, Meyre D. Jumping on the Train of Personalized Medicine: A Primer for Non- Geneticist Clinicians: Part 3. Clinical Applications in the Personalized Medicine Area. CURRENT PSYCHIATRY REVIEWS 2014; 10:118-132. [PMID: 25598768 PMCID: PMC4287884 DOI: 10.2174/1573400510666140630170549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/17/2022]
Abstract
The rapid decline of sequencing costs brings hope that personal genome sequencing will become a common feature of medical practice. This series of three reviews aim to help non-geneticist clinicians to jump into the fast-moving field of personalized genetic medicine. In the first two articles, we covered the fundamental concepts of molecular genetics and the methodologies used in genetic epidemiology. In this third article, we discuss the evolution of personalized medicine and illustrate the most recent success in the fields of Mendelian and complex human diseases. We also address the challenges that currently limit the use of personalized medicine to its full potential.
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Affiliation(s)
| | - David Meyre
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8N 3Z5, Canada
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Eeles R, Goh C, Castro E, Bancroft E, Guy M, Al Olama AA, Easton D, Kote-Jarai Z. The genetic epidemiology of prostate cancer and its clinical implications. Nat Rev Urol 2014; 11:18-31. [PMID: 24296704 DOI: 10.1038/nrurol.2013.266] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Worldwide, familial and epidemiological studies have generated considerable evidence of an inherited component to prostate cancer. Indeed, rare highly penetrant genetic mutations have been implicated. Genome-wide association studies (GWAS) have also identified 76 susceptibility loci associated with prostate cancer risk, which occur commonly but are of low penetrance. However, these mutations interact multiplicatively, which can result in substantially increased risk. Currently, approximately 30% of the familial risk is due to such variants. Evaluating the functional aspects of these variants would contribute to our understanding of prostate cancer aetiology and would enable population risk stratification for screening. Furthermore, understanding the genetic risks of prostate cancer might inform predictions of treatment responses and toxicities, with the goal of personalized therapy. However, risk modelling and clinical translational research are needed before we can translate risk profiles generated from these variants into use in the clinical setting for targeted screening and treatment.
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Affiliation(s)
- Rosalind Eeles
- Oncogenetics Team, Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Chee Goh
- Oncogenetics Team, Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Elena Castro
- Oncogenetics Team, Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Elizabeth Bancroft
- Clinical Academic Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - Michelle Guy
- Oncogenetics Team, Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Ali Amin Al Olama
- Cancer Research UK Centre for Cancer Genetic Epidemiology, Strangeways Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Douglas Easton
- Departments of Public Health & Primary Care and Oncology, Strangeways Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Zsofia Kote-Jarai
- Oncogenetics Team, Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
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Nordgren A. Neither as harmful as feared by critics nor as empowering as promised by providers: risk information offered direct to consumer by personal genomics companies. J Community Genet 2014; 5:59-68. [PMID: 22477021 PMCID: PMC3890068 DOI: 10.1007/s12687-012-0094-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/22/2012] [Indexed: 12/21/2022] Open
Abstract
In this paper, I investigate ethical and policy aspects of the genetic services and web-rhetoric of companies offering genetic information direct to consumer, and I do so with a special focus on genetic risk information. On their websites, the companies stress that genetic risk testing for multifactorial complex medical conditions such as cardiovascular disease and cancer may empower the consumer and provide valuable input to personal identity. Critics maintain, on the other hand, that testing can be psychologically harmful, is of limited clinical and preventive value, and vulnerable to misinterpretation. I stress the importance of empirical studies in assessing the pros and cons of direct-to-consumer testing and point out that recent empirical studies indicate that this testing is neither as harmful as feared by critics nor as empowering as promised by the companies. However, the testing is not entirely harmless. Remaining problems include testing of third parties without consent and ownership of genotypic and phenotypic information. Moreover, the testing, although not particularly empowering, may still provide input to self-understanding that some people find valuable. Regarding policy-making, I suggest that self-regulation in terms of best practice guidelines may play an important role, but I also stress that national and international regulation may be necessary.
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Affiliation(s)
- Anders Nordgren
- Centre for Applied Ethics, Linköping University, 58183, Linköping, Sweden,
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40
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Hurlimann T, Menuz V, Graham J, Robitaille J, Vohl MC, Godard B. Risks of nutrigenomics and nutrigenetics? What the scientists say. GENES AND NUTRITION 2013; 9:370. [PMID: 24293399 DOI: 10.1007/s12263-013-0370-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/18/2013] [Indexed: 01/12/2023]
Abstract
Nutrigenomics and nutrigenetics (hereafter NGx) have stimulated expectations for beneficial applications in public health and individuals. Yet, the potential achievability of such promise is not without socioethical considerations that challenge NGx implementation. This paper focuses on the opinions of NGx researchers about potential risks raised by NGx. The results of an online survey show that these researchers (n = 126) are fairly confident about the potential benefits of NGx, and that most downplay its potential risks. Researchers in this field do not believe that NGx will reconfigure foods as medication or transform the conception of eating into a health hazard. The majority think that NGx will produce no added burden on individuals to get tested or to remain compliant with NGx recommendations, nor that NGx will threaten individual autonomy in daily food choice. The majority of researchers do not think that NGx will lead to discrimination against and/or stigmatization of people who do not comply with NGx dietary recommendations. Despite this optimism among NGx researchers, we suggest that key risk factors raised by the socioethical context in which NGx applications will be implemented need to be considered.
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Affiliation(s)
- T Hurlimann
- Department of Social and Preventive Medicine, Bioethics Programmes, School of Public Health (ESPUM), University of Montreal, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
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Chrystoja CC, Diamandis EP. Whole genome sequencing as a diagnostic test: challenges and opportunities. Clin Chem 2013; 60:724-33. [PMID: 24227285 DOI: 10.1373/clinchem.2013.209213] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Extraordinary technological advances and decreases in the cost of DNA sequencing have made the possibility of whole genome sequencing (WGS) as a highly accessible clinical test for numerous indications feasible. There have been many recent, successful applications of WGS in establishing the etiology of complex diseases and guiding therapeutic decision-making in neoplastic and nonneoplastic diseases and in various aspects of reproductive health. However, there are major, but not insurmountable, obstacles to the increased clinical implementation of WGS, such as hidden costs, issues surrounding sequencing and analysis, quality assurance and standardization protocols, ethical dilemmas, and difficulties with interpretation of the results. CONTENT The widespread use of WGS in routine clinical practice remains a distant proposition. Prospective trials will be needed to establish if, and for whom, the benefits of WGS will outweigh the likely substantial costs associated with follow-up tests, the risks of overdiagnosis and overtreatment, and the associated emotional distress. SUMMARY WGS should be carefully implemented in the clinic to allow the realization of its potential to improve patient health in specific indications. To minimize harm the use of WGS for all other reasons must be carefully evaluated before clinical implementation.
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Affiliation(s)
- Caitlin C Chrystoja
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Abstract
Recent advances in genetic analysis especially DNA sequencing technology open a new strategy for adult disease prevention by genetic screening. Physicians presently treat disease pathology with less emphasis on disease risk prevention/reduction. Genetic screening has reduced the incidence of untreatable childhood genetic diseases and improved the care of newborns. The opportunity exists to expand screening programs and reduce the incidence of adult onset diseases via genetic risk identification and disease intervention. This article outlines the approach, challenges, and benefits of such screening for adult genetic disease risks.
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Brashers DE, Hogan TP. The appraisal and management of uncertainty: Implications for information-retrieval systems. Inf Process Manag 2013. [DOI: 10.1016/j.ipm.2013.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schneider KI, Schmidtke J. Patient compliance based on genetic medicine: a literature review. J Community Genet 2013; 5:31-48. [PMID: 23934761 DOI: 10.1007/s12687-013-0160-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 07/02/2013] [Indexed: 12/19/2022] Open
Abstract
For this literature review, medical literature data bases were searched for studies on patient compliance after genetic risk assessment. The review focused on conditions where secondary or tertiary preventive options exist, namely cancer syndromes (BRCA-related cancer, HNPCC/colon cancer), hemochromatosis, thrombophilia, smoking cessation, and obesity. As a counterpart, patient compliance was assessed regarding medication adherence and medical advice in some of the most epidemiologically important conditions (including high blood pressure, metabolic syndrome, and coronary heart disease) after receiving medical advice based on nongenetic risk information or a combination of genetic and nongenetic risk information. In the majority of studies based on genetic risk assessments, patients were confronted with predictive rather than diagnostic genetic profiles. Most of the studies started from a knowledge base around 10 years ago when DNA testing was at an early stage, limited in scope and specificity, and costly. The major result is that overall compliance of patients after receiving a high-risk estimate from genetic testing for a given condition is high. However, significant behavior change does not take place just because the analyte is "genetic." Many more factors play a role in the complex process of behavioral tuning. Without adequate counseling and guidance, patients may interpret risk estimates of predictive genetic testing with an increase in fear and anxiety.
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Affiliation(s)
- Kai Insa Schneider
- Institute of Human Genetics, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Belsky DW, Moffitt TE, Caspi A. Genetics in population health science: strategies and opportunities. Am J Public Health 2013; 103 Suppl 1:S73-83. [PMID: 23927511 DOI: 10.2105/ajph.2012.301139] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Translational research is needed to leverage discoveries from the frontiers of genome science to improve public health. So far, public health researchers have largely ignored genetic discoveries, and geneticists have ignored important aspects of population health science. This mutual neglect should end. In this article, we discuss 3 areas where public health researchers can help to advance translation: (1) risk assessment: investigate genetic profiles as components in composite risk assessments; (2) targeted intervention: conduct life-course longitudinal studies to understand when genetic risks manifest in development and whether intervention during sensitive periods can have lasting effects; and (3) improved understanding of environmental causation: collaborate with geneticists on gene-environment interaction research. We illustrate with examples from our own research on obesity and smoking.
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Affiliation(s)
- Daniel W Belsky
- Daniel W. Belsky is with the Center for the Study of Aging and Human Development, Duke University Medical Center, and the Institute for Genome Sciences and Policy, Duke University, Durham, NC. Terrie E. Moffitt and Avshalom Caspi are with the Institute for Genome Sciences and Policy, Duke University and the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, the Department of Psychology and Neuroscience, Duke University, and the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, London, UK
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Darst BF, Madlensky L, Schork NJ, Topol EJ, Bloss CS. Perceptions of genetic counseling services in direct-to-consumer personal genomic testing. Clin Genet 2013; 84:335-9. [PMID: 23590221 DOI: 10.1111/cge.12166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/10/2013] [Indexed: 11/27/2022]
Abstract
To describe consumers' perceptions of genetic counseling services in the context of direct-to-consumer personal genomic testing is the purpose of this research. Utilizing data from the Scripps Genomic Health Initiative, we assessed direct-to-consumer genomic test consumers' utilization and perceptions of genetic counseling services. At long-term follow-up, approximately 14 months post-testing, participants were asked to respond to several items gauging their interactions, if any, with a Navigenics genetic counselor, and their perceptions of those interactions. Out of 1325 individuals who completed long-term follow-up, 187 (14.1%) indicated that they had spoken with a genetic counselor. The most commonly given reason for not utilizing the counseling service was a lack of need due to the perception of already understanding one's results (55.6%). The most common reasons for utilizing the service included wanting to take advantage of a free service (43.9%) and wanting more information on risk calculations (42.2%). Among those who utilized the service, a large fraction reported that counseling improved their understanding of their results (54.5%) and genetics in general (43.9%). A relatively small proportion of participants utilized genetic counseling after direct-to-consumer personal genomic testing. Among those individuals who did utilize the service, however, a large fraction perceived it to be informative, and thus presumably beneficial.
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Affiliation(s)
- B F Darst
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA
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Graves KD, Leventhal KG, Nusbaum R, Salehizadeh Y, Hooker GW, Peshkin BN, Butrick M, Tuong W, Mathew J, Goerlitz D, Fishman MB, Shields PG, Schwartz MD. Behavioral and psychosocial responses to genomic testing for colorectal cancer risk. Genomics 2013; 102:123-30. [PMID: 23583311 DOI: 10.1016/j.ygeno.2013.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 11/28/2022]
Abstract
We conducted a translational genomic pilot study to evaluate the impact of genomic information related to colorectal cancer (CRC) risk on psychosocial, behavioral and communication outcomes. In 47 primary care participants, 96% opted for testing of three single nucleotide polymorphisms (SNPs) related to CRC risk. Participants averaged 2.5 of 6 possible SNP risk alleles (10% lifetime risk). At 3-months, participants did not report significant increases in cancer worry/distress; over half reported physical activity and dietary changes. SNP risk scores were unrelated to behavior change at 3-months. Many participants (64%) shared their SNP results, including 28% who shared results with a physician. In this pilot, genomic risk education, including discussion of other risk factors, appeared to impact patients' health behaviors, regardless of the level of SNP risk. Future work can compare risk education with and without SNP results to evaluate if SNP information adds value to existing approaches.
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Affiliation(s)
- Kristi D Graves
- Cancer Prevention and Control Program and the Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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Bloss CS, Wineinger NE, Darst BF, Schork NJ, Topol EJ. Impact of direct-to-consumer genomic testing at long term follow-up. J Med Genet 2013; 50:393-400. [DOI: 10.1136/jmedgenet-2012-101207] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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Effect of direct-to-consumer genetic tests on health behaviour and anxiety: a survey of consumers and potential consumers. J Genet Couns 2013; 22:565-75. [PMID: 23547022 DOI: 10.1007/s10897-013-9582-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 03/18/2013] [Indexed: 01/24/2023]
Abstract
Direct-to-consumer (DTC) genetic tests can be purchased over the internet. Some companies claim to provide relative genetic risks for various diseases and thus encourage healthy behaviour. There are concerns that exposure to such information may actually discourage healthy behaviour or increase health anxiety. An online survey was conducted (n = 275). Respondents were composed of individuals who had purchased a DTC genetic test and received their results (consumers, n = 189), as well as individuals who were either awaiting test results or considering purchasing a test (potential consumers, n = 86). Consumers were asked if their health behaviour or health anxiety had changed after receiving their results. Respondents' current health behaviour and health anxiety were queried and compared. In total, 27.3 % of consumers claimed a change in health behaviour, all either positive or neutral, with no reported cessation of any existing health behaviour. A change in health anxiety was claimed by 24.6 % of consumers, 85.3 % of which were a reduction. Consumers had significantly better health behaviour scores than potential consumers (p = 0.02), with no significant difference in health anxiety. This study points towards an association between receipt of DTC genetic test results and increased adoption of healthy behaviours for a minority of consumers based on self-report, with more mixed results in relation to health anxiety.
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