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Ellard S, Morgan S, Wynn SL, Walker S, Parrish A, Mein R, Juett A, Ahn JW, Berry I, Cassidy EJ, Durkie M, Fish L, Hall R, Howard E, Rankin J, Wright CF, Deans ZC, Scott RH, Hill SL, Baple EL, Taylor RW. Rare disease genomic testing in the UK and Ireland: promoting timely and equitable access. J Med Genet 2024:jmg-2024-110228. [PMID: 39327040 DOI: 10.1136/jmg-2024-110228] [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: 07/09/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE AND SCOPE The aim of this position statement is to provide recommendations regarding the delivery of genomic testing to patients with rare disease in the UK and Ireland. The statement has been developed to facilitate timely and equitable access to genomic testing with reporting of results within commissioned turnaround times. METHODS OF STATEMENT DEVELOPMENT A 1-day workshop was convened by the UK Association for Clinical Genomic Science and attended by key stakeholders within the NHS Genomic Medicine Service, including clinical scientists, clinical geneticists and patient support group representatives. The aim was to identify best practice and innovations for streamlined, geographically consistent services delivering timely results. Attendees and senior responsible officers for genomic testing services in the UK nations and Ireland were invited to contribute. RESULTS AND CONCLUSIONS We identified eight fundamental requirements and describe these together with key enablers in the form of specific recommendations. These relate to laboratory practice (proportionate variant analysis, bioinformatics pipelines, multidisciplinary team working model and test request monitoring), compliance with national guidance (variant classification, incidental findings, reporting and reanalysis), service development and improvement (multimodal testing and innovation through research, informed by patient experience), service demand, capacity management, workforce (recruitment, retention and development), and education and training for service users. This position statement was developed to provide best practice guidance for the specialist genomics workforce within the UK and Ireland but is relevant to any publicly funded healthcare system seeking to deliver timely rare disease genomic testing in the context of high demand and limited resources.
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Affiliation(s)
- Sian Ellard
- Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Sian Morgan
- All Wales Genetics Laboratory, University Hospital of Wales, Cardiff, UK
| | - Sarah L Wynn
- Rare Chromosome Disorder Support Group, Unique, Surrey, UK
| | | | - Andrew Parrish
- Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- South West Genomic Medicine Service, England, UK
| | | | - Ana Juett
- South West Genomic Medicine Service, England, UK
| | - Joo Wook Ahn
- Cambridge Genomics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Berry
- South West Genomic Medicine Service, England, UK
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, UK
| | - Emma-Jane Cassidy
- Wessex Genomics Laboratory Service, University Hospital Southampton NHS Foundation Trust, Salisbury, UK
| | - Miranda Durkie
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | | | - Emma Howard
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Julia Rankin
- South West Genomic Medicine Service, England, UK
- Peninsula Clinical Genetics Service, Exeter, UK
| | - Caroline F Wright
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Zandra C Deans
- GenQA, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard H Scott
- Genomics England Limited, London, UK
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, UK
| | | | - Emma L Baple
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- South West Genomic Medicine Service, England, UK
- Peninsula Clinical Genetics Service, Exeter, UK
| | - Robert W Taylor
- Mitochondrial Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, North East and Yorkshire Genomic Laboratory Hub, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Hayeems RZ, Luca S, Assamad D, Bhatt A, Ungar WJ. Utility of Genetic Testing from the Perspective of Parents/Caregivers: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:259. [PMID: 33801725 PMCID: PMC8067127 DOI: 10.3390/children8040259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
In genomics, perceived and personal utility have been proposed as constructs of value that include the subjective meanings and uses of genetic testing. Precisely what constitutes these constructs of utility and how they vary by stakeholder perspective remains unresolved. To advance methods for measuring the value of genetic testing in child health, we conducted a scoping review of the literature to characterize utility from the perspective of parents/caregivers. Peer reviewed literature that included empiric findings from parents/caregivers who received genetic test results for an index child and was written in English from 2016-2020 was included. Identified concepts of utility were coded according to Kohler's construct of personal utility. Of 2142 abstracts screened, 33 met inclusion criteria. Studies reflected a range of genetic test types; the majority of testing was pursued for children with developmental or neurodevelopmental concerns. Coding resulted in 15 elements of utility that mapped to Kohler's four domains of personal utility (affective, cognitive, behavioural and social) and one additional medical management domain. An adapted construct of utility for parents/caregivers may enable specific and standardized strategies for researchers to use to generate evidence of the post-test value of genetic testing. In turn, this will contribute to emerging methods for health technology assessment and policy decision making for genomics in child health.
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Affiliation(s)
- Robin Z. Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Stephanie Luca
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
| | - Daniel Assamad
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
| | - Ayushi Bhatt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Wendy J. Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, ON M5T 3M6, Canada
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