1
|
Peipins LA, Dasari S, Viox MH, Rodriguez JL. Information needs persist after genetic counseling and testing for BRCA1/2 and Lynch Syndrome. Breast Cancer Res Treat 2024:10.1007/s10549-024-07377-9. [PMID: 39046629 DOI: 10.1007/s10549-024-07377-9] [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: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Research has shown that cancer genetic risk is often not well understood by patients undergoing genetic testing and counseling. We describe the barriers to understanding genetic risk and the needs of high-risk persons and cancer survivors who have undergone genetic testing. METHODS Using data from an internet survey of adults living in the USA who responded 'yes' to having ever had a genetic test to determine cancer risk (N = 696), we conducted bivariate analyses and multivariable logistic regression models to evaluate associations between demographic, clinical, and communication-related variables by our key outcome of having vs. not having enough information about genetics and cancer to speak with family. Percentages for yes and no responses to queries about unmet informational needs were calculated. Patient satisfaction with counseling and percentage disclosure of genetic risk status to family were also calculated. RESULTS We found that a lack of resources provided by provider to inform family members and a lack of materials provided along with genetic test results were strongly associated with not having enough information about genetics and cancer (OR 4.54 95% CI 2.40-8.59 and OR 2.19 95% CI 1.16-4.14 respectively). Among participants undergoing genetic counseling, almost half reported needing more information on what genetic risk means for them and their family and how genetic testing results might impact future screening. CONCLUSION High levels of satisfaction with genetic counseling may not give a full picture of the patient-provider interaction and may miss potential unmet needs of the patient. Accessible resources and ongoing opportunities for updating family history information could reinforce knowledge about genetic risk.
Collapse
Affiliation(s)
- Lucy A Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Centers for Disease Control and Prevention, NCCDPHP/DCPC, 4770 Buford Hwy., NE, Mailstop S107-4, Chamblee, GA, USA.
| | | | | | - Juan L Rodriguez
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
2
|
Gmmash A, Alsobhi M, Alzahrani NM, Balamash LM, Alsubhi RM, Almaddah M. Diagnosis and referrals to physical therapy among caregivers of children with genetic disorders: a qualitative inquiry. Disabil Rehabil 2024; 46:1815-1824. [PMID: 37114504 DOI: 10.1080/09638288.2023.2206164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Genetic disorders are common in Saudi Arabia. Impaired motor development is one of the major characteristics associated with genetic disorders. Early identifications and referrals are key to receiving physical therapy. This study aims to explore caregivers of children with genetic disorders' experience with early identification and referrals to physical therapy. MATERIALS AND METHODS An inductive qualitative design of 16 caregivers of children with genetic disorders was done to investigate the identification and referral process to physical therapy. A thematic analysis was used to analyze the data and multiple coders coded the data to increase the trustworthiness of the analysis. RESULTS The analysis led to emergence of four main themes. Caregivers revealed their struggle with the detection process. They struggled with the vague information related to their children's condition. They also expressed a desperate need for guidance to clarify the process for genetic testing, counseling, and rehabilitation. Although their overall experience with physical therapy was satisfactory, they encountered a number of issues related to scheduling appointments, delayed referrals, and unconfirmed diagnoses. CONCLUSION The results of this study could indicate that more efforts are required to expedite and elucidate the identification and referral of children with genetic disorders in Saudi Arabia.
Collapse
Affiliation(s)
- Afnan Gmmash
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael Alsobhi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nouran Mohammed Alzahrani
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lama Mohammed Balamash
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf Mansour Alsubhi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muataz Almaddah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Hall MJ, D'Avanzo PA, Chertock Y, Kelly PJA, Brajuha J, Singley K, Luck CC, Bass SB. Oncologists' perceptions of tumor genomic profiling and barriers to communicating secondary hereditary risks to African American cancer patients. BMC Cancer 2024; 24:412. [PMID: 38566032 PMCID: PMC10988900 DOI: 10.1186/s12885-024-12184-y] [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: 11/27/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Tumor genomic profiling (TGP) identifies targets for precision cancer treatments, but also secondary hereditary risks. Oncologists are poorly trained to communicate the results of TGP, especially among patients with lower health literacy, poorer genetics knowledge, and higher mistrust. African American (AA) patients are especially vulnerable to poor understanding due to significant cancer disparities and lower uptake of TGP. The goal of this research is to inform the development of an internet-based brief educational support for oncologists to prepare them to provide better decisional support related to TGP for their AA cancer patients. METHODS This mixed-methods study used semi-structured interviews of oncologists to inform development of an online survey with a convenience sample of US-based oncologists (n = 50) to assess perceptions of the challenges of TGP and communicating results to AA patients. RESULTS Most interviewed oncologists felt it was important to consider racial/cultural differences when communicating about hereditary risks. Cost, family dynamics, discrimination concerns, and medical mistrust were identified as particularly salient. Survey respondents' views related to AAs and perceptions of TGP were strongly associated with years since completing training, with recent graduates expressing stronger agreement with statements identifying barriers/disadvantages to TGP for AA patients. CONCLUSIONS Oncologists who had more recently completed training expressed more negative perceptions of TGP and more perceived challenges in communicating about TGP with their AA patients. Focused training for oncologists that addresses barriers specific to AAs may be helpful in supporting improved communication about TGP and improved decisional support for AA patients with cancer considering TGP to evaluate their tumors.
Collapse
Affiliation(s)
- Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Paul A D'Avanzo
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Yana Chertock
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Patrick J A Kelly
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Jesse Brajuha
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Katie Singley
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Caseem C Luck
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Sarah B Bass
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| |
Collapse
|
4
|
Mladenić T, Mavrinac M, Dević Pavlić S, Malnar A, Matić M, Mikić S, Ostojić S, Pereza N. Non-genetic physicians' knowledge, attitudes and behavior towards medical genetics. Wien Klin Wochenschr 2024; 136:137-145. [PMID: 36763136 DOI: 10.1007/s00508-023-02152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/08/2023] [Indexed: 02/11/2023]
Abstract
To examine the knowledge, behavior, and attitudes toward medical genetics among obstetrics and gynecology, pediatrics, and neurology residents and specialists, who encounter the highest number of patients with specific genetic disorders, in their everyday practice. The cross-sectional study involved 182 nongenetic residents and specialists in the Republic of Croatia, who completed a validated online questionnaire anonymously and voluntarily. The questionnaire consisted of five groups of questions: general information, knowledge, behavior in practice, attitude toward genetic testing, and additional education in medical genetics. The median score for overall knowledge of medical genetics was 70.2% among obstetrician-gynecologists, 80.5% among pediatricians, and 76.7% among neurologists (P < 0.001, lowest median in obstetrician-gynecologists). When asked about their behavior in daily practice, around 90% of respondents admitted the possibility of not recognizing patients with genetic disorders, which is why more than 90% emphasized the need for additional education in medical genetics. In addition, the respondents showed a positive attitude toward genetic testing, but they did not feel educated enough to interpret the results of genetic testing. The results highlight the need for further genetic education of non-genetic health professionals, which would lead to greater confidence and ability to recognize patients with genetic disorders, select the appropriate genetic testing method and achieve more efficient communication with patients.
Collapse
Affiliation(s)
- Tea Mladenić
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Martina Mavrinac
- Department of Medical Informatics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sanja Dević Pavlić
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Anna Malnar
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Matea Matić
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sara Mikić
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Saša Ostojić
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nina Pereza
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
| |
Collapse
|
5
|
Katapodi MC, Pedrazzani C, Barnoy S, Dagan E, Fluri M, Jones T, Kim S, Underhill-Blazey ML, Uveges MK, Dwyer AA. ACCESS: an empirically-based framework developed by the International Nursing CASCADE Consortium to address genomic disparities through the nursing workforce. Front Genet 2024; 14:1337366. [PMID: 38264211 PMCID: PMC10804848 DOI: 10.3389/fgene.2023.1337366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction: Efforts are needed across disciplines to close disparities in genomic healthcare. Nurses are the most numerous trained healthcare professionals worldwide and can play a key role in addressing disparities across the continuum of care. ACCESS is an empirically-based theoretical framework to guide clinical practice in order to ameliorate genomic disparities. Methods: The framework was developed by the International Nursing CASCADE Consortium based on evidence collected between 2005 and 2023 from individuals and families of various ethnic backgrounds, with diverse hereditary conditions, and in different healthcare systems, i.e., Israel, Korea, Switzerland, and several U.S. States. The components of the framework were validated against published scientific literature. Results: ACCESS stands for Advocating, Coping, Communication, cascadE Screening, and Surveillance. Each component is demonstrated in concrete examples of clinical practice within the scope of the nursing profession related to genomic healthcare. Key outcomes include advocacy, active coping, intrafamilial communication, cascade screening, and lifelong surveillance. Advocacy entails timely identification of at-risk individuals, facilitating referrals to specialized services, and informed decision-making for testing. Active coping enhances lifelong adaptation and management of disease risk. Effective intrafamilial communication of predisposition to hereditary disease supports cascade testing of unaffected at-risk relatives. Lifelong surveillance is essential for identifying recurrence, changes in health status, and disease trajectory for life-threatening and for life-altering conditions. Discussion: ACCESS provides a standardized, systematic, situational, and unifying guide to practice and is applicable for nursing and for other healthcare professions. When appropriately enacted it will contribute towards equitable access to genomic resources and services.
Collapse
Affiliation(s)
- Maria C. Katapodi
- International Nursing CASCADE Consortium, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Carla Pedrazzani
- International Nursing CASCADE Consortium, Basel, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Sivia Barnoy
- International Nursing CASCADE Consortium, Basel, Switzerland
- Nursing Department, Tel-Aviv University, Tel Aviv, Israel
| | - Efrat Dagan
- International Nursing CASCADE Consortium, Basel, Switzerland
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Muriel Fluri
- International Nursing CASCADE Consortium, Basel, Switzerland
- Inselspital, Bern University Hospital, Bern, Switzerland
| | - Tarsha Jones
- International Nursing CASCADE Consortium, Basel, Switzerland
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, United States
| | - Sue Kim
- International Nursing CASCADE Consortium, Basel, Switzerland
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Meghan L. Underhill-Blazey
- International Nursing CASCADE Consortium, Basel, Switzerland
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Melissa K. Uveges
- International Nursing CASCADE Consortium, Basel, Switzerland
- William F. Connell School of Nursing, Boston College, Boston, MA, United States
| | - Andrew A. Dwyer
- International Nursing CASCADE Consortium, Basel, Switzerland
- William F. Connell School of Nursing, Boston College, Boston, MA, United States
- Massachusetts General Hospital, Harvard Center for Reproductive Medicine, Boston, MA, United States
| |
Collapse
|
6
|
Britten-Jones AC, Mack HG, Vincent AL, Hill LJ, Edwards TL, Ayton LN. Genetic testing and gene therapy in retinal diseases: Knowledge and perceptions of optometrists in Australia and New Zealand. Clin Genet 2024; 105:34-43. [PMID: 37553298 PMCID: PMC10952375 DOI: 10.1111/cge.14415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
With advances in gene-based therapies for heritable retinal diseases, primary eye care clinicians should be informed on ocular genetics topics. This cross-sectional survey evaluated knowledge, attitudes, and concerns regarding genetic testing and gene therapy for retinal diseases among optometrists in Australia and New Zealand. Survey data included practitioner background, attitudes and practices towards genetic testing for monogenic inherited retinal disease (IRDs) and age-related macular degeneration, and knowledge of ocular genetics and gene therapy. Responses were received from 516 optometrists between 1 April and 31 December 2022. Key perceived barriers to accessing genetic testing were lack of clarity on referral pathways (81%), cost (65%), and lack of treatment options if a genetic cause is identified (50%). Almost all respondents (98%) believed that ophthalmologists should initiate genetic testing for IRDs and fewer understood the role of genetic counsellors and clinical geneticists. This study found that optometrists in Australia and New Zealand have a high level of interest in ocular genetics topics. However, knowledge gaps include referral pathways and awareness of genetic testing and gene therapy outcomes. Addressing perceived barriers to access and promoting sharing of knowledge between interdisciplinary networks can set the foundation for genetic education agendas in primary eye care.
Collapse
Affiliation(s)
- Alexis Ceecee Britten-Jones
- Faculty of Medicine, Dentistry and Health Sciences, Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Heather G Mack
- Faculty of Medicine, Dentistry and Health Sciences, Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Andrea L Vincent
- Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Lisa J Hill
- School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Thomas L Edwards
- Faculty of Medicine, Dentistry and Health Sciences, Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Faculty of Medicine, Dentistry and Health Sciences, Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Arshad M, Trepanier A, Hashmi SS, Naeem R, Mehmood S, Ashfaq M. Medical students' self-perceived knowledge and clinical comfort with genetics in Pakistan. J Genet Couns 2023. [PMID: 37960989 DOI: 10.1002/jgc4.1828] [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: 02/22/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023]
Abstract
Pakistan has a high rate of genetic disorders and neonatal mortality concurrent with noted lack of genetic counselors and geneticists. To meet the needs of the patient population, the responsibility of providing clinical genetic services falls on general and specialty physicians. However, their education regarding these essential services is not standardized in medical school curricula nor has it ever been evaluated. The purpose of this work is to describe the self-perceived knowledge, clinical comfort, and perspectives of Pakistani medical students toward their medical genetics' education. A web-based survey was distributed electronically to medical schools around the country. The survey comprised of four sections: (1) participant demographics, (2) self-perceived medical genetics knowledge, (3) level of comfort in applying genetic knowledge and skills, and (4) attitudes toward medical genetics education. Descriptive statistics and a one-way analysis of variance were used for data analysis. Medical students in years 3, 4, and 5 (n = 473) from 25 medical schools participated in this research representing medical education in four Pakistani provinces. Most medical students reported "minimal" to "basic" knowledge of genetic testing methodology (64.7%), cancer genetics (64.9%), prenatal genetic testing (63.02%), and treatment strategies for genetic disease (72.9%). A plurality of students (37%) reported they were uncomfortable with interpreting and communicating genetic test results to patients. Medical students also expressed dissatisfaction with their medical genetics (40%) and genetic counselors training (42%). The self-perceived knowledge and clinical comfort with genetics among Pakistani medical students was limited, especially regarding genetic testing. A significant portion (74.5%) expressed desire for additional genetics education during medical school to aid in their role as future physicians. It is important for physicians-in-training to have a solid understanding of genetic concepts, technologies, and genetic counseling to best support their patients. As endorsed by the participating medical students, this study supports inclusion of more robust genetics' education into Pakistan's medical school curricula.
Collapse
Affiliation(s)
- Maheen Arshad
- Wayne State University School of Medicine, Center for Molecular Medicine and Genetics, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | - Angela Trepanier
- Wayne State University School of Medicine, Center for Molecular Medicine and Genetics, Detroit, Michigan, USA
| | - S Shahrukh Hashmi
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Rizwan Naeem
- Albert Einstein College of Medicine, New York City, New York, USA
| | - Saqib Mehmood
- University of Health Sciences, Lahore, Punjab, Pakistan
| | - Myla Ashfaq
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas, USA
| |
Collapse
|
8
|
Shafqat S, Naseem M, Rana M, Naseem Z, Ahmed W, Musharraf MD, Zaheer A, Shaikh AS, Musharraf MB, Niaz M, Khan S, Irfan R, Imran A, Mehmood Z. Knowledge, attitude, and perceptions about cancer genetic testing in clinical practice in Karachi, Pakistan. J Community Genet 2023:10.1007/s12687-023-00650-2. [PMID: 37147454 DOI: 10.1007/s12687-023-00650-2] [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: 10/03/2022] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
Healthcare professionals (HCP) play an important role in the practical application of genetic screening tests but often feel inadequately prepared for cancer genetic testing (CGT) in clinical care. As the complexity of gene-related malignancies increases, it demands HCPs' preparedness to cater to patients' needs. Therefore, the aim of our study is to assess the knowledge, attitude, and practices of HCPs in Pakistan regarding the application of cancer genetics. Our cross-sectional survey was conducted from April 2022 to June 2022 amongst HCPs at a private and a governmental institution in Karachi, Pakistan. Non-probability random convenience sampling was used to select the population; however. non-clinical HCPs, as well as Interns, were excluded from our study. A total of 210 HCPs, 56.7% (119) bearing an experience of over 5 years of clinical experience, were included in this study. Most respondents from both hospitals deemed their knowledge inadequate, with only 2% (2) and 1.8% (2) being extremely knowledgeable, respectively. 68.6% (144) HCPs displayed a positive attitude towards CGT, with 55.2% (116) participants perceiving CGT in a positive light. As compared to the private sector, significantly more HCPs in the public sector dedicated ≥ 5 h/week for CME (P = 0.006), and were better prepared to counsel patients (P = 0.021) and interpret results concerning CGT (P = 0.020). Additionally, screening tests for specific cancer types were popularly considered a worthwhile avenue of investment to improve the current state of CGT in our healthcare system [47.6% (N = 100)]. Demonstrating a lack of knowledge among Pakistani doctors, our results call upon the need for additional training concerning CGT in both the public and private sectors alike. Understanding specific gaps in knowledge may further help enhance post-graduate training programs and eventually lead to effective incorporation of CGT into our healthcare setting.
Collapse
Affiliation(s)
| | | | - Masooma Rana
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Zehra Naseem
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Warda Ahmed
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | - Arisha Zaheer
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | | | - Mahnoor Niaz
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Saifullah Khan
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Rabiya Irfan
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Areeba Imran
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Zahid Mehmood
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
| |
Collapse
|
9
|
Arulogun O, Nichols M, Jenkins C, Fakunle AG, Akpa O, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Okekunle AP, Akinyemi J, Ogbole G, Calys-Tagoe B, Adeleye A, Mensah Y, Asowata OJ, Adeoye AM, Appiah L, Singh A, Adebayo P, Arnett D, Tiwari HK, Lackland D, Ibinaiye P, Oguike W, Melikam C, Sunday A, Bello A, Ogah O, Akinyemi R, Ovbiagele B, Owolabi M. Are there differences in perceptions, preferences and attitudes towards disclosure of genetic testing for Stroke? A qualitative study among stroke-free SIREN-SIBS genomics study participants. J Stroke Cerebrovasc Dis 2023; 32:106978. [PMID: 36634397 PMCID: PMC9928805 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106978] [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: 09/21/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE This study explored perceptions, preferences and attitudes towards disclosure of genetic testing results for stroke among stroke-free controls (and their family members) in the SIREN-SIBS Genomics Study, healthcare providers and policymakers. MATERIALS AND METHODS We conducted a qualitative thematic analysis of key informant interviews with 61 participants recruited from community advisory boards (30) and health care providers (31) across seven sites in Nigeria and Ghana. RESULTS Major findings illustrate differences in the knowledge of genetic testing with superior knowledge among health care professionals. Relatives and religious leaders were opined as the best to receive the disclosure as they would be able to break the news to the patient in a culturally sensitive manner to reduce the likely resultant emotional outburst. Poor level of awareness of national guidelines for disclosing genetic results exist. Key facilitating factors for disclosure are education, enabling environment, involvement of religious and community leaders, campaigns, and possible treatment options. Disclosure inhibitors include inadequate information, fear of marital break-up or family displacement, fear of stigmatization, fear of isolation, religious beliefs, health worker attitude, and lack of preparedness to accept results. CONCLUSIONS These necessitate culturally sensitive interventions for continuing education, increased awareness and sustained engagement to equip all stakeholders in genetic testing disclosure process.
Collapse
Affiliation(s)
- Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Nigeria
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, South Carolina, USA
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, South Carolina, USA
| | - Adekunle Gregory Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria; Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria; Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Akinkunmi Paul Okekunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria; Department of Food and Nutrition, Seoul National University, Seoul, Korea
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | | | - Adeniji Adeleye
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Yaw Mensah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Abiodun M Adeoye
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Donna Arnett
- College of Public Health, University of Kentucky, USA
| | - Hemant K Tiwari
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel Lackland
- College of Nursing, Medical University of South Carolina, South Carolina, USA
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Adeniyi Sunday
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Abiodun Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Okechukwu Ogah
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Rufus Akinyemi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San-Francisco, USA
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria.
| |
Collapse
|
10
|
Scheuner MT, Sales P, Hoggatt K, Zhang N, Whooley MA, Kelley MJ. Genetics professionals are key to the integration of genetic testing within the practice of frontline clinicians. Genet Med 2023; 25:103-114. [PMID: 36301261 DOI: 10.1016/j.gim.2022.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Genetic tests have become widely available. We sought to understand the use of genetic tests in the practice of frontline clinicians within the United States Department of Veterans Affairs (VA). METHODS We administered a web-based survey to clinicians at 20 VA facilities. Physicians, nurse practitioners, physician assistants, and pharmacists were eligible. We excluded genetics providers and clinicians not seeing patients. We used multiple logistic regression to evaluate the associations between clinician characteristics and experience with genetics. RESULTS The response rate was 11.3% (1207/10,680) and of these, 909 respondents were eligible. Only 20.8% of the respondents reported feeling prepared to use genetic tests and 13.0% of the respondents were currently ordering genetic tests; although, it was usually only 1 or 2 a year. Delivery of genetic tests without involving genetics providers was preferred by only 7.9% of the respondents. Characteristics positively associated with currently ordering genetic tests included practice in clinical and research settings, believing improving genetics knowledge could alter their practice, feeling prepared to use genetic tests, and referral of at least 1 patient to genetics in the past year. CONCLUSION Most VA clinicians don't feel prepared to use genetic tests. Those with genetic testing experience are more likely to consult genetics providers. The demand for genetics providers should increase as frontline clinicians use genetic tests in their practice.
Collapse
Affiliation(s)
- Maren T Scheuner
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Francisco, San Francisco, CA.
| | - Paloma Sales
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA
| | - Katherine Hoggatt
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Ning Zhang
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA
| | - Mary A Whooley
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Michael J Kelley
- National Oncology Program, Specialty Care Services, Department of Veterans Affairs, Washington, DC; Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University, Durham, NC
| |
Collapse
|
11
|
Handra J, Guimond C, Jordan I, Lenahan B, Ohs K, Beauchesne R, Adam S, Friedman JM, Birch P. A personalized genomic results e-booklet, co-designed and pilot-tested by families. PEC INNOVATION 2022; 1:100039. [PMID: 37213729 PMCID: PMC10194288 DOI: 10.1016/j.pecinn.2022.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 05/23/2023]
Abstract
Objective To develop and evaluate a personalizable genomic results e-booklet that helps families understand their genomic testing results and navigate available resources. Methods The need for the Genomics Results e-Booklet was identified by families, after which this tool was developed by a team of clinical researchers and three parent-advisors. We customized the genomic results e-booklet for 50 families participating in a genomic sequencing research study. We conducted an assessment using a 19-question survey and semi-structured interviews to elicit feedback and iteratively improve the tool. Results 25 users provided feedback via questionnaires and seven respondents were interviewed. Genomic Results e-Booklet recipients responded favorably: 96% of participants stated that it helped them remember information shared during their results appointment, 80% said it had or would help them communicate their results with other healthcare providers, 68% felt that it helped to identify and guide their next steps, and 72% anticipated that the e-booklet would have future utility. Conclusion The Genomic Results e-Booklet is a patient and family-oriented resource that complements post-test genetic counselling. Innovation Compared to traditional laboratory reports and clinical letters, the Genomics Results e-Booklet is patient-conceived and patient-centered, and allows clinicians to efficiently personalize content and prioritize patient understanding and support.
Collapse
Affiliation(s)
- Julia Handra
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
- Corresponding author.
| | - Colleen Guimond
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | | | | | - Kelsey Ohs
- Parent Research Advisor, British Columbia, Canada
| | - Rhea Beauchesne
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Jan M. Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| |
Collapse
|
12
|
Parobek CM, Thorsen MM, Has P, Lorenzi P, Clark MA, Russo ML, Lewkowitz AK. Video education about genetic privacy and patient perspectives about sharing prenatal genetic data: a randomized trial. Am J Obstet Gynecol 2022; 227:87.e1-87.e13. [PMID: 35351406 DOI: 10.1016/j.ajog.2022.03.047] [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: 12/10/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Laboratories offering cell-free DNA often reserve the right to share prenatal genetic data for research or even commercial purposes, and obtain this permission on the patient consent form. Although it is known that nonpregnant patients are often reluctant to share their genetic data for research, pregnant patients' knowledge of, and opinions about, genetic data privacy are unknown. OBJECTIVE We investigated whether pregnant patients who had already undergone cell-free DNA screening were aware that genetic data derived from cell-free DNA may be shared for research. Furthermore, we examined whether pregnant patients exposed to video education about the Genetic Information Nondiscrimination Act-a federal law that mandates workplace and health insurance protections against genetic discrimination-were more willing to share cell-free DNA-related genetic data for research than pregnant patients who were unexposed. STUDY DESIGN In this randomized controlled trial (ClinicalTrials.gov Identifier: NCT04420858), English-speaking patients with singleton pregnancies who underwent cell-free DNA and subsequently presented at 17 0/7 to 23 6/7 weeks of gestation for a detailed anatomy scan were randomized 1:1 to a control or intervention group. Both groups viewed an infographic about cell-free DNA. In addition, the intervention group viewed an educational video about the Genetic Information Nondiscrimination Act. The primary outcomes were knowledge about, and willingness to share, prenatal genetic data from cell-free DNA by commercial laboratories for nonclinical purposes, such as research. The secondary outcomes included knowledge about existing genetic privacy laws, knowledge about the potential for reidentification of anonymized genetic data, and acceptability of various use and sharing scenarios for prenatal genetic data. Eighty-one participants per group were required for 80% power to detect an increase in willingness to share data from 60% to 80% (α=0.05). RESULTS A total of 747 pregnant patients were screened, and 213 patients were deemed eligible and approached for potential study participation. Of these patients, 163 (76.5%) consented and were randomized; one participant discontinued the intervention, and two participants were excluded from analysis after the intervention when it was discovered that they did not fulfill all eligibility criteria. Overall, 160 (75.1%) of those approached were included in the final analysis. Most patients in the control group (72 [90.0%]) and intervention (76 [97.4%]) group were either unsure about or incorrectly thought that cell-free DNA companies could not share prenatal genetic data for research. Participants in the intervention group were more likely to incorrectly believe that their prenatal genetic data would not be shared for nonclinical purposes than participants in the control group (28.8% in the control group vs 46.2% in the intervention; P=.03). However, video education did not increase participant willingness to share genetic data in multiple scenarios. Non-White participants were less willing than White participants to allow sharing of genetic data specifically for academic research (P<.001). CONCLUSION Most participants were unaware that their prenatal genetic data may be used for nonclinical purposes. Pregnant patients who were educated about the Genetic Information Nondiscrimination Act were not more willing to share genetic data than those who did not receive this education. Surprisingly, video education about the Genetic Information Nondiscrimination Act led patients to falsely believe that their data would not be shared for research, and participants who identified as racial minorities were less willing to share genetic data. New strategies are needed to improve pregnant patients' understanding of genetic privacy.
Collapse
|
13
|
Kutsa O, Gwaltney A, Creamer A, Raspa M. Severe Combined Immunodeficiency: Knowledge and Information Needs Among Healthcare Providers. Front Pediatr 2022; 10:804709. [PMID: 35265562 PMCID: PMC8899266 DOI: 10.3389/fped.2022.804709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe combined immunodeficiency (SCID) is a group of life-threatening genetic disorders responsible for severe dysfunctions of the immune system. Despite the expansion of newborn screening in the U.S., there are gaps in healthcare providers' knowledge of SCID. METHODS We recruited 277 U.S. healthcare providers for an online survey. The survey assessed providers' experience with SCID patients, knowledge about SCID, and needs and preferred formats for SCID-related informational resources. We examined differences between providers who have seen 2 or more patients with SCID (SCID provider group) and those who have seen 0-1 SCID patients (non-SCID provider group). RESULTS Overall, 210 (75.8%) providers were included in the non-SCID provider group, and 121 (57.6%) of these providers were pediatricians. Compared to the SCID provider group, non-SCID provider group reported lower mean rating of SCID knowledge (x̄ = 4.8 vs. x̄ = 8.6, p < 0.0001) and higher informational needs. The largest informational needs identified by the non-SCID provider group were "understanding specific type of SCID" and "understanding what to expect across the lifespan." In the SCID provider group, the highest rated informational need was "family support referrals." Participants in the non-SCID provider group identified scientific publications and websites as preferred formats, with some variation between medical specialties. CONCLUSION Based on their experience with treating SCID patients, providers have varying levels of SCID knowledge and different informational needs. For providers who have encountered few SCID patients, informational needs start early, usually immediately after receiving a positive newborn screening result. These findings provide useful direction for the development and preferred outlets for receiving SCID-related information, with some variations between different types of providers. Results from this study will serve as a guide for creating relevant and accessible SCID resources for providers who can utilize them to improve care for SCID patients.
Collapse
Affiliation(s)
- Oksana Kutsa
- GenOmics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, United States
| | - Angela Gwaltney
- GenOmics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, United States
| | | | - Melissa Raspa
- GenOmics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, United States
| |
Collapse
|
14
|
Alotaibi AA, Cordero MAW. Assessing Medical Students' Knowledge of Genetics: Basis for Improving Genetics Curriculum for Future Clinical Practice. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1521-1530. [PMID: 35002351 PMCID: PMC8722570 DOI: 10.2147/amep.s337756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The knowledge of genetics among medical students was assessed to identify and analyze gaps that serve as bases for the revision of the current genetics curriculum of the (Bachelor of Medicine, Bachelor of Surgery) MBBS Program of the College of Medicine at Princess Nourah bint Abdulrahman University (PNU). METHODS A 65-item multiple-choice (MCQs) test in Genetics was administered to 71 second and fourth-year medical students to assess their knowledge in Genetics. MCQs were validated and tested for their reliability. Self-assessment of students' genetics knowledge was also determined by asking them whether their knowledge in genetics is sufficient or not sufficient for their future clinical practice. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20. RESULTS Forty-one second-year and thirty fourth-year medical students took the Genetic test. Exam results showed insufficient knowledge of Genetics, with 43.85% among the students answering the exam correctly. In self-assessment, the majority (83.3% to 87.8%) of the respondents considered their knowledge of genetics insufficient for future clinical practice. A higher knowledge level of basic genetics compared with clinically related genetics concepts was observed. Generally, second-year students significantly scored higher in molecular and cytogenetics (P=0.012), principles of genetic transmission (P=0.022), and inheritance of genetic diseases (P=0.024), compared with the fourth-year medical students who only scored higher in items related to cancer genetics (P=0.022). CONCLUSION Medical students' genetics knowledge is insufficient, especially on clinically oriented concepts like genetic testing and genetic counseling and should be strengthened for future clinical practice. The fourth-year medical students do not retain the knowledge of genetics; thus, integrating medical genetics in clinical years is imperative.
Collapse
Affiliation(s)
- Amal A Alotaibi
- Basic Science Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 11671, Kingdom of Saudi Arabia
| | - Mary Anne W Cordero
- Basic Science Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 11671, Kingdom of Saudi Arabia
| |
Collapse
|
15
|
Bajguz D, Danylchuk NR, Czarniecki M, Selig JP, Sutphen R, Kaylor J. Utilization of genetic testing: Analysis of 4,499 prior authorization requests for molecular genetic tests at four US regional health plans. J Genet Couns 2021; 31:771-780. [PMID: 34939253 DOI: 10.1002/jgc4.1543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/11/2022]
Abstract
Continuous advances in genetic testing methodologies and an increased understanding of the genetic mechanisms of diseases have fueled genetic testing utilization across health care specialties. To our knowledge, national trends in the ordering of genetic testing have not been studied broadly across clinical indications, testing methodologies, and ordering provider specialties. We performed a retrospective analysis of 4,499 complete prior authorization requests for molecular genetic testing submitted to four regional health plans' commercial lines of business between May 1, 2019 and May 31, 2019. Ordering providers were characterized by their certification(s) and specialty of practice. Among 4,499 genetic testing requests, 92% were ordered by non-genetics providers. Obstetrician/gynecology (OBGYN) (63%), oncology (15%), and genetics (8%) providers ordered genetic testing most frequently. Reproductive, hereditary cancer, and tumor testing were the most frequently ordered genetic tests. Seventy-nine percent of all prior authorization requests were approved. When analyzing complex genetic testing requests, we found that testing ordered by genetics providers was more likely to be approved based on health plan policy than testing ordered by non-genetics providers. Our results suggest that health care providers across multiple medical specialties may benefit from involvement of genetics specialists in decision-making regarding molecular tests.
Collapse
Affiliation(s)
- Dominika Bajguz
- Genetic Counseling Department, College for Health Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Noelle R Danylchuk
- Genetic Counseling Department, College for Health Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - James P Selig
- Biostatistics Department, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Julie Kaylor
- Genetic Counseling Department, College for Health Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,InformedDNA, Inc., St. Petersburg, Florida, USA
| |
Collapse
|
16
|
Ganne P, Damagatla M, Naidu NK. Knowledge of genetic eye diseases and genetic services and attitudes toward genetic testing and gene therapy. Taiwan J Ophthalmol 2021; 11:372-379. [PMID: 35070666 PMCID: PMC8757527 DOI: 10.4103/tjo.tjo_34_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE: Genetic eye diseases are among the top ten causes of ocular health burden. Asia accounts for nearly two-thirds of the global burden of genetic eye diseases. A great deal of resources is being invested in genetic research and development of genetic services including gene testing laboratories and genetic counseling in India. These efforts will be meaningful only if the public and clinicians are aware of their existence. This study aimed to understand the level of knowledge about genetic eye diseases and genetic services and attitudes toward genetic testing and gene therapy in four groups of participants (undergraduate medical students, paramedical staff, non-ophthalmologist doctors, and the general public). MATERIALS AND METHODS: This was a cross-sectional survey in India. Four hundred questionnaires were analyzed from the four groups of participants. Knowledge score was calculated for the different questions. To bring out the differences across the groups, Chi-square test was done with a post hoc Mann–Whitney U-test and Kruskal–Wallis test. P < 0.05 was taken as statistically significant. RESULTS: The level of awareness about genetic eye diseases was better among undergraduate students, doctors, and paramedical staff compared to the general public (P < 0.001). The majority across all three groups had a positive attitude toward genetic testing and gene therapy. However, most of the participants across all groups were not aware of the genetic facilities available in our country. CONCLUSION: This study shows a positive attitude toward genetic medicine. However, there is a need to improve public awareness about genetic eye diseases and facilities available for genetic testing and gene therapy.
Collapse
Affiliation(s)
- Pratyusha Ganne
- Department of Ophthalmology, All India Institute of Medical Sciences, Guntur, Andhra Pradesh, India
| | - Manikanta Damagatla
- Department of Ophthalmology, All India Institute of Medical Sciences, Guntur, Andhra Pradesh, India
| | - Navya Krishna Naidu
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Guntur, Andhra Pradesh, India
| |
Collapse
|
17
|
Truong TK, Kenneson A, Rosen AR, Singh RH. Genetic Referral Patterns and Responses to Clinical Scenarios: A Survey of Primary Care Providers and Clinical Geneticists. J Prim Care Community Health 2021; 12:21501327211046734. [PMID: 34583568 PMCID: PMC8485275 DOI: 10.1177/21501327211046734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary care physicians (PCPs) are considered the gatekeepers of genetic services, but they often underutilize or inappropriately utilize such services, leading to lack of early treatment, incorrect diagnoses, and unnecessary procedures. This study aims to delineate PCP referral patterns, including the frequency of, motivators for, and barriers to genetic referrals and testing in the present landscape of genomics. Methods: A 34-item online survey was distributed to PCPs in the United States (US). PCP demographics, practice characteristics, and referral patterns, motivators, and barriers were analyzed. Six hypothetical clinical scenarios included in the survey also were presented to a cohort of clinical geneticists. We calculated PCPs’ rates of ordering genetic tests and of referral to genetics services in the past year. Rates and responses to clinical scenarios were compared based on respondents’ personal and practice characteristics. Results: A total of 95 PCPs and 25 clinical geneticists participated. Among the PCPs, 79% reported referring and 50% reported ordering genetic testing in the last year. PCPs with genetic counselors (GCs) in their clinic referred at significantly higher rates than those without (P = .008). White PCPs referred at significantly higher rates compared to Black or African American PCPs (P = .009). The most commonly reported motivators for referring patients to genetic services were preference for specialist coordination, lack of knowledge, and family’s desire for risk information. The most commonly reported barriers were patient refusal, provider concerns about costs to patients, and uncertainty of when a genetic referral is appropriate. In response to clinical scenarios, clinical geneticists were in agreement about the need for genetic testing or referral for 2 of the scenarios. For these 2 scenarios, only 48% and 71% of PCPs indicated that they would offer genetic testing or referral, respectively. Conclusions: Responses to clinical scenarios suggest that it is not clear to PCPs when referrals or testing are needed. Collaboration with GCs is one approach to reducing barriers to and improving PCPs’ utilization of genetic services. Clear guidelines from clinical geneticists may help facilitate appropriate use of genetics services by PCPs. Additional research is needed to further describe barriers that PCPs face in genetic testing/referrals.
Collapse
Affiliation(s)
- Tina K Truong
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ami R Rosen
- Emory University School of Medicine, Atlanta, GA, USA
| | - Rani H Singh
- Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
18
|
Hall MJ, D'Avanzo P, Chertock Y, Brajuha J, Bass SB. Oncologists' Perceptions of Tumor Genomic Profiling and the Communication of Test Results and Risks. Public Health Genomics 2021; 24:304-309. [PMID: 34325422 DOI: 10.1159/000517486] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Tumor genomic profiling (TGP) identifies genetic targets for precision cancer treatments. The complexity of TGP can expose gaps in oncologists' skills, complicating test interpretation and patient communication. Research on oncologists' use and perceptions of TGP could inform practice patterns and training needs. To study this, a sample of oncologists was surveyed to assess TGP use, perceptions, and perceived skills in TGP interpretation/communication, especially in communication of hereditary risks. Genomic self-efficacy and TGP knowledge were also assessed. The goal sample (n = 50) was accrued from 12/2019 to 1/2020. Respondents were primarily medical oncologists (78%) with >10 (mean 17.7) years of practice experience. TGP use was moderate/high (median 50 [range 2-398]) tests/year. Most oncologists reported informal/no training in interpretation (72%) or communication (86%) of TGP results and risks. Genomic self-efficacy was high and was associated with higher use of TGP (p = 0.047). Perceptions of the benefits and limitations of TGP were mixed: heterogeneity was seen by years of experience, TGP use, and knowledge. Most participants agreed that additional training in TGP communication was needed, especially in communication of hereditary risks, and that an online training tool would be useful (86%). We conclude that oncologists are frequently using TGP despite having mixed views about its utility and not feeling prepared to communicate risks to patients. Oncologists receive little education in interpreting TGP or communicating its results and risks, and would value training in this area.
Collapse
Affiliation(s)
- Michael J Hall
- Department of Clinical Genetics, Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Paul D'Avanzo
- College of Public Health, Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania, USA
| | - Yana Chertock
- Department of Clinical Genetics, Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jesse Brajuha
- College of Public Health, Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania, USA
| | - Sarah B Bass
- College of Public Health, Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Bogaerts E, den Boer E, Peelman L, Van Nieuwerburgh F, Fieten H, Saunders JH, Broeckx BJG. Veterinarians' Competence in Applying Basic Genetic Principles and Daily Implementation of Clinical Genetics: A Study in a University Environment. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021:e20210029. [PMID: 34323673 DOI: 10.3138/jvme-2020-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Veterinarian competency in genetics is vital for a meaningful application of the rapidly growing number of genetic tests available for animals. We evaluated the use of genetic tests in the daily veterinary practice and the competency of university-employed veterinarians in applying basic principles of genetics in a clinical setting through an electronic survey with 14 cases and 7 statements on genetics. Ninety-one non-geneticist veterinarians from two veterinary faculties in two different countries responded. Almost half of the participants apply genetic tests during their daily work, with frequencies varying between weekly and once a year. The most common indication to request a genetic test was diagnostic testing of clinically ill patients. Although 80% of the veterinarians communicated the result of a genetic test themselves, only 56% of them found it "very to rather easy" to find the correct test, and only 32% of them always felt competent to interpret the result of the test. The number of correctly answered questions varied widely, with median scores of 9/14 (range 0-14) and 5/7 (range 0-7) for the cases and statements, respectively. Most difficulties were seen with recognition of pedigree inheritance patterns, while veterinarians scored better in breeding advice and probability of disease estimations. Veterinarians scored best on questions related to autosomal recessive inheritance, followed by complex, autosomal dominant, X-linked recessive, and X-linked dominant inheritance. This study exposed pain points in veterinarians' knowledge and has led to the formulation of recommendations for future education and communication between laboratories, geneticists, and veterinarians.
Collapse
|
20
|
Yehya A, Matalgah L. Toward Interprofessional Education of Pharmacogenomics: An Interdisciplinary Assessment. Pharmacology 2021; 106:534-541. [PMID: 34304231 DOI: 10.1159/000517385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pharmacogenomics, which emerged from disciplines such as pharmacology and genetics, is an increasingly important interdisciplinary field of health research, as indicated by the rapid growth of related literature. The aim of this study was to evaluate knowledge among genetics and pharmacology health-care students and to evaluate their exposure to and perceptions of pharmacogenomics. METHODS An anonymous, 28-item online survey was distributed to medical and pharmacy students enrolled at Yarmouk University, Jordan. RESULTS The respondents (n = 300) had an overall moderate level of knowledge regarding genetics and pharmacology. Most respondents recognized the benefits of pharmacogenomics for therapy optimization, but they had insufficient exposure to the topic. Most respondents supported providing pharmacogenetic testing in Jordan. The most preferred educational format in pharmacogenomics was integration in pharmacology courses. DISCUSSION/CONCLUSION Medical and pharmacy students are becoming increasingly aware of the importance of pharmacogenomics in therapy optimization. Challenges such as the complexity of the topic and low retention of previous knowledge should be addressed to promote pharmacogenomics education. More work is needed to increase students' exposure to pharmacogenomics information. A deeper integration of pharmacogenomics applications into pharmacology courses is proposed to emphasize applications of pharmacogenomics.
Collapse
Affiliation(s)
- Alaa Yehya
- Department of Clinical Pharmacy and Pharmacy Practice, Irbid, Jordan
| | - Laila Matalgah
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| |
Collapse
|
21
|
Thom J, Haw T. Awareness of genetic counseling services among allied healthcare professionals in South Africa. J Genet Couns 2021; 30:1649-1657. [PMID: 33934426 DOI: 10.1002/jgc4.1431] [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: 12/15/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/05/2022]
Abstract
Genetic counseling has been shown to increase patient empowerment leading to positive outcomes. However, in the Johannesburg state healthcare system, the genetic counseling service is underutilized. Individuals with genetic disorders present with a variety of symptoms and are frequently referred to allied healthcare professionals for management; therefore, these professionals are in a unique position to identify appropriate patients and refer them for genetic counseling. This study aimed to determine whether allied health professionals, including physiotherapists, occupational therapists, and speech and language therapists, were aware of genetic counseling services in Johannesburg, South Africa, and whether they had previously referred patients to these services. The study also aimed to identify barriers and facilitators to referral. An adapted paper-copy questionnaire was administered to allied health professionals working at one of three state hospitals in Johannesburg. A total of 57 participants were included in this study. Results indicated that 29/57 (50.9%) of allied health professionals knew that genetic counseling services were available but only 15/29 (51.7%) of those who knew of the service had referred patients to these services in the last year. Barriers to referral included misconceptions about the role of genetic counselors, insufficient knowledge of which patients would benefit from genetic counseling, and being unable to obtain appropriate information from the Genetics Clinic for patient referral. However, allied health professionals recognized the benefit of genetic counseling and 53/57 (93%) wanted to increase their genetics knowledge. Therefore, genetics education of allied health professionals, and improved information regarding the referral procedure for genetic counseling, may improve the number of patients referred.
Collapse
Affiliation(s)
- Jamey Thom
- Division of Human Genetics, National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tabitha Haw
- Division of Human Genetics, National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
22
|
The impact of needs-based education on the change of knowledge and attitudes towards medical genetics in medical students. Eur J Hum Genet 2021; 29:726-735. [PMID: 33398082 PMCID: PMC8110770 DOI: 10.1038/s41431-020-00791-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 01/29/2023] Open
Abstract
In this research we aimed to (1) develop and validate a new questionnaire examining attitudes and knowledge towards medical genetics, (2) examine the knowledge and attitudes towards medical genetics in students of the Medical Faculty in Rijeka, Croatia and (3) evaluate the impact of education from the mandatory course Medical Genetics on the change of knowledge and attitudes. The study was conducted on 191 fifth- and sixth-year students of the Integrated Undergraduate and Graduate University Study of Medicine in the academic year 2019/2020. Students completed the validated online questionnaire anonymously and voluntarily. Fifth-year students completed the questionnaire twice (beginning/end of the course), while sixth-year students completed the questionnaire once, 3 months after completing the course. The education was carefully designed for medical students according to the CoreCompetences in Genetics for Health Professionals in Europe issued by the European Society of Human Genetics. Using the Kruskal-Wallis test, a statistically significant difference was found between fifth year before and after education and between the fifth year before education and sixth year for (a) total knowledge (P < 0.001), (b) total attitudes (P < 0.001) and (c) personal assessment of knowledge in medical genetics (P < 0.001). Moreover, positive attitudes were associated with higher levels of knowledge. In conclusion, our results emphasise the importance of needs-based education in medical genetics for medical students, which is indispensable for the increase in the level of knowledge and development of positive attitudes in order to provide better health care for patients with genetic disorders.
Collapse
|
23
|
Specialist physicians' referral behavior regarding preimplantation genetic testing for single-gene disorders: Is there room to grow? F S Rep 2021; 2:215-223. [PMID: 34278357 PMCID: PMC8267388 DOI: 10.1016/j.xfre.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To assess whether primary care specialists’ demographics, specialty, and knowledge of preimplantation genetic testing for monogenic disorders (PGT-M) influence their practice patterns. Design Cross-sectional survey study. Setting Academic medical center. Patient(s) Not applicable. Intervention(s) None. Main Outcome Measure(s) Objective PGT-M knowledge, subjective comfort with PGT-related topics, PGT care practices (discussions/referrals), and PGT-M implementation barriers. Result(s) Our survey had 145 respondents: 65 obstetrician/gynecologists, 36 internists, and 44 pediatricians. Overall, 88% believed that patients at a risk of passing on genetic disorders should be provided PGT-M information. However, few discussed PGT-M with their patients (24%) or referred them for testing (23%). Over half (63%) believed that the lack of physician knowledge was a barrier to PGT use. In terms of subjective comfort with PGT, only 1 in 5 physicians felt familiar enough with the topic to answer patient questions. There were higher odds of discussing (odds ratio, 3.21; 95% confidence interval, 1.75–5.87) or referring for PGT (odds ratio, 2.52; 95% confidence interval, 1.41–4.51) for each additional 0.5 correct answers to PGT knowledge-related questions. The odds of referring patients for PGT-M were the highest among obstetrician/gynecologists compared with those among the internists and pediatricians. Conclusion(s) Physician specialty and PGT knowledge were associated with PGT-M care delivery practices. Although most specialists believed in equipping at-risk patients with PGT-M information, <1 in 4 discussed or referred patients for PGT. The low levels of PGT-related care among providers may be owed to inadequate knowledge of and comfort with the topic. An opportunity to promote greater understanding of PGT-M among primary care specialists exists and can in turn improve the use of referrals to PGT-M services.
Collapse
|
24
|
Abstract
Neurodevelopmental disorders are the most prevalent chronic medical conditions encountered in pediatric primary care. In addition to identifying appropriate descriptive diagnoses and guiding families to evidence-based treatments and supports, comprehensive care for individuals with neurodevelopmental disorders includes a search for an underlying etiologic diagnosis, primarily through a genetic evaluation. Identification of an underlying genetic etiology can inform prognosis, clarify recurrence risk, shape clinical management, and direct patients and families to condition-specific resources and supports. Here we review the utility of genetic testing in patients with neurodevelopmental disorders and describe the three major testing modalities and their yields - chromosomal microarray, exome sequencing (with/without copy number variant calling), and FMR1 CGG repeat analysis for fragile X syndrome. Given the diagnostic yield of genetic testing and the potential for clinical and personal utility, there is consensus that genetic testing should be offered to all patients with global developmental delay, intellectual disability, and/or autism spectrum disorder. Despite this recommendation, data suggest that a minority of children with autism spectrum disorder and intellectual disability have undergone genetic testing. To address this gap in care, we describe a structured but flexible approach to facilitate integration of genetic testing into clinical practice across pediatric specialties and discuss future considerations for genetic testing in neurodevelopmental disorders to prepare pediatric providers to care for patients with such diagnoses today and tomorrow.
Collapse
Affiliation(s)
- Juliann M. Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | | |
Collapse
|
25
|
Chin JJ, Tham HW. Knowledge, Awareness, and Perception of Genetic Testing for Hereditary Disorders Among Malaysians in Klang Valley. Front Genet 2020; 11:512582. [PMID: 33343613 PMCID: PMC7744680 DOI: 10.3389/fgene.2020.512582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 10/30/2020] [Indexed: 01/02/2023] Open
Abstract
Genetic testing aids patients in making important decisions in the prevention, treatment, or early detection of hereditary disorders. Low awareness of the importance of genetic testing contributes to the increase in the incidence of hereditary disorders. This study aims to explore the knowledge, awareness, and perception of genetic testing for hereditary disorders among local residents of the Klang Valley, Malaysia, and the potential variables that influence their understanding of genetic testing. A survey was conducted in different municipalities of the Klang Valley through self-administered questionnaire assessing the public's knowledge, awareness, and perception of genetic testing. Overall, the results revealed adequate knowledge and positive awareness of genetic testing, in which both were influenced by the respondent's educational level (P < 0.001), field of study (P < 0.001), and status of heard or unheard of genetic testing (P < 0.001). The perception of genetic testing was generally positive and influenced by the respondent's differences in age (P < 0.016), educational level (P < 0.001), field of study (P < 0.001), and status of heard or unheard of genetic testing (P < 0.001). Although positive responses were obtained, ~20.2% of the respondents had never heard of genetic testing. Of the respondents, 24.5% were unwilling to undergo genetic testing, with 25.1% believing that genetic testing tampers with nature and 18% believing that it opposes religion and their beliefs. Such attitude calls for the need to conduct programs to eliminate any misconception, as well as to educate the public to lessen any perceived misunderstanding of the concepts of genetic testing.
Collapse
Affiliation(s)
- Jia-Jia Chin
- Biopharmaceutical Research Unit, Biology Research Laboratory, Faculty of Pharmacy, SEGi University, Petaling Jaya, Malaysia
| | - Hong-Wai Tham
- Biopharmaceutical Research Unit, Biology Research Laboratory, Faculty of Pharmacy, SEGi University, Petaling Jaya, Malaysia
| |
Collapse
|
26
|
McPheron MA, Craven HJ, Molleston JP, Dilly CK. Genetic Testing and Counseling in Metabolic Liver Disease: An Interactive Lecture for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10996. [PMID: 33117886 PMCID: PMC7586753 DOI: 10.15766/mep_2374-8265.10996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Medical students have limited opportunities to learn about current genetic testing. This session provided exposure to different types of testing and the complex issues that physicians may encounter when counseling patients on proper testing and interpreting results. METHODS We designed a 1-hour interactive lecture for second-year medical students. We presented an overview of the topic, then applied the concepts to specific disorders and cases. Students were asked to answer questions regarding cases using an audience response system, and we used their responses as the basis for our in-class discussion. This session has been held twice, with 25 students attending in 2018 and 31 students in 2019. The session was also recorded so that additional students not in attendance could watch, and was available to 151 students in 2018 and 333 students in 2019. RESULTS Students answered questions via audience response system. There was a range of 47%-100% of students giving the correct answers in 2018, and 55%-93% in 2019. Exam questions covering genetic counseling issues were answered correctly by 66% and 77% of students in 2018, and 70% and 68% of students in 2019. DISCUSSION This session provided an opportunity for medical students to be exposed to some of the complex ethical and psychosocial issues that may arise with genetic testing for liver disease and to consider how to navigate them. Using an audience response system during the lecture made the session more interactive and allowed the teacher to correct errors and teach based on the responses.
Collapse
Affiliation(s)
- Molly A. McPheron
- Assistant Professor, Medical and Molecular Genetics, Indiana University School of Medicine
| | - Hannah J. Craven
- Assistant Librarian, Ruth Lilly Medical Library, Indiana University School of Medicine
| | - Jean P. Molleston
- Professor of Clinical Pediatrics, Department of Pediatrics, Indiana University School of Medicine
| | - Christen K. Dilly
- Assistant Professor, Department of Medicine, Indiana University School of Medicine; Roudebush VA Medical Center
| |
Collapse
|
27
|
Adams D, Roche L, Heussler H. Parent perceptions, beliefs, and fears around genetic treatments and cures for children with Angelman syndrome. Am J Med Genet A 2020; 182:1716-1724. [PMID: 32449301 DOI: 10.1002/ajmg.a.61631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 01/21/2023]
Abstract
Genetic therapies have shown recent promise in alleviating some of the cognitive issues associated with some genetic disorders; however, these therapies may come with significant health and socio-ethical concerns, particularly when they involve child participants. Little is known about what parents of children with genetic disorders think about genetic therapies, or about their knowledge of how genetic-based therapy might treat their child's symptoms. Forty-two parents of children with Angelman syndrome (AS) and 27 parents of a mixed etiology comparison group completed an online survey reporting on their perceptions of, and priorities for, genetic therapy. Almost all parents of children with AS (95%) and the comparison group (89%) agreed that treatments aiming to reduce symptoms associated with their child's syndrome were positive. However, significantly more parents of children with AS (95%) than the comparison group (56%) felt that genetic treatment trials aiming to "cure" their child should be a research priority. AS parent priorities for the focus of clinical trials were neurology/seizures, communication skills, and motor skills/mobility. For the comparison group, the priorities were IQ, immune response, and expressive speech. Parents of both groups did not want treatments to change their child's personality or their happiness. Global assumptions cannot be made about targets for therapy between syndromes, about parental understanding of genetics, or about research evidence across syndromes. This study highlights the need for true family and patient engagement in all stages of the research design and treatment evaluation.
Collapse
Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, Griffith University, Brisbane, Queensland, Australia
| | - Laura Roche
- Autism Centre of Excellence, Griffith University, Brisbane, Queensland, Australia
| | - Helen Heussler
- Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Children's Health Queensland, Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Weersink RA, Abadier M, de Boer A, Taxis K, Borgsteede SD. Medication safety in patients with hepatic impairment: A survey of community pharmacists' knowledge level and their practice in caring for these patients. Br J Clin Pharmacol 2020; 86:763-770. [PMID: 31756269 PMCID: PMC7098861 DOI: 10.1111/bcp.14177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 01/27/2023] Open
Abstract
Aims To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients. Methods Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6‐item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses. Results In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment). Conclusion Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment.
Collapse
Affiliation(s)
- Rianne A Weersink
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Marianna Abadier
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands.,Department of Pharmaceutical Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Anthonius de Boer
- Department of Pharmaceutical Sciences, University of Utrecht, Utrecht, The Netherlands.,Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, The Netherlands
| | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Sander D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
29
|
Kaufman-Shriqui V, Salem H, Boaz M, Birk R. Knowledge and Attitudes Towards Nutrigenetics: Findings from the 2018 Unified Forces Preventive Nutrition Conference (UFPN). Nutrients 2020; 12:nu12020335. [PMID: 32012749 PMCID: PMC7071140 DOI: 10.3390/nu12020335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Nutrigenetics indicates that individual genetic variability results in altered health outcomes necessitating personalized nutrition adaptation. Registered dietitians are recognized as the clinical nutrition experts, but their knowledge and attitudes regarding nutrigenetics has not been delineated. Methods: This cross sectional online survey was conducted in a convenience sample of 169 national nutrition conference attendees. The survey queried demographics, knowledge, and attitudes towards nutrigenetics and information on training in nutrigenetics. Results: The majority of participants were registered dietitians and female, 45% of whom held advanced degrees. Personalized nutrition was perceived by 93.5% of participants as highly important or important; however, 94% of respondents indicated they are not sufficiently knowledgeable in personalized nutrition and only 9.5% had received training in nutrigenetics. The mean nutrigenetics knowledge score was 6.89 ± 1.67 (out of a possible 12). A multivariate regression model of knowledge score identified education as the only independent predictor of this outcome. Conclusion: Personalized nutrition is a rapidly developing field that incorporates genetic data into clinical practice. Dietitians recognize the importance of advanced studies to acquire knowledge in nutrigenetics. Only by acquiring the necessary knowledge can dietitians accurately translate this nutrigenetics into clinical practice.
Collapse
Affiliation(s)
| | | | | | - Ruth Birk
- Correspondence: ; Tel.: +972-3-976-5704; Fax: +972-3-542-3553
| |
Collapse
|
30
|
Farwell Hagman KD, Lamb Thrush D, Freeze S, Dorsainville DL, Eichmeyer J, Banks KC. Facing the challenge of genetic counselors' need for rapid continuing education about genomic technologies. J Genet Couns 2020; 29:838-848. [PMID: 31916674 DOI: 10.1002/jgc4.1213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 01/09/2023]
Abstract
The last couple of decades have seen the rapid advancement of genomic technologies (GT) and their equally rapid adoption into clinical testing. Regardless of specialty, all genetic counselors are unified by the fundamental goal to aid in diagnosing patient's genetic disease underscoring the importance for genetic counselors to maintain an in-depth understanding of GT. The National Society of Genetic Counselors' (NSGC) GT Special Interest Group conducted an online survey of NSGC members to assess current genomic technologies knowledge gaps. A total of 171 individuals from a variety of primary work settings completed the survey sufficiently to be included in the analysis. The majority of respondents received their degree in genetic counseling in more recent years (2000-2015). On average across all technologies, >70% of respondents deemed knowledge of GTs as important for successful job performance, 55% responded that additional job training in GTs is needed to successfully perform job functions, and only 28% responded that graduate training in GTs was good. Overall, the data show that participating genetic counselors perceive that their knowledge of GTs is inadequate while it is a key component of their jobs. These results have implications both for training programs and for continuing education efforts. These data can be used as a starting point for additional research into GT educational needs of genetic counselors.
Collapse
Affiliation(s)
| | - Devon Lamb Thrush
- Department of Clinical Genomics, Ambry Genetics, Aliso Viejo, CA, USA
| | | | | | | | - Kimberly C Banks
- Department of Medical Affairs, Guardant Health, Redwood City, CA, USA
| | | |
Collapse
|
31
|
Attitude of Jordanian Physicians toward Biochemistry and Genetics. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3176951. [PMID: 31815130 PMCID: PMC6877946 DOI: 10.1155/2019/3176951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/08/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022]
Abstract
Background. Several studies found that physicians develop a negative attitude toward biochemistry and genetics disciplines. Many medical schools adopt an integrated system-based curriculum supplemented with clinical correlations. Medical schools in Jordan switched to the integrated curriculum; however, studies that evaluate the attitude of physicians toward biochemistry and genetics are lacking. Objectives. This study aimed to evaluate the attitude of physicians toward biochemistry and genetics including the correlation of their curricula with clinical practice. Materials and Methods. A structured questionnaire consisting of 40 statements was distributed to a random sample of 616 physicians practicing in private and governmental hospitals in Jordan. Participants earned their MD or MBBS degree from Jordan or other countries and were interns, residents, or specialists. Results. More than half of the participants admitted that biochemistry and genetics are intellectually challenging and were among their least favourite subjects (59.1%); however, many of them were familiar with some of the contemporary advances in biochemistry and genetics and their translational potential (64.0%). Most of the participants felt that modifying the medical school curriculum by integrating biochemical and genetic concepts with clinical teaching will motivate the medical students (74%). In univariate analysis, residents showed the most positive attitudes and were the most knowledgeable about the biochemical changes associated with diseases and about the contemporary advances in biochemistry or genetics (P<0.05). In multivariate analysis, physicians practicing in the private sector or those with more than five years of experience generally had a more positive attitude toward biochemistry and genetics (P<0.05). Conclusion. Physicians in Jordan showed an overall positive attitude toward biochemistry and genetics. This was more evident among residents, physicians with more than five years of experience, or those practicing in the private sector.
Collapse
|
32
|
Deuitch N, Soo-Jin Lee S, Char D. Translating genomic testing results for pediatric critical care: Opportunities for genetic counselors. J Genet Couns 2019; 29:78-87. [PMID: 31701594 DOI: 10.1002/jgc4.1182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
Genomic sequencing (GS), such as whole genome and exome sequencing, is rapidly being integrated into pediatric critical care settings. Results are being used to make high impact decisions including declarations of futility, withdrawal of care, and rationing of scarce resources. In this qualitative study, we conducted interviews with clinicians involved in the care of critically ill children with congenital heart disease (CHD) to investigate their views on implementation of GS into clinical practice. Interviews were transcribed and inductively analyzed for major themes using grounded theory and thematic analysis. Three major themes emerged surrounding the use of genomic information in the high-stakes, time pressured decision making that characterizes clinical care of critically ill children with CHD: (a) that clinicians felt they did not have sufficient training to accurately assess genetic results despite pressure to incorporate results into clinical decisions; (b), that they desire knowledge support from genetic specialists, such as genetic counselors, who both understand the critical care context and are available within the time constraints of critical care clinical pressures; and (c), that clinicians feel a pressing need for increased genetics education to be able to safely and appropriately incorporate GS results into clinical decisions Our data suggest that genetics specialists may need a stronger presence in the pediatric critical care setting.
Collapse
Affiliation(s)
- Natalie Deuitch
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Danton Char
- Department of Anesthesiology, Perioperative and Pain Management, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
33
|
Identifying patients with a history of ovarian cancer for referral for genetic counselling: non-randomised comparison of two case-finding strategies in primary care. Br J Gen Pract 2019; 68:e750-e756. [PMID: 30348886 PMCID: PMC6193781 DOI: 10.3399/bjgp18x699533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022] Open
Abstract
Background Recent guidelines recommend genetic counselling and DNA testing (GCT) for patients with ovarian cancer and survivors of ovarian cancer. Finding survivors of ovarian cancer is challenging. Detecting and referring them for GCT via primary care, to allow proper screening recommendations for patients and their family, may be a solution. Aim To compare the effectiveness and acceptance of two pilot strategies directed at case finding women with a history of ovarian cancer for referral for GCT by their GP. Design and setting Non-randomised comparison of the pilot implementation of two case-finding strategies for women with a history of ovarian cancer in Dutch primary care from May 2016 to April 2017. Method Strategy A (unsupported) asked GPs to identify and refer eligible patients with a history of ovarian cancer. Strategy B (ICT-supported) provided GPs with information and communication technology (ICT) support to identify patients with a history of ovarian cancer electronically. The effectiveness of each strategy was assessed as the proportion of patients who were approached, referred for GCT, and seen by the clinical geneticist. Acceptance of each strategy was assessed by the intervention uptake of GP practices and GP and patient questionnaires. Results Nineteen out of 30 (63%) patients identified with a history of ovarian cancer were deemed eligible for referral for strategy A, and 39 out of 94 (41%) for strategy B. For each strategy, eight patients were referred and five (63%) were seen for GCT. The intervention uptake by GP practices was 31% (11 out of 36) for strategy A and 46% (21 out of 46) for strategy B. GPs considered ‘relevance’ and ‘workability’ as facilitators across both strategies whereas, for strategy B, technical barriers hindered implementation. Conclusion The effectiveness and acceptance of both strategies for case finding of survivors of ovarian cancer in primary care for GCT is promising, but larger studies are required before wide-scale implementation is warranted.
Collapse
|
34
|
Crellin E, McClaren B, Nisselle A, Best S, Gaff C, Metcalfe S. Preparing Medical Specialists to Practice Genomic Medicine: Education an Essential Part of a Broader Strategy. Front Genet 2019; 10:789. [PMID: 31572433 PMCID: PMC6749815 DOI: 10.3389/fgene.2019.00789] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Abstract
Developing a competent workforce will be crucial to realizing the promise of genomic medicine. The preparedness of medical specialists without specific genetic qualifications to play a role in this workforce has long been questioned, prompting widespread calls for education across the spectrum of medical training. Adult learning theory indicates that for education to be effective, a perceived need to learn must first be established. Medical specialists have to perceive genomic medicine as relevant to their clinical practice. Here, we review what is currently known about medical specialists’ perceptions of genomics, compare these findings to those from the genetics era, and identify areas for future research. Previous studies reveal that medical specialists’ views on the clinical utility of genomic medicine are mixed and are often tempered by several concerns. Specialists generally perceive their confidence and understanding to be lacking; subsequently, they welcome additional educational support, although specific needs are rarely detailed. Similar findings from the genetics era suggest that these challenges are not necessarily new but on a different scale and relevant to more specialties as genomic applications expand. While existing strategies developed for genetic education and training may be suitable for genomic education and training, investigating the educational needs of a wider range of specialties is critically necessary to determine if tailored approaches are needed and, if so, to facilitate these. Other interventions are also required to address some of the additional challenges identified in this review, and we encourage readers to see education as part of a broader implementation strategy.
Collapse
Affiliation(s)
- Erin Crellin
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Belinda McClaren
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
35
|
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.
Collapse
Affiliation(s)
- Martina C Cornel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
36
|
Graf M, Char D, Hanson-Kahn A, Magnus D. Use of genetic risks in pediatric organ transplantation listing decisions: A national survey. Pediatr Transplant 2019; 23:e13402. [PMID: 31012250 PMCID: PMC6836721 DOI: 10.1111/petr.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/04/2018] [Accepted: 01/14/2019] [Indexed: 01/02/2023]
Abstract
There is a limited supply of organs for all those who need them for survival. Thus, careful decisions must be made about who is listed for transplant. Studies show that manifesting genetic disease can impact listing eligibility. What has not yet been studied is the impact genetic risks for future disease have on a patient's chance to be listed. Surveys were emailed to 163 pediatric liver, heart, and kidney transplant programs across the United States to elicit views and experiences of key clinicians regarding each program's use of genetic risks (ie, predispositions, positive predictive testing) in listing decisions. Response rate was 42%. Sixty-four percent of programs have required genetic testing for specific indications prior to listing decisions. Sixteen percent have required it without specific indications, suggesting that genetic testing may be used to screen candidates. Six percent have chosen not to list patients with secondary findings or family histories of genetic conditions. In hypothetical scenarios, programs consider cancer predispositions and adult-onset neurological conditions to be relative contraindications to listing (61%, 17%, and 8% depending on scenario), and some consider them absolute contraindications (5% and 3% depending on scenario). Only 3% of programs have formal policies for these scenarios, but all consult genetic specialists at least "sometimes" for results interpretation. Our study reveals that pediatric transplant programs are using future onset genetic risks in listing decisions. As genetic testing is increasingly adopted into pediatric medicine, further study is needed to prevent possible inappropriate use of genetic information from impacting listing eligibility.
Collapse
Affiliation(s)
- Madeline Graf
- Department of Genetics, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Danton Char
- Department of Anesthesiology, Perioperative and Pain Management, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Andrea Hanson-Kahn
- Department of Genetics, Stanford University School of Medicine, Stanford University, Stanford, California
- Division of Medical Genetics, Department of Pediatrics, Stanford University Medical Center, Stanford University, Stanford, California
| | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford University, Stanford, California
| |
Collapse
|
37
|
Aartsma-Rus A, Hegde M, Ben-Omran T, Buccella F, Ferlini A, Gallano P, Howell RR, Leturcq F, Martin AS, Potulska-Chromik A, Saute JA, Schmidt WM, Sejersen T, Tuffery-Giraud S, Uyguner ZO, Witcomb LA, Yau S, Nelson SF. Evidence-Based Consensus and Systematic Review on Reducing the Time to Diagnosis of Duchenne Muscular Dystrophy. J Pediatr 2019; 204:305-313.e14. [PMID: 30579468 DOI: 10.1016/j.jpeds.2018.10.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Madhuri Hegde
- Department of Human Genetics, Emory University School of Medicine/School of Biological Sciences, Georgia Institute of Technology/Perkin Elmer Genetics, Atlanta, GA
| | - Tawfeg Ben-Omran
- Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Pia Gallano
- U705 CIBERER, Servei de Genetica, Hospital de Sant Pau, Barcelona, Spain
| | | | - France Leturcq
- Department of Genetics and Molecular Biology, Hospitalier Universitaire Paris Centre, Cochin Hospital, Paris, France
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Hackensack, NJ
| | | | - Jonas A Saute
- Medical Genetics and Neurology Services, Hospital de Clinicas de Porto Alegre/Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Wolfgang M Schmidt
- Neuromuscular Research Department, Medical University of Vienna, Vienna, Austria
| | - Thomas Sejersen
- Department of Women's and Children's Health, Karolinska Institute/Astrid Lindgrens Barnsjukhus, Karolinska University Hospital, Stockholm, Sweden
| | - Sylvie Tuffery-Giraud
- Laboratory of Rare Genetic Diseases (LGMR), University of Montpellier, Montpellier, France
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Shu Yau
- Viapath Analytics, Guy's Hospital, London, United Kingdom
| | - Stanley F Nelson
- Department of Human Genetics, University of California, Los Angeles, CA.
| |
Collapse
|
38
|
Cohen SA, Tucker ME. Movement of Genetic Counselors from Clinical to Non-clinical Positions: Identifying Driving Forces. J Genet Couns 2018; 27:792-799. [PMID: 29508181 DOI: 10.1007/s10897-018-0242-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/18/2018] [Indexed: 01/13/2023]
Abstract
A previous study of genetic counselors (GCs) in the state of Indiana identified movement out of clinical positions within the past 2 years. The aims of this study were to determine if this trend is nationwide and identify reasons why GCs are leaving their positions and factors that might help employers attract and retain GCs. An email was sent to members of the American Board of Genetic Counseling with a link to an online confidential survey. There were 939 responses (23.5% response rate). Overall, 52% of GCs report being highly satisfied in their current position, although almost two thirds think about leaving and one third had changed jobs within the past 2 years. Of those who had changed jobs (n = 295), 74.9% had been working in a hospital/clinic setting but only 46.3% currently do, demonstrating a major shift out of the clinic (p < 0.001). The top three reasons cited for leaving a position were work environment/institutional climate, salary/benefits, and a lack of feeling valued/recognized as a professional. These results confirm that GCs are moving out of clinical positions and document elements of job satisfaction. We suggest points for employers to consider when trying to recruit or retain GCs.
Collapse
Affiliation(s)
- Stephanie A Cohen
- Cancer Genetics Risk Assessment Program, St. Vincent Health, 8402 Harcourt Rd #324, Indianapolis, IN, 46260, USA.
| | - Megan E Tucker
- Genetic Counseling Graduate Program, The Center for Genomic Advocacy, Indiana State University, Terre Haute, IN, USA
| |
Collapse
|
39
|
Anticipating uncertainty and irrevocable decisions: provider perspectives on implementing whole-genome sequencing in critically ill children with heart disease. Genet Med 2018; 20:1455-1461. [PMID: 29493583 DOI: 10.1038/gim.2018.25] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/30/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the potential impacts of whole-genome sequencing (WGS) in the pediatric critical-care context, we examined how clinicians caring for critically ill children with congenital heart disease (CHD) anticipate and perceive the impact of WGS on their decision-making process and treatment recommendations. METHODS We conducted semistructured in-person and telephone interviews of clinicians involved in the care of critically ill children with CHD at a high-volume pediatric heart center. We qualitatively analyzed the transcribed interviews. RESULTS In total, 34 clinicians were interviewed. Three themes emerged: (i) uncertainty about the accuracy of WGS testing and adequacy of testing validation; (ii) the use of WGS to facilitate life-limiting decisions such as futility, rationing, and selective prenatal termination; and (iii) moral distress over using WGS with a lack of decision support. CONCLUSION Despite uncertainty about WGS testing, the interviewed clinicians were using, and anticipated expanding the use of, WGS results to justify declarations of futility, withdrawal of care, and rationing in critically ill children with CHD. This situation is causing moral distress in providers who have to make high-stakes decisions involving WGS results, with only partial understanding of them. Decision support for clinicians, and discussion with families of the risks of using WGS for rationing or withdrawal, is needed.
Collapse
|
40
|
Allyse MA, Robinson DH, Ferber MJ, Sharp RR. Direct-to-Consumer Testing 2.0: Emerging Models of Direct-to-Consumer Genetic Testing. Mayo Clin Proc 2018; 93:113-120. [PMID: 29304915 DOI: 10.1016/j.mayocp.2017.11.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
Direct-to-consumer (DTC) genetic testing emerged in the early 2000s as a means of allowing consumers to access information on their genetics without the involvement of a physician. Although early models of DTC were popular with consumers, they were controversial in medical and regulatory circles. In this article, we trace the history of DTC genetic testing, discuss its regulatory implications, and describe the emergence of a new hybrid model we call DTC 2.0.
Collapse
Affiliation(s)
- Megan A Allyse
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - David H Robinson
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | | | - Richard R Sharp
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.
| |
Collapse
|
41
|
Physicians’ Awareness and Utilization of Genetic Services in Texas. J Genet Couns 2017; 27:968-977. [DOI: 10.1007/s10897-017-0199-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/14/2017] [Indexed: 01/22/2023]
|
42
|
Hann KEJ, Fraser L, Side L, Gessler S, Waller J, Sanderson SC, Freeman M, Jacobs I, Lanceley A. Health care professionals' attitudes towards population-based genetic testing and risk-stratification for ovarian cancer: a cross-sectional survey. BMC WOMENS HEALTH 2017; 17:132. [PMID: 29246147 PMCID: PMC5732525 DOI: 10.1186/s12905-017-0488-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ovarian cancer is usually diagnosed at a late stage when outcomes are poor. Personalised ovarian cancer risk prediction, based on genetic and epidemiological information and risk stratified management in adult women could improve outcomes. Examining health care professionals' (HCP) attitudes to ovarian cancer risk stratified management, willingness to support women, self-efficacy (belief in one's own ability to successfully complete a task), and knowledge about ovarian cancer will help identify training needs in anticipation of personalised ovarian cancer risk prediction being introduced. METHODS An anonymous survey was distributed online to HCPs via relevant professional organisations in the UK. Kruskal-Wallis tests and pairwise comparisons were used to compare knowledge and self-efficacy scores between different types of HCPs, and attitudes toward population-based genetic testing and risk stratified management were described. Content analysis was undertaken of free text responses concerning HCPs willingness to discuss risk management options with women. RESULTS One hundred forty-six eligible HCPs completed the survey: oncologists (31%); genetics clinicians (30%); general practitioners (22%); gynaecologists (10%); nurses (4%); and 'others'. Scores for knowledge of ovarian cancer and genetics, and self-efficacy in conducting a cancer risk consultation were generally high but significantly lower for general practitioners compared to genetics clinicians, oncologists, and gynaecologists. Support for population-based genetic testing was not high (<50%). Attitudes towards ovarian cancer risk stratification were mixed, although the majority of participants indicated a willingness to discuss management options with patients. CONCLUSIONS Larger samples are required to investigate attitudes to population-based genetic testing for ovarian cancer risk and to establish why some HCPs are hesitant to offer testing to all adult female patients. If ovarian cancer risk assessment using genetic testing and non-genetic information including epidemiological information is rolled out on a population basis, training will be needed for HCPs in primary care to enable them to provide appropriate support to women at each stage of the process.
Collapse
Affiliation(s)
- Katie E J Hann
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK
| | - Lindsay Fraser
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK
| | - Lucy Side
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Gessler
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK
| | - Jo Waller
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Saskia C Sanderson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Great Ormond Street Hospital, London, UK
| | - Madeleine Freeman
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ian Jacobs
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.,The University of New South Wales, Sydney, NSW, Australia
| | - Anne Lanceley
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.
| | | |
Collapse
|
43
|
Calzone KA, Jenkins J, Culp S, Badzek L. Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings. Nurs Outlook 2017; 66:244-253. [PMID: 29544651 DOI: 10.1016/j.outlook.2017.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce. PURPOSE This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice. METHODS We examined genomic competency outcomes in 8,150 RNs. FINDINGS Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis. DISCUSSION Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted.
Collapse
Affiliation(s)
- Kathleen A Calzone
- National Institutes of Health, National Cancer Institute, Center for Cancer Research, Bethesda, MD.
| | - Jean Jenkins
- National Institutes of Health, National Human Genome Research Institute, Genomic Healthcare Branch, Bethesda, MD
| | - Stacey Culp
- Department of Statistics, West Virginia University, Morgantown, WV
| | - Laurie Badzek
- University of North Carolina Wilmington School of Nursing, Wilmington, NC
| |
Collapse
|
44
|
The current state of genetic counseling and newborn screening: an interview with Megan Tucker. Future Sci OA 2017; 3:FSO181. [PMID: 28883988 PMCID: PMC5583692 DOI: 10.4155/fsoa-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/02/2017] [Indexed: 11/29/2022] Open
Abstract
Megan Tucker talks to Francesca Lake, Managing Editor: A certified genetic counselor for over 10 years, Megan is currently the director of the Indiana State University Genetic Counseling Graduate Program and the Genetic Counseling Clinic at Union Hospital (Terre Haute, IN, USA). She began her career split between the Center for Prenatal Diagnosis and the Medical Genetics and Neurodevelopmental Center at St Vincent Hospital (Indianapolis, IN, USA). During this time she was instrumental in both the development of the statewide Perinatal Loss Evaluation Program and a hospital protocol to ensure collection of cord blood to allow time to effectively genetically evaluate babies. Her current clinical focus is in cancer and psychiatric genetic counseling.
Collapse
|
45
|
McClatchey T, Lay E, Strassberg M, Van den Veyver IB. Missed opportunities: unidentified genetic risk factors in prenatal care. Prenat Diagn 2017; 38:75-79. [PMID: 28384392 DOI: 10.1002/pd.5048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/13/2017] [Accepted: 04/01/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Trissa McClatchey
- Baylor College of Medicine; School of Medicine, One Baylor Plaza; Houston TX USA
| | - Erica Lay
- Baylor College of Medicine; School of Medicine, One Baylor Plaza; Houston TX USA
| | - Melissa Strassberg
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine; Baylor College of Medicine, One Baylor Plaza; Houston TX USA
- Department of Molecular and Human Genetics; Baylor College of Medicine, One Baylor Plaza; Houston TX USA
- Texas Children's Hospital; Pavilion for Women; 6651 Main St. Houston TX USA
| | - Ignatia B. Van den Veyver
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine; Baylor College of Medicine, One Baylor Plaza; Houston TX USA
- Department of Molecular and Human Genetics; Baylor College of Medicine, One Baylor Plaza; Houston TX USA
- Texas Children's Hospital; Pavilion for Women; 6651 Main St. Houston TX USA
| |
Collapse
|
46
|
Malogajski J, Jansen ME, Ouburg S, Ambrosino E, Terwee CB, Morré SA. The attitudes of Dutch fertility specialists towards the addition of genetic testing in screening of tubal factor infertility. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:123-127. [PMID: 28477924 DOI: 10.1016/j.srhc.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/31/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aims to identify elements perceived by Dutch fertility specialists as barriers and facilitators for the introduction of genetic testing, and their attitudes towards the use of genetic information. The genetic test would be implemented in routine screening for tubal pathology and identifies SNPs relevant for the immune response causing tubal pathology. METHODS Experienced reproductive specialists working in Dutch Academic Hospitals were interviewed. Based on the results of four interviews a questionnaire was developed and used to survey medical doctors in six out of eight Dutch Academic hospitals. RESULTS 60.4% (n=91) stated that the addition of genetic markers to the Chlamydia trachomatis antibody test (CAT) in screening for tubal pathology would increase screening accuracy. 68.2% (n=90) agreed they would require additional training on clinical genetics. Clinical utility (91.2%, n=91) and cost-effectiveness (95.6%, n=91) were recognized by the respondents as important factors in gaining support for the new screening strategy. CONCLUSION In summary, respondents showed a positive attitude towards the implementation of a genetic test combined with CAT for tubal factor infertility (TFI) screening. To gain their support the majority of respondents agreed that clinical utility, specifically cost-effectiveness, is an important factor. Comprehensive research about economic implications and utility regarding the introduction of genomic markers should be the next step in the implementation strategy. Furthermore, education and training would need to be developed and offered to fertility care professionals about genetic markers, their interpretation, and implications for clinical decision-making.
Collapse
Affiliation(s)
- Jelena Malogajski
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Marleen E Jansen
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Servaas A Morré
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands; Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
47
|
Chen LS, Chang FW, Kim M, Talwar D, Zhao S. Genomic medicine practice among physicians in Taiwan. Per Med 2017; 14:109-121. [DOI: 10.2217/pme-2016-0067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aim: To examine genomic medicine (GM) practice and associated factors (i.e., attitudes, intention, self-efficacy, previous training in genomics, and demographic characteristics) among Taiwanese physicians. Methods: A survey was distributed to physicians attending an internal training workshop at a large medical center in Taiwan. Data were analyzed using structural equation modeling. Results: A total of 137 physicians comprised our final sample; less than a third of them had practiced GM. Yet, participants overall had positive intention, favorable attitudes, and high self-efficacy in GM practice. Moreover, intention, attitudes, self-efficacy, educational level, and continuing education in GM were positively and significantly associated with participants’ GM practice. Conclusion: Offering continuing education for Taiwanese physicians is needed to enhance their practice in GM.
Collapse
Affiliation(s)
- Lei-Shih Chen
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Minjung Kim
- Department of Psychology, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Divya Talwar
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shixi Zhao
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| |
Collapse
|
48
|
Dickmann LJ, Ware JA. Pharmacogenomics in the age of personalized medicine. DRUG DISCOVERY TODAY. TECHNOLOGIES 2017; 21-22:11-16. [PMID: 27978982 DOI: 10.1016/j.ddtec.2016.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/23/2022]
Abstract
The aim of personalized medicine is to offer the right treatment to the right person at the right dose, thus maximizing efficacy and minimizing toxicity for each individual patient. Pharmacogenomic approaches attempt to refine the aim of personalized medicine by utilizing an individual's germline and somatic DNA signatures to guide treatment. In this review, we highlight the current use of pharmacogenomic based biomarker information in drug labeling. We also present several case studies on the implementation of pharmacogenomic strategies in drug discovery and development. Lastly, we comment on current challenges to implementing pharmacogenomic based testing in the clinic.
Collapse
Affiliation(s)
- Leslie J Dickmann
- Department of Clinical Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA 94080, United States.
| | - Joseph A Ware
- Department of Clinical Pharmacology, Genentech, 1 DNA Way, South San Francisco, CA 94080, United States
| |
Collapse
|
49
|
Health Orientation, Knowledge, and Attitudes toward Genetic Testing and Personalized Genomic Services: Preliminary Data from an Italian Sample. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6824581. [PMID: 28105428 PMCID: PMC5220460 DOI: 10.1155/2016/6824581] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/14/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
Objective. The study aims at assessing personality tendencies and orientations that could be closely correlated with knowledge, awareness, and interest toward undergoing genetic testing. Methods. A sample of 145 subjects in Italy completed an online survey, investigating demographic data, health orientation, level of perceived knowledge about genetic risk, genetic screening, and personal attitudes toward direct to consumer genetic testing (DTCGT). Results. Results showed that respondents considered genetic assessment to be helpful for disease prevention, but they were concerned that results could affect their life planning with little clinical utility. Furthermore, a very high percentage of respondents (67%) had never heard about genetic testing directly available to the public. Data showed that personality tendencies, such as personal health consciousness, health internal control, health esteem, and confidence, motivation to avoid unhealthiness and motivation for healthiness affected the uptake of genetic information and the interest in undergoing genetic testing. Conclusions. Public knowledge and attitudes toward genetic risk and genetic testing among European countries, along with individual personality and psychological tendencies that could affect these attitudes, remain unexplored. The present study constitutes one of the first attempts to investigate how such personality tendencies could motivation to undergo genetic testing and engagement in lifestyle changes.
Collapse
|
50
|
Pokharel HP, Hacker NF, Andrews L. Genetic testing in a gynaecological oncology care in developing countries-knowledge, attitudes and perception of Nepalese clinicians. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:12. [PMID: 27980798 PMCID: PMC5137212 DOI: 10.1186/s40661-016-0034-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022]
Abstract
Background Genetic testing for an inherited susceptibility to cancer is an emerging technology in medical practice. Little information is currently available about physicians’ attitudes towards these tests in developing countries. Methods We conducted an email survey of Nepalese physicians practicing in academic and non-academic settings in Nepal, regarding knowledge, attitudes and perception towards genetic testing for gynaecologic cancer. Results Responses were received from 251 of 387 practitioners (65%). Only 46% of all respondents felt prepared to answer patients’ questions about genetic testing for gynaecologic cancer, despite 80% reporting that patients had asked questions about genetic testing, and 55% being asked more than 5 times in the past year. 42% reported more than 10 of their patients having had genetic testing for cancer, the majority for BRCA1/2. Access (40%), cost (37%) and lack of physicians’ information (24%) were cited as the main barriers to testing. The most commonly identified concerns regarding genetic testing were the potential for increased patient anxiety, misinterpretation of results by patients, and maintaining confidentiality of results (64%, 47% and 38% of respondents respectively). Conclusion This study shows the gap among the health care providers in developing countries and the available modern scientific tools and skills in regard to the benefits of genetic testing for gynaecological cancers in a developing nation. These findings indicate the need for the introduction of further genetic counselling education and support into gynaecological care in Nepal. Electronic supplementary material The online version of this article (doi:10.1186/s40661-016-0034-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hanoon P Pokharel
- Department of Obstetrics & Gynaecology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Neville F Hacker
- Royal Hospital for Women, Randwick, Australia ; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Lesley Andrews
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia ; Prince of Wales Hospital, Randwick, Australia
| |
Collapse
|