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Fishbein JE, Dass LW, Lienczewski C, Kretzler M, Gbadegesin RA, Roberts JS, Sampson MG, Uhlmann WR. Assessment of the Needs of Nephrology Divisions to Implement Return of Clinically Significant Research Genetic Results: A Survey of Nephrotic Syndrome Study Network (NEPTUNE) Investigators. GLOMERULAR DISEASES 2023; 3:178-188. [PMID: 37901694 PMCID: PMC10601953 DOI: 10.1159/000533501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/05/2023] [Indexed: 10/31/2023]
Abstract
Introduction There is an increasing need to return genetic testing results to patients with kidney disease who were first genotyped on a research basis. Operationalizing this process in nephrology clinics is challenged by a limited number of genetic providers with whom to partner and a general lack of support services for all clinicians. Methods We administered a survey in March 2022 to assess the current ability and ongoing needs of nephrology divisions to return clinically significant research genetic results to patients and to implement clinical genetic testing. This survey was distributed to institutions within the Nephrotic Syndrome Study Network (NEPTUNE) as part of the planning process for return of research genetic results to participants with pathogenic variants in Mendelian nephrotic syndrome genes. Results Twenty-seven of 28 sites (96%) completed the survey. 59% (n = 16) of sites said they could handle return of research genetic results independently, with the rest expressing hesitation about the volume and complexity of patients and the limited resources and access to genetics services. 81% (n = 22) of these institutions did have a genetics clinic and 26% (n = 7) have a nephrology genetics clinic. However, 70% (n = 10) of these clinics have a waiting time over 1 month. 89% of divisions (n = 24) were conducting genetic testing and 96% of those (n = 23) used a kidney multi-gene panel. In 46% of divisions (n = 11), nephrologists were handling logistics of obtaining genetic testing samples themselves. Conclusion We identified specific areas of support needed for return of clinically significant genetic results from research studies. While the surveyed nephrologists were conducting genetic testing, there were limitations in the support services available. This survey will help guide other research studies that wish to return genetic results to participants and also highlight the need for increasing support to effectively operationalize genetic testing in nephrology clinics.
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Affiliation(s)
| | - Loryn Wilson Dass
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC, USA
| | - Chrysta Lienczewski
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Kretzler
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Rasheed A. Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC, USA
| | - J. Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - NEPTUNE
- Division of Nephrology, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Kidney Disease Initiative and Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAUSA
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Matthew G. Sampson
- Division of Nephrology, Boston Children’s Hospital, Boston, MA, USA
- Kidney Disease Initiative and Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAUSA
| | - Wendy R. Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, MI, USA
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Donohue KE, Gooch C, Katz A, Wakelee J, Slavotinek A, Korf BR. Pitfalls and challenges in genetic test interpretation: An exploration of genetic professionals experience with interpretation of results. Clin Genet 2021; 99:638-649. [PMID: 33818754 DOI: 10.1111/cge.13917] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
The interpretation of genetic testing results is subject to error. This observational study illustrates examples of pitfalls and challenges in interpretation of genetic testing results as reported by genetics professionals. We surveyed genetics professionals to describe interpretation challenges, the types of variants that were involved, and the reported clinical impact of misconception of a test result. Case studies were then collected from a select group to further explore potential causes of misunderstanding. A total of 83% of survey respondents were aware of at least one instance of genetic test misinterpretation. Both professionals with and without formal training in genetics were challenged by test reports, and variants of unknown significance were most frequently involved. Case submissions revealed that interpretation pitfalls extend beyond variant classification analyses. Inferred challenges in case submissions include lack of genetic counseling, unclear wording of reports, and suboptimal communication among providers. Respondents and case submitters noted that incorrect interpretation can trigger unnecessary follow-up tests and improperly alter clinical management. Further research is needed to validate and quantify large-scale data regarding challenges of genetic results interpretation.
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Affiliation(s)
- Katherine E Donohue
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Gooch
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Pediatrics, Division of Genetics and Genomic Medicine, Washington University at St Louis School of Medicine, St. Louis, MO, USA
| | - Alexander Katz
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Jessica Wakelee
- Center for the Study of Community Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anne Slavotinek
- Division of Genetics, Department of Pediatrics, University of California, San Francisco, California, USA
| | - Bruce R Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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3
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Cornel MC. Evidence-Based Genetic Education of Non-Genetic-Expert Physicians: Experiences Over Three Decades in Amsterdam. Front Genet 2019; 10:712. [PMID: 31428139 PMCID: PMC6687771 DOI: 10.3389/fgene.2019.00712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/05/2019] [Indexed: 11/25/2022] Open
Abstract
To study and improve the competences of health-care workers in the domain of genetics, attention needs to be paid to attitudes, activities, knowledge, and changes in performance. Three decades of research on genetic education for non-genetic-experts in Amsterdam are summarized, including both local and international collaborative efforts. Evidence shows that assessment of learners’ needs and the definition of competences have driven slow but gradual improvement in genetics competence among non-geneticists. Attitudes and behavior are mainly influenced by face-to-face training. eLearning modules can serve to increase knowledge in a large number of participants in a rapidly changing field. Materials developed for accredited courses will sometimes be used for reference or just in time learning. Taking a theoretically informed evaluation approach, it has been possible to demonstrate satisfaction, improved knowledge, and self-reported behavioral change, although measuring effects on health-care practice and population health remains challenging. A flexible approach is needed to serve learners’ needs in a field with many upcoming challenges.
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Affiliation(s)
- Martina C Cornel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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4
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Harding B, Webber C, Rühland L, Dalgarno N, Armour C, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips SP, MacKenzie JJ. Bridging the gap in genetics: a progressive model for primary to specialist care. BMC MEDICAL EDUCATION 2019; 19:195. [PMID: 31185964 PMCID: PMC6558677 DOI: 10.1186/s12909-019-1622-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/22/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND The rapid expansion of genetic knowledge, and the implications for healthcare has resulted in an increased role for Primary Care Providers (PCPs) to incorporate genetics into their daily practice. The objective of this study was to explore the self-identified needs, including educational needs, of both urban and rural Primary Care Providers (PCPs) in order to provide genetic care to their patients. METHODS Using a qualitative grounded theory approach, ten key informant interviews, and one urban and two rural PCP focus groups (FGs) (n = 19) were conducted. All PCPs practiced in Southeastern Ontario. Data was analyzed using a constant comparative method and thematic design. The data reported here represent a subset of a larger study. RESULTS Participants reported that PCPs have a responsibility to ensure patients receive genetic care. However, specific roles and responsibilities for that care were poorly defined. PCPs identified a need for further education and resources to enable them to provide care for individuals with genetic conditions. Based on the findings, a progressive stepped model that bridges primary and specialty genetic care was developed; the model ranged from PCPs identifying patients with genetic conditions that they could manage alone, to patients who they could manage with informal or electronic consultation to those who clearly required specialist referral. CONCLUSIONS PCPs identified a need to integrate genetics into primary care practice but they perceived barriers including a lack of knowledge and confidence, access to timely formal and informal consultation and clearly defined roles for themselves and specialists. To address gaps in PCP confidence in providing genetic care, interventions that are directed at accessible just-in-time support and consultation have the potential to empower PCPs to manage patients' genetic conditions. Specific attention to content, timing, and accessibility of educational interventions is critical to address the needs of both urban and rural PCPs. A progressive framework for bridging primary to specialty care through a 'stepped' model for providing continuing medical education, and genetic care can was developed and can be used to guide future design and delivery of educational interventions and resources.
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Affiliation(s)
- Brittany Harding
- Department of Pediatrics, McMaster University, Hamilton, Ontario Canada
| | - Colleen Webber
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Lucia Rühland
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Nancy Dalgarno
- Botterell Hall, Queen’s University, 18 Stuart Street, Kingston, Ontario K7L 3N6 Canada
| | - Christine Armour
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | | | - Glenn Brown
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - June C. Carroll
- Department of Family and Community Medicine, Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario M5T 3L9 Canada
| | - Michael Flavin
- Department of Pediatrics, Faculty of Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Susan P. Phillips
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - Jennifer J. MacKenzie
- Department of Pediatrics, McMaster Children’s Hospital, 1280, Main St. West, 3N11-G, Hamilton, Ontario L8S 4K1 Canada
- Department of Medicine, Queen’s University, Kingston, Ontario Canada
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5
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Chapman R, Likhanov M, Selita F, Zakharov I, Smith-Woolley E, Kovas Y. New literacy challenge for the twenty-first century: genetic knowledge is poor even among well educated. J Community Genet 2019; 10:73-84. [PMID: 29589204 PMCID: PMC6325037 DOI: 10.1007/s12687-018-0363-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/07/2018] [Indexed: 11/10/2022] Open
Abstract
We live in an age of rapidly advancing genetic research. This research is generating new knowledge that has implications for personal health and well-being. The present study assessed the level of genetic knowledge and personal engagement with genetics in a large sample (N = 5404) of participants. Participants received secondary education in 78 countries, with the largest samples from Russia, the UK and the USA. The results showed significant group differences in genetic knowledge between different countries, professions, education levels and religious affiliations. Overall, genetic knowledge was poor. The questions were designed to assess basic genetic literacy. However, only 1.2% of participants answered all 18 questions correctly, and the average score was 65.5%. Genetic knowledge was related to peoples' attitudes towards genetics. For example, those with greater genetic knowledge were on average more willing to use genetic knowledge for their personal health management. Based on the results, the paper proposes a number of immediate steps that societies can implement to empower the public to benefit from ever-advancing genetic knowledge.
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Affiliation(s)
- Robert Chapman
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK
| | | | - Fatos Selita
- Tomsk State University, Tomsk, Russia
- IBL Consultancy, London, UK
| | - Ilya Zakharov
- Psychological Institute of the Russian Academy of Education, Moscow, Russia
| | - Emily Smith-Woolley
- Social, Genetic and Developmental Psychiatry Centre, King's College, London, UK
| | - Yulia Kovas
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK.
- Tomsk State University, Tomsk, Russia.
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6
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Harding B, Webber C, Ruhland L, Dalgarno N, Armour CM, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips S, MacKenzie JJ. Primary care providers' lived experiences of genetics in practice. J Community Genet 2018; 10:85-93. [PMID: 29700759 PMCID: PMC6325046 DOI: 10.1007/s12687-018-0364-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/12/2018] [Indexed: 12/28/2022] Open
Abstract
To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners’ additional concerns included cost, distance, and poor patient engagement. PCPs’ perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.
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Affiliation(s)
- Brittany Harding
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, Kingston, Ontario, K7L 2N6, Canada
| | - Colleen Webber
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Lucia Ruhland
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Nancy Dalgarno
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Richard Birtwhistle
- Centre for Studies in Primary Care, Queen's University, 220 Bagot Street, P.O.#8888, Kingston, Ontario, K7L 5E9, Canada
| | - Glenn Brown
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - June C Carroll
- Department of Family & Community Medicine, Mount Sinai Hospital, Granovsky Gluskin Family Medicine Centre, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario, M5T 3L9, Canada
| | - Michael Flavin
- Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
| | - Susan Phillips
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - Jennifer J MacKenzie
- Department of Pediatrics, McMaster Children's Hospital, 1280 Main St. West, 3N11-G, Hamilton, ON, L8S 4K1, Canada.
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7
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Amara N, Blouin-Bougie J, Bouthillier D, Simard J. On the readiness of physicians for pharmacogenomics testing: an empirical assessment. THE PHARMACOGENOMICS JOURNAL 2017; 18:308-318. [DOI: 10.1038/tpj.2017.22] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 03/02/2017] [Accepted: 04/14/2017] [Indexed: 01/24/2023]
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8
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Slade I, Subramanian DN, Burton H. Genomics education for medical professionals - the current UK landscape. Clin Med (Lond) 2016; 16:347-52. [PMID: 27481379 PMCID: PMC6280204 DOI: 10.7861/clinmedicine.16-4-347] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Genomics education in the UK is at an early stage of development, and its pace of evolution has lagged behind that of the genomics research upon which it is based. As a result, knowledge of genomics and its applications remains limited among non-specialist clinicians. In this review article, we describe the complex landscape for genomics education within the UK, and highlight the large number and variety of organisations that can influence, direct and provide genomics training to medical professionals. Postgraduate genomics education is being shaped by the work of the Health Education England (HEE) Genomics Education Programme, working in conjunction with the Joint Committee on Genomics in Medicine. The success of their work will be greatly enhanced by the full cooperation and engagement of the many groups, societies and organisations involved with medical education and training (such as the royal colleges). Without this cooperation, there is a risk of poor coordination and unnecessary duplication of work. Leadership from an organisation such as the HEE Genomics Education Programme will have a key role in guiding the formulation and delivery of genomics education policy by various stakeholders among the different disciplines in medicine.
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Affiliation(s)
- Ingrid Slade
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; specialist registrar, Oxford University Hospitals Trust, Oxford, UK; director, Centre for Personalised Medicine, University of Oxford, Oxford, UK
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9
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A review of consanguinity in Ireland—estimation of frequency and approaches to mitigate risks. Ir J Med Sci 2015; 185:17-28. [DOI: 10.1007/s11845-015-1370-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
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10
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Family physicians' management of genetic aspects of a cardiac disease: a scenario-based study from slovenia. Balkan J Med Genet 2014; 17:15-22. [PMID: 25741210 PMCID: PMC4347472 DOI: 10.2478/bjmg-2014-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to find out how Slovenian family physicians (FPs) would manage a hypothetical clinical case, to explore their views about possible ethical dilemmas associated with this clinical case and to determine possible associations with demographic and other characteristics of FPs. This was an observational cross-sectional postal study in the Slovenian FPs' surgeries. The study population consisted of the whole population of Slovenian FPs (n = 950). The main outcome measures were the percentages of the answers of FPs on different questions about the clinical case on the management of patient and his relative with hereditary cardiomyopathy. There were 271 FPs who answered the questionnaire (response rate was 27.1%). A sample included 66 (24.4%) men and the mean age of all respondents was 45.5 ± 10.6 years. When dealing with the clinical case, most FPs expressed willingness to take the patient's family history. Only 34.2% FPs did not believe that ordering genetic tests was part of their job. Additionally, only 50.0% of them felt competent to interpret the genetic risk, 25.0% of them would give information about genetic testing and only 6.0% would interpret the results of the genetic testing. Family physicians in Slovenia were willing to include genetic tasks into routine management of their patients, but they do not feel competent enough to interpret the genetic risks and the results of genetic testing. However, an important part of FPs would not refer patients at risk to genetic counseling. The inclusion of genetic topics to family medicine specialization curriculum is needed.
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11
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Nippert I, Julian-Reynier C, Harris H, Evans G, van Asperen CJ, Tibben A, Schmidtke J. Cancer risk communication, predictive testing and management in France, Germany, the Netherlands and the UK: general practitioners' and breast surgeons' current practice and preferred practice responsibilities. J Community Genet 2013; 5:69-79. [PMID: 24297247 DOI: 10.1007/s12687-013-0173-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022] Open
Abstract
Genetic testing has its greatest public health value when it identifies individuals who will benefit from specific interventions based upon their risk. This paradigm is the basis for the use of predictive tests, such as BRCA1/BRCA2 testing which has become part of clinical practice for more than a decade. Currently predictive BRCA1/BRCA2 testing is offered to women using low, moderate and high risk based upon family history as cut-off levels. Non-genetic health professionals such as general practitioners (GPs) and breast surgeons (BS) are seen as gatekeepers to manage demand and/or facilitate access to appropriate services for high-risk patients. Data about current practices are lacking. The paper presents data on the current practice of GPs' and BS' cancer risk assessment, referral practices and preferred practice responsibilities for women at risk for familial breast cancer in France, Germany, the Netherlands and the UK derived by a self-administered questionnaire send to a representative sample of GPs and BS in the four countries. One thousand one hundred ninety-seven GPs and 1,223 BS completed the questionnaire. Both GPs and BS reported that they are consulted by a considerable number of patients presenting with concerns about a family history of cancer. Both commonalities and striking differences could be observed between GPs and BS from the four participating countries. GPs from France and Germany reported significantly higher proportions taking a family history of cancer including the extended family than GPs from the Netherlands and the UK. Most GPs from France, Germany and the Netherlands stated their willingness for providing risk assessment for an unaffected (high-risk) woman with a family history of breast cancer and the vast majority of BS from all four countries reported that they themselves would provide risk assessment for an unaffected (high-risk) woman with a family history of breast cancer. However, a substantial number of both GPs and BS would not have taken an appropriate family history for their patient failing to take into account the paternal side of the family. GPs from Germany reported a significantly lower readiness to refer a patient with a family history of a BRCA1 mutation for specialist genetic counselling when compared to the GPs from the other countries. GPs and BS from France, Germany and the Netherlands significantly less often assigned practice responsibilities to a genetic specialist as compared to the participating GPs and BS from the UK. The outcome of the study confirms the need for capability building in genetics for non-genetic health professionals. Using genetic risk assessment tools without a full understanding could result in missed opportunities for cancer prevention and harm patients. In order to provide best possible services for high-risk patients presenting with cancer concerns, close collaboration with clinical geneticists should become routine part of mainstream medical practice.
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Affiliation(s)
- Irmgard Nippert
- Women's Health Research Unit/Department of Human Genetics, Medical School, Westfaelische Wilhelms-University, Münster, Germany,
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12
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Veltman JA, Cuppen E, Vrijenhoek T. Challenges for implementing next-generation sequencing-based genome diagnostics: it's also the people, not just the machines. Per Med 2013; 10:473-484. [PMID: 29758834 DOI: 10.2217/pme.13.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The scope of next-generation DNA sequencing (NGS) is transitioning from research to diagnostics (and beyond), but the conditions for routine clinical application have not been clearly defined. Technological limitations for sequencing a patient's DNA fast and affordably are rapidly disappearing. At the same time, more and more is known about the role of DNA variation in disease susceptibility, disease development and response to treatment. Consequently, more and more pediatricians, cardiologists and other medical specialists would like to apply NGS-based diagnostics. The standard, comprehensive and easy-to-handle genetic test these specialists are looking for, however, is not yet available. Molecular diagnostic laboratories have started to implement NGS into their routine workflows, but are also becoming increasingly aware that the context in which they operate is changing. It becomes apparent that the major challenges are not in the technology, but rather in anticipating the changing scope and scale. Developing the infrastructure to sustainably perform NGS-based diagnostics in a changing technological, clinical and societal context is therefore more relevant than defining minimal performance criteria or standard analysis pipelines. Implementing NGS-based diagnostics comes with novel applications, emerging service models and reconfiguration of professional roles, and should thus be considered in the context of future healthcare. Here, we present the key elements for transition of NGS from research to diagnostics.
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Affiliation(s)
- Joris A Veltman
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Centre for Genome Diagnostics, Utrecht, The Netherlands
| | - Edwin Cuppen
- Centre for Genome Diagnostics, Utrecht, The Netherlands.,Department of Medical Genetics, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Terry Vrijenhoek
- Department of Medical Genetics, Utrecht University Medical Centre, Utrecht, The Netherlands.,Centre for Genome Diagnostics, Utrecht, The Netherlands.
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Dhar SU, Alford RL, Nelson EA, Potocki L. Enhancing exposure to genetics and genomics through an innovative medical school curriculum. Genet Med 2011; 14:163-7. [DOI: 10.1038/gim.0b013e31822dd7d4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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14
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Dodson C. Knowledge and attitudes concerning pharmacogenomics among healthcare professionals. Per Med 2011; 8:421-428. [DOI: 10.2217/pme.11.28] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pharmacogenomics has become an area of great potential in the medical community. Therefore, the assessment of the knowledge and attitudes among healthcare professionals is essential. The purpose of this systematic literature review is to explore the knowledge and attitudes of healthcare professionals regarding pharmacogenetic testing with a specific emphasis in oncology. A total of 12 articles were found and reviewed. A majority of the articles reported only on the attitudes of healthcare professionals. Four of the articles reported on both knowledge and attitudes of healthcare professionals concerning pharmacogenetic testing, and one article reported only on the knowledge level of healthcare professionals. This systematic literature review revealed that healthcare professionals generally perceive themselves to have limited knowledge regarding pharmacogenetic testing. In addition, these articles highlighted the overwhelming ethical concerns surrounding pharmacogenomics. However, these articles also revealed that healthcare professionals believed that there were also many advantages regarding the utilization of pharmacogenomics.
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Affiliation(s)
- Crystal Dodson
- University of North Carolina, Chapel Hill, Department of Social Medicine, 347A MacNider, CB 7240, Columbia Street, Chapel Hill, NC 27599-27240, USA
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15
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Dodson CH, Lewallen LP. Nursing students' perceived knowledge and attitude towards genetics. NURSE EDUCATION TODAY 2011; 31:333-9. [PMID: 20678829 DOI: 10.1016/j.nedt.2010.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 06/01/2010] [Accepted: 07/10/2010] [Indexed: 05/22/2023]
Abstract
The purpose of this study was to assess the knowledge base of nursing students regarding the topic of genetics and how this may change as a student progresses through the nursing program. A 70 item multiple-choice and dichotomous survey was given to freshman, sophomore, junior, and senior nursing students at a university school of nursing in the eastern part of the United States. Two hundred and seventy five pre-licensure nursing students, 255 females and 18 males, comprised the sample. A one-way analysis of variance (ANOVA) was performed and the results concluded that there was a significant difference among the freshmen, sophomores, juniors, and seniors in regards to having at least a 'minimal' knowledge or better of medical genetic terminology and conditions. Seniors reported a higher number of terms which they had at least a 'minimal' knowledge level or better than freshmen or sophomores. Also the juniors reported a higher number of terms which they had at least a 'minimal' knowledge level or better than sophomores.
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Challen K, Harris H, Kristoffersson U, Nippert I, Schmidtke J, Ten Kate LP, Benjamin C, Anionwu E, Plass AM, Julian-Reynier C, Harris R. General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices. J Community Genet 2011; 1:83-90. [PMID: 21475668 PMCID: PMC3063843 DOI: 10.1007/s12687-010-0013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 07/28/2010] [Indexed: 11/25/2022] Open
Abstract
It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding responsibility for genetic tasks and factors affecting those perceptions. Postal questionnaire including a hypothetical case management scenario of a cardiac condition with a genetic component was sent to random samples of medically qualified general practitioners in France, Germany, Netherlands, Sweden and UK (n = 1,168). Logistic regression analysis of factors affecting primary care practitioners' willingness to carry out genetic tasks themselves was conducted; 61% would take a family history themselves but only 38% would explain an inheritance pattern and 16% would order a genetic test. In multivariate analysis, only the country of practice was consistently predictive of willingness to carry out genetic tasks, although male gender predicted willingness to carry out the majority of tasks studied. The stage of career at which education in genetics had been provided was not predictive of willingness to carry out any of the tasks analysed. Country of practice is significantly predictive of attitudes towards genetics in primary care practice and therefore genetic education structure and content in Europe will need to be significantly tailored towards country-specific approaches.
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Affiliation(s)
- Kirsty Challen
- GenEd Co-ordinating Centre, University of Manchester, Manchester, UK
| | - Hilary Harris
- GenEd Co-ordinating Centre, University of Manchester, Manchester, UK
| | - Ulf Kristoffersson
- Department of Clinical Genetics, University and Regional Laboratories, Lund University, Lund, Sweden
| | - Irmgard Nippert
- Women’s Health Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Joerg Schmidtke
- Insititut fur Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Leo P. Ten Kate
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Caroline Benjamin
- School of Health Sciences, University of Birmingham and Liverpool Women’s NHS Foundation Trust, Liverpool, UK
| | - Elizabeth Anionwu
- Emeritus Professor of Nursing, Thames Valley University, Reading, UK
| | | | | | - Rodney Harris
- GenEd Co-ordinating Centre, University of Manchester, Manchester, UK
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Nippert I, Harris HJ, Julian-Reynier C, Kristoffersson U, Ten Kate LP, Anionwu E, Benjamin C, Challen K, Schmidtke J, Nippert RP, Harris R. Confidence of primary care physicians in their ability to carry out basic medical genetic tasks-a European survey in five countries-Part 1. J Community Genet 2010; 2:1-11. [PMID: 22109718 DOI: 10.1007/s12687-010-0030-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022] Open
Abstract
Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians' background in medical genetics.
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Affiliation(s)
- Irmgard Nippert
- Frauengesundheitsforschung/Institut für Humangenetik, Universitätsklinikum Münster, Niels- Stensen-Str. 14, 48149, Münster, Germany,
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Gharaibeh H, Oweis A, Hamad K. Nurses' and midwives' knowledge and perceptions of their role in genetic teaching. Int Nurs Rev 2010; 57:435-42. [DOI: 10.1111/j.1466-7657.2010.00814.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsouroufli M. Routinisation and constraints on informed choice in a one-stop clinic offering first trimester chromosomal antenatal screening for Down's syndrome. Midwifery 2010; 27:431-6. [PMID: 20947230 DOI: 10.1016/j.midw.2010.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 02/01/2010] [Accepted: 02/20/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to explore routinisation and constraints on informed choice in a one-stop clinic offering first trimester antenatal chromosomal screening for Down's syndrome. DESIGN recordings of booking appointments and pre-screening consultations in both a community and a hospital clinic setting. SETTING one antenatal clinic site in the UK offering first trimester nuchal translucency screening in combination with maternal serum screening. PARTICIPANTS 57 taped clinical consultations involving pregnant women and midwives and health-care assistants (HCAs). FINDINGS midwives and HCAs expected women to make informed decisions about screening for Down's syndrome. However, midwives' attempts to maintain the normality of pregnancy and avoid discussions about potential scenarios, as well as their emphasis on the high accuracy rate of first trimester screening have routinised first trimester antenatal screening for Down's syndrome. Also, a general expectation in the clinic to take up screening and the constrained service context in which midwives and HCAs work had implications for women's informed choices. KEY CONCLUSIONS directive information combined with lack of purposeful dialogue with pregnant women have constrained the process of information-giving about antenatal screening for Down's syndrome. IMPLICATIONS the provision of information about antenatal screening for Down's syndrome is a challenging role for midwives. Changes in midwifery practice resulting from continuing education as well as less constraining service contexts could improve the quality of information about antenatal screening for Down's syndrome.
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Affiliation(s)
- Maria Tsouroufli
- School of Medicine Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK.
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Plass AMC, Baars MJ, Cornel MC, Julian-Reynier C, Nippert I, Harris H, Kristoffersson U, Schmidtke J, Anionwu EN, Benjamin C, Challen K, Harris R, ten Kate LP. Testing the Children: Do Non-Genetic Health-Care Providers Differ in Their Decision to Advise Genetic Presymptomatic Testing on Minors? A Cross-Sectional Study in Five Countries in the European Union. Genet Test Mol Biomarkers 2009; 13:367-76. [DOI: 10.1089/gtmb.2008.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne Marie C. Plass
- Department of Clinical Genetics, Subdivision of Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
- EMGO-Institute, Amsterdam, The Netherlands
| | | | - Martina C. Cornel
- Department of Clinical Genetics, Subdivision of Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
- EMGO-Institute, Amsterdam, The Netherlands
| | - Claire Julian-Reynier
- INSERM, UMR912; Marseilles, France
- Institut Paoli-Calmettes; Marseilles, France
- Université Aix-Marseille, Marseilles, France
| | - Irmgard Nippert
- Frauengesundheitsforschung, Institut für Humangenetik, Universitätsklinikum, Münster, Germany
| | - Hillary Harris
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | | | - Jörg Schmidtke
- Institut für Humangenetik, Medizinische Hochschule, Hannover, Germany
| | - Elizabeth N. Anionwu
- Faculty of Health and Human Sciences, Thames Valley University, London, United Kingdom
| | - Caroline Benjamin
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Kirsty Challen
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Rodney Harris
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Leo P. ten Kate
- Department of Clinical Genetics, Subdivision of Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
- EMGO-Institute, Amsterdam, The Netherlands
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Assessing educational priorities in genetics for general practitioners and specialists in five countries: factor structure of the Genetic-Educational Priorities (Gen-EP) scale. Genet Med 2008; 10:99-106. [PMID: 18281916 DOI: 10.1097/gim.0b013e3181614271] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE A scale assessing primary care physicians' priorities for genetic education (The Gen-EP scale) was developed and tested in five European countries. The objective of this study was to determine its factor structure, to test scaling assumptions and to determine internal consistency. METHODS The sample consisted of 3686 practitioners (general practitioners, gyneco-obstetricians, pediatricians) sampled in France, Germany, the Netherlands, Sweden, and United Kingdom. We first determined the factor structure of the Gen-EP scale (30 items) on the whole sample. Scaling assumptions were then tested on each country using multitrait scaling analysis. Internal consistency was assessed across the five countries. RESULTS Six factors were identified accounting for 63.3% of the variance of the items. They represented the following priorities for genetic education: "Genetics of Common Diseases"; "Ethical, Legal, and Public Health Issues"; "Approaching Genetic Risk Assessment in Clinical Practice"; "Basic Genetics and Congenital Malformations"; "Techniques and Innovation in Genetics" and "Psychosocial and Counseling Issues." In each country, convergent and discriminant validity were satisfactory. Internal-consistency reliability coefficients (Cronbach's alpha) were all above the acceptable threshold (0.70). CONCLUSION The Gen-EP scale could be a helpful instrument in different countries to organize and evaluate the impact of genetic educational programs for primary care providers.
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Benjamin CM, Anionwu EN, Kristoffersson U, ten Kate LP, Plass AMC, Nippert I, Julian-Reynier C, Harris HJ, Schmidtke J, Challen K, Calefato JM, Waterman C, Powell E, Harris R. Educational priorities and current involvement in genetic practice: a survey of midwives in the Netherlands, UK and Sweden. Midwifery 2008; 25:483-99. [PMID: 18068279 DOI: 10.1016/j.midw.2007.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 06/25/2007] [Accepted: 08/20/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to investigate whether practising midwives are adequately prepared to integrate genetic information into their practice. DESIGN a cross-sectional, postal, structured questionnaire survey was sent to practising midwives. SETTING practising midwives from the Netherlands (NL), Sweden (SE) and the United Kingdom (UK). PARTICIPANTS 1021 replies were received, achieving a response rate of 62%. FINDINGS 79% (799/1015) of midwives reported attending courses with some 'genetic content' during their initial training. Sixty-eight per cent (533/784) judged this to have been useful for clinical practice. Variation was seen between countries in the amount of genetic content in post-registration training (SE 87%, NL 44%, UK 17%) and most was considered useful. Questions assessing clinical activity identified a current need for genetic knowledge. Midwives described low levels of self-reported confidence both in overtly genetic procedures and in everyday tasks that were underpinned by genetic knowledge. For eight of the 12 procedures, fewer than 20% of midwives considered themselves to be confident. Differences were apparent between countries. Midwives identified psychosocial, screening and risk assessment aspects of genetic education as being important to them, rather than technical aspects or genetic science. CONCLUSIONS given the low reported confidence with genetic issues in clinical practice, it is essential that this is addressed in terms of the amount, content and targeting of genetic education. This is especially important to ensure the success of national antenatal and baby screening programmes. The results of this study suggest that midwives would welcome further training in genetics, addressing genetic topics most relevant to their clinical practice.
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Metcalfe A, Haydon J, Bennett C, Farndon P. Midwives’ views of the importance of genetics and their confidence with genetic activities in clinical practice: implications for the delivery of genetics education. J Clin Nurs 2008; 17:519-30. [PMID: 17608634 DOI: 10.1111/j.1365-2702.2006.01884.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alison Metcalfe
- School of Health Sciences, University of Birmingham, Edgbaston, UK
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Telner DE, Carroll JC, Talbot Y. Genetics education in medical school: a qualitative study exploring educational experiences and needs. MEDICAL TEACHER 2008; 30:192-8. [PMID: 18464146 DOI: 10.1080/01421590701827353] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Genetic discoveries increasingly have an impact on clinical medicine. Primary care providers (PCPs) need to be prepared to address patients' concerns about their genetic risks. AIMS To explore family medicine residents' experiences with genetics in medical school and residency training and to understand their educational needs in genetics. METHODS Four focus groups were held with 33 family medicine residents at the University of Toronto, which represented graduates of 9 different Canadian medical schools. Groups were audio-taped, transcribed and analysed independently by 4 reviewers using content analysis. Recurrent themes were identified. RESULTS Participants described their experiences with genetics in medical school as almost entirely related to rare disorders, so genetics was not perceived to be clinically relevant. There was little awareness of the complex ethical and psychosocial issues that accompany genetics. However, participants felt that genetics would become significant in medical care in the future and PCPs would play an important role. They expressed a need for more knowledge of genetics to fulfill this role and practical teaching in genetics by clinicians. CONCLUSIONS Medical school educational experiences may not be preparing future PCPs to address genetic issues with patients. A change and a broadening of the teaching of genetics are required to fulfill this need.
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Coviello DA, Skirton H, Ceratto N, Lewis C, Kent A. Genetic testing and counselling in Europe: health professionals current educational provision, needs assessment and potential strategies for the future. Eur J Hum Genet 2007; 15:1203-4. [PMID: 17895901 DOI: 10.1038/sj.ejhg.5201927] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Domenico A Coviello
- Laboratory of Medical Genetics, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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Metcalfe A, Haydon J, Bennett C, Farndon P. Midwives? views of the importance of genetics and their confidence with genetic activities in clinical practice: implications for the delivery of genetics education. J Clin Nurs 2007. [DOI: 10.1111/j.1365-2702.2007.01884.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM This paper reports a literature review exploring genetics education for nursing professionals. The aim was to contribute to the debate about the future direction of such education. BACKGROUND Advances in genetics science and technology have profound implications for health care and the growing importance and relevance of genetics for everyday nursing practice is increasingly recognized. METHOD A search was conducted in February 2005 using the CINAHL and Google Scholar databases and the keywords nurse, midwife, health visitor, education and genetics. Papers were included if they were published in English between 1994 and 2005 and included empirical data about genetics education in nursing. In addition, attempts were made to access the grey literature, with requests for information on research, for example, to members of the Association of Genetic Nurses and Counsellors and searches of relevant websites. FINDINGS Agreement on the relevance of genetics for nursing practice is extensive. Empirical evidence of the learning needs of practitioners highlights widespread deficits in knowledge and skills, and low confidence levels. Provision of nursing education in genetics is patchy and insubstantial across a number of countries, further hampered by lack of strategic development. Significant progress has been made in the identification of learning outcomes for nurses. Research on the delivery of genetics education is limited, but the role of skills-based training, use of clinical scenarios, and importance of assessment have all been identified as factors that can promote learning. CONCLUSION Whilst areas of good performance were revealed, many studies identified gaps in professional competence and/or education. New initiatives are underway to support genetics education and its integration into professional practice, but further research is needed on the most effective forms of educational delivery, and an international collaborative approach to this should be considered.
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Affiliation(s)
- Sarah Burke
- Centre for Research in Medical and Dental Education, University of Birmingham, Birmingham, UK.
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Baars MJH, Henneman L, Ten Kate LP. Deficiency of knowledge of genetics and genetic tests among general practitioners, gynecologists, and pediatricians: A global problem. Genet Med 2005; 7:605-10. [PMID: 16301861 DOI: 10.1097/01.gim.0000182895.28432.c7] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The objective of this study was to assess knowledge of genetics and awareness of genetic tests among Dutch general practitioners (GPs), gynecologists (GYNs), and pediatricians (PEDs), as well as factors influencing their knowledge and awareness. METHODS An anonymous questionnaire inquiry was used, validated with a sample of 52 clinical geneticists (CGs). The study was carried out in primary care (general practice) and secondary care (general and university hospitals) in The Netherlands. A random sample of 200 GPs, 300 GYNs, and 265 PEDs received a questionnaire. In addition, all registered CGs (58) received a questionnaire for validation. In total, 122 GPs, 187 GYNs, 164 PEDs, and 52 CGs returned a completed questionnaire. The main outcome measures were differences in knowledge scores between physicians working in different disciplines and factors influencing these scores. RESULTS Knowledge scores of GPs (mean 64% correct answers, 61%-66% [95% confidence interval]), GYNs (mean 75% correct answers, 73%-76% [95% confidence interval]), and PEDs (mean 81% correct answers, 79%-82% [95% confidence interval]) were lower than those in the CG validation group (mean 95% correct answers, 94%-96% [95% confidence interval]). The 5th percentile of GPs, GYNs, and PEDs was at approximately 40%, 52% and 62% correct answers, respectively. There was a specific lack of knowledge about DNA testing. In addition to specialty, important factors positively associated with the knowledge scores of nongeneticists are more recent graduation, having taken an elective course in genetics, and providing genetic counseling in their own practice. CONCLUSION The overall knowledge levels of genetics in many nongeneticist health care providers show clear deficiencies. This is in line with reports from other countries, showing that these deficiencies are a global problem.
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Affiliation(s)
- Marieke J H Baars
- Department of Clinical Genetics and Human Genetics, VU University Medical Center, Amsterdam, The Netherlands
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Baars MJH, Scherpbier AJJA, Schuwirth LW, Henneman L, Beemer FA, Cobben JM, Hennekam RCM, Verweij MMJJ, Cornel MC, Ten Kate LP. Deficient knowledge of genetics relevant for daily practice among medical students nearing graduation. Genet Med 2005; 7:295-301. [PMID: 15915080 DOI: 10.1097/01.gim.0000162877.87333.9a] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to investigate whether the knowledge of genetics relevant for daily practice among medical students nearing graduation in the Netherlands was sufficient to react appropriately to the change of relevance of genetics in medicine. METHODS A computer examination validated in a group of clinical geneticists, medical students nearing graduation, and nonmedical students. The examination consisted of 215 genetic questions classified by the designers into three categories of relevance: "essential" knowledge (requirement: > 95% correct answers), "desirable" knowledge (requirement: > 60% correct answers), and "too specialized" knowledge (no requirement). To set an independent standard, the questions were also judged by clinical geneticists and nongenetic health care providers in an Angoff procedure. In total, 291 medical students nearing graduation from seven out of the eight medical schools in the Netherlands participated. RESULTS As expected, the mean score for "essential" knowledge (71.63%, 95% CI 70.74-72.52) was higher than for "desirable" knowledge (55.99%, 95% CI 55.08-56.90); the mean score for "too specialized" knowledge (44.40%, 95% CI 43.19-45.62) was the lowest. According to passing scores set for "essential" knowledge as defined by the designers, the clinical geneticists, and the nongenetic health care providers, only 0%, 26%, and 3%, respectively, of the participants would have passed. CONCLUSIONS Medical students nearing graduation lack genetic knowledge that is essential for daily practice. Therefore, changes should be made in the medical curricula.
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Affiliation(s)
- Marieke J H Baars
- Department of Clinical Genetics and Human Genetics, VU University Medical Center, Amsterdam, The Netherlands
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