1
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Verdez S, Bardou M, Duffourd Y, Luu M, Thauvin-Robinet C, Faivre L, Picard N. Experience and expectations of pharmacogenetic tests in France. Therapie 2024; 79:341-349. [PMID: 37516659 DOI: 10.1016/j.therap.2023.07.002] [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: 02/24/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
Although French genomic medicine is reaching a turning point in its history and the implementation of genome sequencing in routine is being implemented as part of the France Genomic Medicine 2025 Plan (FGMP), many questions about secondary data management remain to be addressed. In particular, the use of pharmacogenetic (PGx) information that can be extracted from genome data is a concern. We sought to analyze the opinion of French health professionals on their desire to have access to this information. For this purpose, we created a 22-item questionnaire on the experiences, attitudes, expectations, and knowledge of French physicians and pharmacists about PGx. We collected the responses in different groups and determined a knowledge score with the last 3 questions of the questionnaire. Then, we built a prediction model for this score and determined which factors may influence it. Half of the responders were physicians (158/311) and the other half were pharmacists (153/311), and the majority of them worked in a hospital (265/311). Almost two third (62.7%, 195/311) of the responders thought that pharmacogenetic data should be communicated with genomic results for the primary indication within the framework of FGMP, and 89.1% (277/311) of them that PGx tests could be an interesting tool to optimize patients' drug therapy in the future. Only 11.2% (35/311) of the responders reached the maximum knowledge score, while 25.4% (76/311) had already prescribed or recommended a PGx test. This study identified a need for training for French physicians and pharmacists in PGx, particularly given the interest of health professionals in it.
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Affiliation(s)
- Simon Verdez
- UMR1231 GAD team, Genetics of Developmental Disorders, Inserm - université Bourgogne-Franche Comté, 21000 Dijon, France; Unité fonctionnelle innovation en diagnostic génomique des maladies rares, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France.
| | - Marc Bardou
- Centre d'investigation clinique, module épidémiologie clinique/essais cliniques, CHU de Dijon, 21000 Dijon, France; Inserm CIC1432, 21000 Dijon, France
| | - Yannis Duffourd
- UMR1231 GAD team, Genetics of Developmental Disorders, Inserm - université Bourgogne-Franche Comté, 21000 Dijon, France; Unité fonctionnelle innovation en diagnostic génomique des maladies rares, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France
| | - Maxime Luu
- Inserm CIC1432, 21000 Dijon, France; Centre d'investigation clinique, module plurithématique, CHU de Dijon, 21000 Dijon, France
| | - Christel Thauvin-Robinet
- UMR1231 GAD team, Genetics of Developmental Disorders, Inserm - université Bourgogne-Franche Comté, 21000 Dijon, France; Unité fonctionnelle innovation en diagnostic génomique des maladies rares, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France; Centre de référence maladies rares « déficiences intellectuelles de causes rares », centre de génétique, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France; Centre de référence maladies rares « anomalies du développement et syndromes malformatifs », centre de génétique, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France
| | - Laurence Faivre
- UMR1231 GAD team, Genetics of Developmental Disorders, Inserm - université Bourgogne-Franche Comté, 21000 Dijon, France; Unité fonctionnelle innovation en diagnostic génomique des maladies rares, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France; Centre de référence maladies rares « déficiences intellectuelles de causes rares », centre de génétique, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France; Centre de référence maladies rares « anomalies du développement et syndromes malformatifs », centre de génétique, FHU-TRANSLAD, CHU de Dijon Bourgogne, 21000 Dijon, France
| | - Nicolas Picard
- Service de pharmacologie et toxicologie, université de Limoges, Inserm U1248, CHU de Limoges, 87042 Limoges, France
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2
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Pereira L, Haidar CE, Haga SB, Cisler AG, Hall A, Shukla SK, Hebbring SJ, Leary EJW. Assessment of the current status of real-world pharmacogenomic testing: informed consent, patient education, and related practices. Front Pharmacol 2024; 15:1355412. [PMID: 38410134 PMCID: PMC10895424 DOI: 10.3389/fphar.2024.1355412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction: The practice of informed consent (IC) for pharmacogenomic testing in clinical settings varies, and there is currently no consensus on which elements of IC to provide to patients. This study aims to assess current IC practices for pharmacogenomic testing. Methods: An online survey was developed and sent to health providers at institutions that offer clinical germline pharmacogenomic testing to assess current IC practices. Results: Forty-six completed surveys representing 43 clinical institutions offering pharmacogenomic testing were received. Thirty-two (74%) respondents obtain IC from patients with variability in elements incorporated. Results revealed that twenty-nine (67%) institutions discuss the benefits, description, and purpose of pharmacogenomic testing with patients. Less commonly discussed elements included methodology and accuracy of testing, and laboratory storage of samples. Discussion: IC practices varied widely among survey respondents. Most respondents desire the establishment of consensus IC recommendations from a trusted pharmacogenomics organization to help address these disparities.
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Affiliation(s)
- Lucas Pereira
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
- Division of Genetics and Metabolism, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Cyrine-Eliana Haidar
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Susanne B Haga
- Program in Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC, United States
| | - Anna G Cisler
- Medical Genetics, Marshfield Clinic Health Systems, Marshfield, WI, United States
| | - April Hall
- Division of Genetics and Metabolism, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Center for Human Genomics and Precision Medicine, Wisconsin Institute for Medical Research, University of Wisconsin-Madison, Madison, WI, United States
| | - Sanjay K Shukla
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
| | - Scott J Hebbring
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
| | - Emili J W Leary
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
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3
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Kodida R, Reble E, Clausen M, Shickh S, Mighton C, Sam J, Forster N, Panchal S, Aronson M, Semotiuk K, Graham T, Silberman Y, Randall Armel S, McCuaig JM, Cohn I, Morel CF, Elser C, Eisen A, Carroll JC, Glogowski E, Schrader KA, Di Gioacchino V, Lerner-Ellis J, Kim RH, Bombard Y. A model for the return and referral of all clinically significant secondary findings of genomic sequencing. J Med Genet 2023; 60:733-739. [PMID: 37217257 DOI: 10.1136/jmg-2022-109091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Secondary findings (SFs) identified through genomic sequencing (GS) can offer a wide range of health benefits to patients. Resource and capacity constraints pose a challenge to their clinical management; therefore, clinical workflows are needed to optimise the health benefits of SFs. In this paper, we describe a model we created for the return and referral of all clinically significant SFs, beyond medically actionable results, from GS. As part of a randomised controlled trial evaluating the outcomes and costs of disclosing all clinically significant SFs from GS, we consulted genetics and primary care experts to determine a feasible workflow to manage SFs. Consensus was sought to determine appropriate clinical recommendations for each category of SF and which clinician specialist would provide follow-up care. We developed a communication and referral plan for each category of SFs. This involved referrals to specialised clinics, such as an Adult Genetics clinic, for highly penetrant medically actionable findings. Common and non-urgent SFs, such as pharmacogenomics and carrier status results for non-family planning participants, were directed back to the family physician (FP). SF results and recommendations were communicated directly to participants to respect autonomy and to their FPs to support follow-up of SFs. We describe a model for the return and referral of all clinically significant SFs to facilitate the utility of GS and promote the health benefits of SFs. This may serve as a model for others returning GS results transitioning participants from research to clinical settings.
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Affiliation(s)
- Rita Kodida
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Emma Reble
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Marc Clausen
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Salma Shickh
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Chloe Mighton
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Sam
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nicole Forster
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Seema Panchal
- The Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Kara Semotiuk
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Tracy Graham
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yael Silberman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan Randall Armel
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Jeanna M McCuaig
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Iris Cohn
- Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chantal F Morel
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine Elser
- The Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Eisen
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - June C Carroll
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | | | - Kasmintan A Schrader
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Di Gioacchino
- The Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Pathology & Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Pathology & Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Raymond H Kim
- Division of Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Genomics Health Services & Policy Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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4
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Gammal RS, Fieg E. Pharmacist and genetic counselor collaboration in pharmacogenomics. Am J Health Syst Pharm 2022; 79:1516-1520. [PMID: 35732271 DOI: 10.1093/ajhp/zxac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Roseann S Gammal
- Massachusetts College of Pharmacy and Health Sciences Boston, MA, USA
| | - Elizabeth Fieg
- Genetics & Genomic Medicine Service Brigham and Women's Hospital Boston, MA, USA
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5
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Zubiaur P, Prósper-Cuesta DN, Novalbos J, Mejía-Abril G, Navares-Gómez M, Villapalos-García G, Soria-Chacartegui P, Abad-Santos F. Patients’ Perceptions of Pharmacogenetic Testing and Access to Their Results: State of the Art in Spain and Systematic Review. J Pers Med 2022; 12:jpm12020270. [PMID: 35207758 PMCID: PMC8879541 DOI: 10.3390/jpm12020270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022] Open
Abstract
The process of clinical pharmacogenetics implementation depends on patients’ and general population’s perceptions. To date, no study has been published addressing Spanish patients’ opinions on pharmacogenetic testing, the availability of the results, and the need for signing informed consent. In this work, we contacted 146 patients that had been previously genotyped at our laboratory and 46 healthy volunteers that had participated in a bioequivalence clinical trial at the Clinical Pharmacology Department of Hospital Universitario de La Princesa and consented to pharmacogenetic testing for research purposes. From the latter, 108 and 34, respectively, responded to the questionnaire (i.e., a response rate of 74%); Participants were scheduled for a face-to-face, telephone, or videoconference interview and were asked a total of 27 questions in Spanish. Great or almost complete acceptance of pharmacogenetic testing was observed (99.3%), age and university education level being the main predictors of acceptance rates and understanding (multivariate analysis, p = 0.004, R2 = 0.17, age being inversely proportional to acceptance rates and understanding and university level being related to higher acceptance rates and understanding compared to other education levels). Mixed perceptions were observed on the requirement of written informed consent (55.6% in favor); therefore, it seems recommendable to continue requesting it for the upcoming years until more perceptions are collected. The majority of participants (95.8%) preferred storing pharmacogenetic results in medical records rather than in electronic sources (55.6%) and highly agreed with the possibility of carrying their results on a portable card (91.5%). Patients agreed to broad genetic testing, including biomarkers unrelated to their disease (93.7%) or with little clinically relevant evidence (94.4%). Patients apparently rely on clinician’s or pharmacogeneticist’s interpretation and seem, therefore, open to the generation of ethically challenging information. Finally, although most patients (68.3%) agreed with universal population testing, some were reluctant, probably due to the related costs and sustainability of the Spanish Health System. This was especially evident in the group of patients who were older and with a likely higher proportion of pensioners.
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Affiliation(s)
- Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28006 Madrid, Spain
- Correspondence: (P.Z.); (F.A.-S.); Tel.: +34-915202425 (P.Z. & F.A.-S.); Fax: +34-915202540 (P.Z. & F.A.-S.)
| | - David Nicolás Prósper-Cuesta
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Jesús Novalbos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Gina Mejía-Abril
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Marcos Navares-Gómez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Gonzalo Villapalos-García
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Paula Soria-Chacartegui
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28006 Madrid, Spain
- Correspondence: (P.Z.); (F.A.-S.); Tel.: +34-915202425 (P.Z. & F.A.-S.); Fax: +34-915202540 (P.Z. & F.A.-S.)
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6
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Cacabelos R, Naidoo V, Corzo L, Cacabelos N, Carril JC. Genophenotypic Factors and Pharmacogenomics in Adverse Drug Reactions. Int J Mol Sci 2021; 22:ijms222413302. [PMID: 34948113 PMCID: PMC8704264 DOI: 10.3390/ijms222413302] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
Adverse drug reactions (ADRs) rank as one of the top 10 leading causes of death and illness in developed countries. ADRs show differential features depending upon genotype, age, sex, race, pathology, drug category, route of administration, and drug–drug interactions. Pharmacogenomics (PGx) provides the physician effective clues for optimizing drug efficacy and safety in major problems of health such as cardiovascular disease and associated disorders, cancer and brain disorders. Important aspects to be considered are also the impact of immunopharmacogenomics in cutaneous ADRs as well as the influence of genomic factors associated with COVID-19 and vaccination strategies. Major limitations for the routine use of PGx procedures for ADRs prevention are the lack of education and training in physicians and pharmacists, poor characterization of drug-related PGx, unspecific biomarkers of drug efficacy and toxicity, cost-effectiveness, administrative problems in health organizations, and insufficient regulation for the generalized use of PGx in the clinical setting. The implementation of PGx requires: (i) education of physicians and all other parties involved in the use and benefits of PGx; (ii) prospective studies to demonstrate the benefits of PGx genotyping; (iii) standardization of PGx procedures and development of clinical guidelines; (iv) NGS and microarrays to cover genes with high PGx potential; and (v) new regulations for PGx-related drug development and PGx drug labelling.
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Affiliation(s)
- Ramón Cacabelos
- Department of Genomic Medicine, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, 15165 Corunna, Spain
- Correspondence: ; Tel.: +34-981-780-505
| | - Vinogran Naidoo
- Department of Neuroscience, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, 15165 Corunna, Spain;
| | - Lola Corzo
- Department of Medical Biochemistry, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, 15165 Corunna, Spain;
| | - Natalia Cacabelos
- Department of Medical Documentation, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, 15165 Corunna, Spain;
| | - Juan C. Carril
- Departments of Genomics and Pharmacogenomics, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, 15165 Corunna, Spain;
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7
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Loudon E, Scott SA, Rigobello R, Scott ER, Zinberg R, Naik H. Pharmacogenomic education among genetic counseling training programs in North America. J Genet Couns 2021; 30:1500-1508. [PMID: 33882174 DOI: 10.1002/jgc4.1417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/06/2022]
Abstract
The increasing number of genetic counselors participating directly in clinical pharmacogenomic post-test counseling prompted our evaluation of pharmacogenomic education across genetic counseling training programs in North America. Thirty-one program leadership participants from both the United States (U.S.) and Canada responded to a survey assessing pharmacogenomics education and the role of genetic counselors. Eighty-five percent of respondents agreed pharmacogenomics is currently within the scope of genetic counseling practice, and 96.3% indicated their training programs currently provide education on pharmacogenomics, with the majority reporting < 7 hr of education. Lectures on pharmacogenomics were the most common method for didactics; however, some programs also included practical modalities (e.g., case studies, clinical rotations) and online resources. Barriers to expanding pharmacogenomic education included the constrained timeline of training, and lack of resources and local expertise. Moreover, participants suggested that genetic counselors ideally should be able to order pharmacogenomic tests and counsel patients on pharmacogenomics, including result interpretation, as they believe pharmacogenomics does fall within the scope of practice of genetic counseling. Our novel results also confirm that training program leadership support a pharmacogenomic service delivery model that includes a combined effort between genetic counselors and pharmacists to utilize their synergistic expertise. However, this model likely still necessitates expanding pharmacogenomic didactics in genetic counseling training programs through more practical training and/or by leveraging online pharmacogenomic courses dedicated to supporting clinical implementation.
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Affiliation(s)
- Elizabeth Loudon
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart A Scott
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, Stamford, CT, USA.,Clinical Genomics Laboratory, Stanford Health Care, Palo Alto, CA, USA
| | | | - Erick R Scott
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Randi Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hetanshi Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Ward KM, Taubman DS, Pasternak AL, Burghardt KJ, Ellingrod VL, Parikh SV. Teaching psychiatric pharmacogenomics effectively: Evaluation of a novel interprofessional online course. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kristen M. Ward
- Department of Clinical Pharmacy, College of Pharmacy University of Michigan Ann Arbor Michigan USA
| | | | - Amy L. Pasternak
- Department of Clinical Pharmacy, College of Pharmacy University of Michigan Ann Arbor Michigan USA
| | - Kyle J. Burghardt
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA
| | - Vicki L. Ellingrod
- Department of Clinical Pharmacy, College of Pharmacy University of Michigan Ann Arbor Michigan USA
- Department of Psychiatry, School of Medicine University of Michigan Ann Arbor Michigan USA
| | - Sagar V. Parikh
- Department of Psychiatry University of Michigan Ann Arbor Michigan USA
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9
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Rigobello R, Rahawi S, Wallsten R, Cody N, Nicoletti P, Owusu Obeng A, Naik H, Dillon MW, Scott SA. Clinical Pharmacogenetic Testing and the Posttest Counseling Conundrum. Clin Pharmacol Ther 2020; 108:924-928. [DOI: 10.1002/cpt.1913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/14/2020] [Indexed: 01/28/2023]
Affiliation(s)
| | | | | | - Neal Cody
- Sema4 Stamford Connecticut USA
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York New York USA
| | - Paola Nicoletti
- Sema4 Stamford Connecticut USA
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York New York USA
| | - Aniwaa Owusu Obeng
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York New York USA
- Charles Bronfman Institute for Personalized Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Hetanshi Naik
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York New York USA
| | - Mitchell W. Dillon
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York New York USA
| | - Stuart A. Scott
- Sema4 Stamford Connecticut USA
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York New York USA
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10
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Karas Kuželički N, Prodan Žitnik I, Gurwitz D, Llerena A, Cascorbi I, Siest S, Simmaco M, Ansari M, Pazzagli M, Di Resta C, Brandslund I, Schwab M, Vermeersch P, Lunshof JE, Dedoussis G, Flordellis CS, Fuhr U, Stingl JC, van Schaik RH, Manolopoulos VG, Marc J. Pharmacogenomics education in medical and pharmacy schools: conclusions of a global survey. Pharmacogenomics 2020; 20:643-657. [PMID: 31250730 DOI: 10.2217/pgs-2019-0009] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Aim: The need for pharmacogenomic education is becoming more and more urgent. Our aim was to evaluate the progress in pharmacogenomics education since then, and to put forward further recommendations. Methods: A survey was sent to 248 schools of medicine, pharmacy, nursing and health professions around the world. Results: The majority of the study programs (87%) include pharmacogenomics education, which is generally taught as part of the pharmacology curriculum. On average, educators and teachers have selected appropriate and highly relevant pharmacogenomics biomarkers to include in their teaching programs. Conclusions: Based on the results, we can conclude that the state of pharmacogenomics education at the surveyed universities has improved substantially since 2005.
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Affiliation(s)
| | | | - David Gurwitz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Sofia Siest
- INSERM UMR U1122, University of Loraine, Nancy, France
| | | | - Marc Ansari
- Onco-Hematology Unit, University Hospital of Geneva, Geneva, Switzerland.,Cansearch Research Laboratory, Geneva Medical School, Geneva, Switzerland
| | | | - Chiara Di Resta
- Vita-Salute San Raffaele University, Milan, Italy.,Genomics Unit for Diagnosis of Human Genetics, Division of Genetics & Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ivan Brandslund
- University of Southern Denmark, Vejle Hospital, Vejle, Denmark
| | - Matthias Schwab
- Department of Clinical Pharmacology, University Hospital Tuebingen, Tuebingen, Germany.,Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,Department of Pharmacy & Biochemistry, University of Tuebingen, Tuebingen, Germany
| | | | - Jeantine E Lunshof
- University of Gröningen, University Medical Center Gröningen, Gröningen, The Netherlands.,Harvard Medical School, Boston, MA, USA.,Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | - Uwe Fuhr
- Centre of Pharmacology, University of Cologne, Cologne, Germany
| | | | - Ron Hn van Schaik
- Deptartment of Clinical Chemistry, Erasmus MC Rotterdam, Rotterdam, The Netherlands.,European Society of Pharmacogenomics & Personalised Therapy, Via Carlo Farini 81, Milan, Italy
| | - Vangelis G Manolopoulos
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Janja Marc
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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11
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Rahawi S, Naik H, Blake KV, Owusu Obeng A, Wasserman RM, Seki Y, Funanage VL, Oishi K, Scott SA. Knowledge and attitudes on pharmacogenetics among pediatricians. J Hum Genet 2020; 65:437-444. [PMID: 31983733 DOI: 10.1038/s10038-020-0723-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/09/2022]
Abstract
Increasing enthusiasm for clinical pharmacogenetic testing and the availability of pharmacogenetic-based guidelines indicate that pediatricians will increasingly be expected to interpret and apply pharmacogenetic test results into medical care. Previous studies have identified a lack of knowledge on pharmacogenetics across many physician specialties; however, this has not been systematically assessed among pediatricians. To evaluate pediatrician knowledge, attitude, and educational interest in pharmacogenetics, we surveyed physician cohorts from both the United States (U.S.) and Japan. A total of 282 pediatricians (210 from the U.S. and 72 from Japan) participated in an anonymous survey (online or hardcopy) on pharmacogenetics knowledge, perception, and education. Over 50% of all respondents had >10 years of clinical experience and >75% had some prior education in genetics. However, <10% felt they were familiar with pharmacogenetics, which was very consistent with <20% of the U.S. pediatricians correctly responding to a codeine/CYP2D6 pharmacogenetics knowledge question and <10% of U.S. pediatricians being aware of the Clinical Pharmacogenetics Implementation Consortium (CPIC). Despite being generally unfamiliar with pharmacogenetics, >80% of all respondents indicated that implementation of clinical pharmacogenetic testing will improve efficacy and safety, and that pediatricians should be capable of applying this testing to their practice. Moreover, the majority (83.1%) were interested in educational opportunities on pharmacogenetics, particularly on result interpretation and therapeutic recommendations. Taken together, these data indicate that although practical knowledge of pharmacogenetics among pediatricians in the U.S. and Japan is currently very low, their interest in clinical pharmacogenetics and related education is high, which will likely facilitate future implementation.
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Affiliation(s)
- Shahad Rahawi
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Sema4, Stamford, CT, 06902, USA
| | - Hetanshi Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Kathryn V Blake
- Department of Biomedical Research, Nemours Children's Health System, Wilmington, DE, USA.,Department of Biomedical Research, Nemours Children's Health System, Jacksonville, Orlando, FL, USA
| | - Aniwaa Owusu Obeng
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Pharmacy, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Rachel M Wasserman
- Department of Biomedical Research, Nemours Children's Health System, Wilmington, DE, USA.,Department of Biomedical Research, Nemours Children's Health System, Jacksonville, Orlando, FL, USA
| | - Yoshinori Seki
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Sema4, Stamford, CT, 06902, USA
| | - Vicky L Funanage
- Department of Biomedical Research, Nemours Children's Health System, Wilmington, DE, USA.,Department of Biomedical Research, Nemours Children's Health System, Jacksonville, Orlando, FL, USA
| | - Kimihiko Oishi
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Stuart A Scott
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .,Sema4, Stamford, CT, 06902, USA.
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12
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Deininger KM, Tran JN, Tsunoda SM, Young GK, Lee YM, Anderson HD, Page II RL, Hirsch JD, Aquilante CL. Stakeholder perspectives of the clinical utility of pharmacogenomic testing in solid organ transplantation. Pharmacogenomics 2019; 20:1291-1302. [DOI: 10.2217/pgs-2019-0129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To assess stakeholder perspectives regarding the clinical utility of pharmacogenomic (PGx) testing following kidney, liver, and heart transplantation. Methods: We conducted individual semi-structured interviews and focus groups with kidney, liver, and heart transplantation patients and providers. We analyzed the qualitative data to identify salient themes. Results: The study enrolled 36 patients and 24 providers. Patients lacked an understanding about PGx, but expressed interest in PGx testing. Providers expressed willingness to use PGx testing, but reported barriers to implementation, such as lack of knowledge, lack of evidence demonstrating clinical utility, and patient healthcare burden. Conclusion: Patient and provider educational efforts, including foundational knowledge, clinical evidence, and applications to patient care beyond just immunosuppression, may be useful to facilitate the use of PGx testing in transplant medicine.
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Affiliation(s)
- Kimberly M Deininger
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Jacinda N Tran
- Division of Clinical Pharmacy, University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA 92093, USA
| | - Shirley M Tsunoda
- Division of Clinical Pharmacy, University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA 92093, USA
| | - Gordon K Young
- Division of Clinical Pharmacy, University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA 92093, USA
| | - Yee Ming Lee
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Heather D Anderson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Robert L Page II
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Jan D Hirsch
- Department of Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
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13
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Waldman L, Shuman C, Cohn I, Kaiser A, Chitayat D, Wasim S, Hazell A. Perplexed by PGx? Exploring the impact of pharmacogenomic results on medical management, disclosures and patient behavior. Pharmacogenomics 2019; 20:319-329. [DOI: 10.2217/pgs-2018-0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pharmacogenomic (PGx) tests represent significant advances in precision medicine. Our aim was to explore perceptions following the return of PGx results, medication management, and disclosure to providers. We surveyed clients who had PGx testing and conducted a chart review of PGx results. Respectively, 84% and 94% of participants found pre- and post-test genetic counseling helpful. There was a significant difference in disclosure, while 6% disclosed results to a pharmacist, 50% disclosed to a physician. Qualitative analysis identified three themes: 1) psychological response; 2) perceived utility; 3) experiences with disclosure. Our study supports the provision of genetic counseling for a non-disease related genetic test. Benefits of PGx testing can be optimized by the collaboration of physicians, pharmacists, genetic counselors and patients.
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Affiliation(s)
- Larissa Waldman
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Shuman
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Iris Cohn
- Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amy Kaiser
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Prenatal Diagnosis & Medical Genetics Program, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Syed Wasim
- Fred A Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allison Hazell
- Medcan Health Management, Inc., Toronto, Ontario, Canada
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14
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Assessment of provider-perceived barriers to clinical use of pharmacogenomics during participation in an institutional implementation study. Pharmacogenet Genomics 2019; 29:31-38. [DOI: 10.1097/fpc.0000000000000362] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Deininger KM, Page RL, Lee YM, Kauffman YS, Johnson SG, Oreschak K, Aquilante CL. Non-interventional cardiologists' perspectives on the role of pharmacogenomic testing in cardiovascular medicine. Per Med 2018; 16:123-132. [PMID: 30543145 DOI: 10.2217/pme-2018-0099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To evaluate factors influencing cardiologists' perspectives about pharmacogenomic (PGx) testing in clinical practice. PATIENTS & METHODS Semistructured interviews with practicing cardiologists were qualitatively analyzed to identify common themes. RESULTS Five themes were identified among 16 cardiologists from four specialties (n = 5 general cardiology, n = 3 electrophysiology, n = 2 adult congenital and n = 6 heart failure/transplant): cardiologists' knowledge and needs, perceived clinical validity and utility of PGx testing, dissemination and management of PGx results, patient-related considerations and incidental findings. CONCLUSION Lack of evidence was considered by many cardiologists to be a major barrier hindering the use of PGx testing. However, they would consider adopting PGx if they were provided additional education, ongoing support and evidence supporting the clinical utility of PGx testing in cardiovascular medicine.
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Affiliation(s)
- Kimberly M Deininger
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Robert L Page
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Yee Ming Lee
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Yardlee S Kauffman
- Department of Pharmacy Practice & Pharmacy Administration, University of the Sciences, Philadelphia, PA, USA
| | - Samuel G Johnson
- Board of Pharmacy Specialties, Washington DC, USA.,Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Kris Oreschak
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
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16
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Gallipani A, Cope R, Fischetti B, Abraham S, Ankireddypalli A. Prescriber Attitudes Toward Implementation of Pharmacogenomic Testing in a Family Medicine Residency Program. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2018; 2:22. [PMID: 32818194 DOI: 10.22454/primer.2018.493524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction Few qualitative studies have explored the attitude of prescribers towards the implementation of pharmacogenomic testing in the family medicine (FM) setting, and none among FM residents. The purpose of this study was to describe the level of engagement and interest in the implementation of pharmacogenomic education and testing in an FM clinic within a residency program. Methods A qualitative study utilizing semistructured interviews was conducted among prescribers within the FM clinic at The Brooklyn Hospital Center (TBHC). Voluntary prescribers included FM residents and attendings. No prescribers were excluded. Prior to the interview, informational sheets about pharmacogenomics were provided to standardize participant knowledge base. The research team created an interview guide of specific open-ended questions. Interviews were audio recorded and transcribed until a point of saturation was achieved. Transcripts of interviews served as data for analysis. Coding and analysis were performed to develop a hypothesis. No formal statistical analysis was required. Results Of the total 28 providers eligible for participation, 15 were recruited and interviewed (53% response rate). Based on analysis of interview data, four key conceptual concerns emerged regarding benefits and risks of testing, feasibility, accessibility, and modification of FM residency training curricula. Conclusion Positive attitudes and perceptions provide support for pharmacogenomic education and testing to be incorporated into FM residency curricula. Addressing practical barriers, such as curricular education and training, will allow for expansion of such initiatives in the future.
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Affiliation(s)
- Alyssa Gallipani
- Fairleigh Dickinson University School of Pharmacy and Health Sciences, Florham Park, NJ. RWJBarnabas Health-Corporate Pharmacy, Livingston, NJ
| | - Rebecca Cope
- Long Island University, Arnold and Marie Schwartz College of Pharmacy and Health Sciences
| | - Briann Fischetti
- Long Island University, Arnold and Marie Schwartz College of Pharmacy and Health Sciences
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17
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Vassilakopoulou P, Skorve E, Aanestad M. Enabling openness of valuable information resources: Curbing data subtractability and exclusion. INFORMATION SYSTEMS JOURNAL 2018. [DOI: 10.1111/isj.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Dunnenberger HM, Biszewski M, Bell GC, Sereika A, May H, Johnson SG, Hulick PJ, Khandekar J. Implementation of a multidisciplinary pharmacogenomics clinic in a community health system. Am J Health Syst Pharm 2018; 73:1956-1966. [PMID: 27864203 DOI: 10.2146/ajhp160072] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development and implementation of a multidisciplinary pharmacogenomics clinic within the framework of an established community-based medical genetics program are described. SUMMARY Pharmacogenomics is an important component of precision medicine that holds considerable promise for pharmacotherapy optimization. As part of the development of a health system-wide integrated pharmacogenomics program, in early 2015 Northshore University Health-System established a pharmacogenomics clinic run by a multidisciplinary team including a medical geneticist, a pharmacist, a nurse practitioner, and genetic counselors. The team identified five key program elements: (1) a billable-service provider, (2) a process for documentation of relevant medication and family histories, (3) personnel with the knowledge required to interpret pharmacogenomic results, (4) personnel to discuss risks, benefits, and limitations of pharmacogenomic testing, and (5) a mechanism for reporting results. The most important program component is expert interpretation of genetic test results to provide clinically useful information; pharmacists are well positioned to provide that expertise. At the Northshore University HealthSystem pharmacogenomics clinic, patient encounters typically entail two one-hour visits and follow a standardized workflow. At the first visit, pharmacogenomics-focused medication and family histories are obtained, risks and benefits of genetic testing are explained, and a test sample is collected; at the second visit, test results are provided along with evidence-based pharmacotherapy recommendations. CONCLUSION A multidisciplinary clinic providing genotyping and related services can facilitate the integration of pharmacogenomics into clinical care and meet the needs of early adopters of precision medicine.
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Affiliation(s)
- Henry M Dunnenberger
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL.
| | - Matthew Biszewski
- Thrombosis and Anticoagulation Unit, NorthShore University HealthSystem, Glenview, IL
| | | | - Annette Sereika
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL
| | - Holley May
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL
| | | | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL
| | - Janardan Khandekar
- Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL
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19
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Wu AC, Mazor KM, Ceccarelli R, Loomer S, Lu CY. Access to Guideline-Recommended Pharmacogenomic Tests for Cancer Treatments: Experience of Providers and Patients. J Pers Med 2017; 7:jpm7040017. [PMID: 29140263 PMCID: PMC5748629 DOI: 10.3390/jpm7040017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 01/20/2023] Open
Abstract
Genomic tests are the fastest growing sector in medicine and medical science, yet there remains a dearth of research on access to pharmacogenomic tests and medications. The objective of this study is to explore providers' and patients' experiences and views on test access as well as strategies used for gaining access. We interviewed clinicians who prescribed medications that should be guided by pharmacogenomic testing and patients who received those prescriptions. We organized the themes into the four dimensions suggested by the World Health Organization framework on access to medications and health technologies. Guideline-recommended pharmacogenomic tests for cancer care are generally available, although the timeliness of return of test results is sometimes suboptimal. Accessibility of pharmacogenomic tests is made challenging by the process of ordering pharmacogenomic tests, which is time-consuming. Affordability is a barrier to some patients as expressed by both providers and patients, who noted that the cost of pharmacogenomic tests and medications is high. Acceptability of the tests is high as both providers and patients view the tests positively. Understanding challenges to accessing pharmacogenomic tests will allow policymakers to develop policies that streamline access to genomics-based technologies to improve population health.
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Affiliation(s)
- Ann Chen Wu
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
| | - Kathleen M Mazor
- Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health; 630 Plantation Street, Worcester, MA 02215, USA.
| | - Rachel Ceccarelli
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
| | - Stephanie Loomer
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
| | - Christine Y Lu
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
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20
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Hertz DL, Luzum JA, Pasternak AL, Ward KM, Zhu HJ, Rae JM, Ellingrod VL. Institutional profile of pharmacogenetics within University of Michigan College of Pharmacy. Pharmacogenomics 2017; 18. [PMID: 28745551 DOI: 10.2217/pgs-2017-0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The University of Michigan College of Pharmacy has made substantial investment in the area of pharmacogenomics to further bolster its activity in pharmacogenomics research, implementation and education. Four tenure-track faculty members have active research programs that focus primarily on the discovery of functional polymorphisms (HJ Zhu), and genetic associations with treatment outcomes in patients with cancer (DL Hertz), cardiovascular disease (JA Luzum) and psychiatric conditions (VL Ellingrod). Recent investments from the University and the College have accelerated the implementation of pharmacogenetics broadly across the institution and in targeted therapeutic areas. Students within the PharmD and other health science professions receive substantial instruction in pharmacogenomics, in preparation for careers in biomedical health in which they can contribute to the generation, dissemination and utilization of pharmacogenomics knowledge to improve patient care.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-41065, USA
| | - Jasmine A Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-41065, USA
| | - Amy L Pasternak
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-41065, USA
| | - Kristen M Ward
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, MI 48109-41065, USA
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-41065, USA
| | - James M Rae
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-41065, USA
| | - Vicki L Ellingrod
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-41065, USA
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21
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Rohrer Vitek CR, Abul-Husn NS, Connolly JJ, Hartzler AL, Kitchner T, Peterson JF, Rasmussen LV, Smith ME, Stallings S, Williams MS, Wolf WA, Prows CA. Healthcare provider education to support integration of pharmacogenomics in practice: the eMERGE Network experience. Pharmacogenomics 2017; 18:1013-1025. [PMID: 28639489 PMCID: PMC5941709 DOI: 10.2217/pgs-2017-0038] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/07/2017] [Indexed: 12/30/2022] Open
Abstract
Ten organizations within the Electronic Medical Records and Genomics Network developed programs to implement pharmacogenomic sequencing and clinical decision support into clinical settings. Recognizing the importance of informed prescribers, a variety of strategies were used to incorporate provider education to support implementation. Education experiences with pharmacogenomics are described within the context of each organization's prior involvement, including the scope and scale of implementation specific to their Electronic Medical Records and Genomics projects. We describe common and distinct education strategies, provide exemplars and share challenges. Lessons learned inform future perspectives. Future pharmacogenomics clinical implementation initiatives need to include funding toward implementing provider education and evaluating outcomes.
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Affiliation(s)
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - John J Connolly
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, 98195, USA
| | - Terrie Kitchner
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, WI, 54449, USA
| | - Josh F Peterson
- Department of Biomedical Informatics & Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Luke V Rasmussen
- Department of Preventive Medicine, Division of Health & Biomedical Informatics, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Maureen E Smith
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Wendy A Wolf
- Department of Pediatrics, Harvard Medical School, Division of Genetics & Genomics, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Cynthia A Prows
- Departments of Pediatrics and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229-3039, USA
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22
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Hussain S, Kenigsberg BB, Danahey K, Lee YM, Galecki PM, Ratain MJ, O'Donnell PH. Disease-drug database for pharmacogenomic-based prescribing. Clin Pharmacol Ther 2016; 100:179-90. [PMID: 26940584 DOI: 10.1002/cpt.364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/04/2016] [Accepted: 02/28/2016] [Indexed: 01/04/2023]
Abstract
Providers have expressed a strong desire to have additional clinical decision-support tools to help with interpretation of pharmacogenomic results. We developed and tested a novel disease-drug association tool that enables pharmacogenomic-based prescribing to treat common diseases. First, 324 drugs were mapped to 484 distinct diseases (mean number of drugs treating each disease was 4.9; range 1-37). Then the disease-drug association tool was pharmacogenomically annotated, with an average of 1.8 pharmacogenomically annotated drugs associated/disease. Applying this tool to a prospectively enrolled >1,000 patient cohort from a tertiary medical center showed that 90% of the top ∼20 diseases in this population and ≥93% of patients could appropriately be treated with ≥1 medication with actionable pharmacogenomic information. When combined with clinical patient genotypes, this tool permits delivery of patient-specific pharmacogenomically informed disease treatment recommendations to inform the treatment of many medical conditions of the US population, a key initial step towards implementation of precision medicine.
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Affiliation(s)
- S Hussain
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
| | - B B Kenigsberg
- Internal Medicine Residency Program, University of Chicago Medical Center, Chicago, Illinois, USA
| | - K Danahey
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.,Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
| | - Y M Lee
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
| | - P M Galecki
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
| | - M J Ratain
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.,Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - P H O'Donnell
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.,Department of Medicine, University of Chicago, Chicago, Illinois, USA
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23
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Abstract
After decades of discovery, inherited variations have been identified in approximately 20 genes that affect about 80 medications and are actionable in the clinic. And some somatically acquired genetic variants direct the choice of 'targeted' anticancer drugs for individual patients. Current efforts that focus on the processes required to appropriately act on pharmacogenomic variability in the clinic are moving away from discovery and towards implementation of an evidenced-based strategy for improving the use of medications, thereby providing a cornerstone for precision medicine.
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24
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Dorfman EH, Brown Trinidad S, Morales CT, Howlett K, Burke W, Woodahl EL. Pharmacogenomics in diverse practice settings: implementation beyond major metropolitan areas. Pharmacogenomics 2015; 16:227-37. [PMID: 25712186 DOI: 10.2217/pgs.14.174] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM The limited formal study of the clinical feasibility of implementing pharmacogenomic tests has thus far focused on providers at large medical centers in urban areas. Our research focuses on small metropolitan, rural and tribal practice settings. MATERIALS & METHODS We interviewed 17 healthcare providers in western Montana regarding pharmacogenomic testing. RESULTS Participants were optimistic about the potential of pharmacogenomic tests, but noted unique barriers in small and rural settings including cost, adherence, patient acceptability and testing timeframe. Participants in tribal settings identified heightened sensitivity to genetics and need for community leadership approval as additional considerations. CONCLUSION Implementation differences in small metropolitan, rural and tribal communities may affect pharmacogenomic test adoption and utilization, potentially impacting many patients. Original submitted 3 September 2014; Revision submitted 3 December 2014.
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Affiliation(s)
- Elizabeth H Dorfman
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA
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25
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Christensen KD, Vassy JL, Jamal L, Lehmann LS, Slashinski MJ, Perry DL, Robinson JO, Blumenthal-Barby J, Feuerman LZ, Murray MF, Green RC, McGuire AL. Are physicians prepared for whole genome sequencing? a qualitative analysis. Clin Genet 2015; 89:228-34. [PMID: 26080898 DOI: 10.1111/cge.12626] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 12/19/2022]
Abstract
Although the integration of whole genome sequencing (WGS) into standard medical practice is rapidly becoming feasible, physicians may be unprepared to use it. Primary care physicians (PCPs) and cardiologists enrolled in a randomized clinical trial of WGS received genomics education before completing semi-structured interviews. Themes about preparedness were identified in transcripts through team-based consensus-coding. Data from 11 PCPs and 9 cardiologists suggested that physicians enrolled in the trial primarily to prepare themselves for widespread use of WGS in the future. PCPs were concerned about their general genomic knowledge, while cardiologists were concerned about how to interpret specific types of results and secondary findings. Both cohorts anticipated preparing extensively before disclosing results to patients by using educational resources with which they were already familiar, and both cohorts anticipated making referrals to genetics specialists as needed. A lack of laboratory guidance, time pressures, and a lack of standards contributed to feeling unprepared. Physicians had specialty-specific concerns about their preparedness to use WGS. Findings identify specific policy changes that could help physicians feel more prepared, and highlight how providers of all types will need to become familiar with interpreting WGS results.
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Affiliation(s)
- K D Christensen
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - J L Vassy
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - L Jamal
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - L S Lehmann
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M J Slashinski
- School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - D L Perry
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - J O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - J Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - L Z Feuerman
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - M F Murray
- Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - R C Green
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Partners Personalized Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - A L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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26
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Trinidad SB, Coffin TB, Fullerton SM, Ralston J, Jarvik GP, Larson EB. "Getting off the Bus Closer to Your Destination": Patients' Views about Pharmacogenetic Testing. Perm J 2015; 19:21-7. [PMID: 26057686 DOI: 10.7812/tpp/15-046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors conducted focus groups with patients prescribed antidepressants (pilot session plus 2 focus groups, n = 27); patients prescribed carbamazepine (2 focus groups, n = 17); and healthy patients (2 focus groups, n = 17). Although participants understood the potential advantages of pharmacogenetic testing, many felt that the risks (discrimination, stigmatization, physician overreliance on genomic results, and denial of certain medications) may outweigh the benefits. These concerns were shared across groups but were more strongly expressed among participants with chronic mental health diagnoses.
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Affiliation(s)
- Susan Brown Trinidad
- Research Scientist in Bioethics and Humanities at the University of Washington in Seattle.
| | - Tara B Coffin
- Doctoral Candidate in the Institute for Public Health Genetics at the University of Washington in Seattle.
| | - Stephanie M Fullerton
- Associate Professor in Bioethics and Humanities at the University of Washington in Seattle.
| | - James Ralston
- Associate Investigator at the Group Health Research Institute in Seattle, WA.
| | - Gail P Jarvik
- Professor and Head of the Division of Medical Genetics at the University of Washington in Seattle.
| | - Eric B Larson
- Executive Director and Senior Investigator at the Group Health Research Institute in Seattle, WA.
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27
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Formea CM, Nicholson WT, Vitek CR. An inter-professional approach to personalized medicine education: one institution's experience. Per Med 2015; 12:129-138. [PMID: 28413426 PMCID: PMC5391796 DOI: 10.2217/pme.14.63] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Personalized medicine offers the promise of better diagnoses, targeted therapies and individualized treatment plans. Pharmacogenomics is an integral component of personalized medicine; it aids in the prediction of an individual's response to medications. Despite growing public acceptance and emerging clinical evidence, this rapidly expanding field of medicine is slow to be adopted and utilized by healthcare providers, although many believe that they should be knowledgeable and able to apply pharmacogenomics in clinical practice. Institutional infrastructure must be built to support pharmacogenomic implementation. Multidisciplinary education for healthcare providers is a critical component for pharmacogenomics to achieve its full potential to optimize patient care. We describe our recent experience at the Mayo Clinic implementing pharmacogenomics education in a large, academic healthcare system facilitated by the Mayo Clinic Center for Individualized Medicine.
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Affiliation(s)
- Christine M Formea
- Hospital Pharmacy Services, Mary Brigh Building G-722, Mayo Clinic Hospital-St Marys Campus, 200 First Street SW, Rochester, MN 55905, USA
| | - Wayne T Nicholson
- Department of Anesthesiology, Mayo Clinic Hospital-St Marys Campus, 200 First Street, Rochester, MN 55905, USA
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28
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Filiptsova O, Kobets M, Kobets Y. Some aspects of genetics and pharmacogenetics understanding by pharmacy students in Ukraine. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2015. [DOI: 10.1016/j.ejmhg.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Pisanu C, Tsermpini EE, Mavroidi E, Katsila T, Patrinos GP, Squassina A. Assessment of the Pharmacogenomics Educational Environment in Southeast Europe. Public Health Genomics 2014; 17:272-9. [DOI: 10.1159/000366461] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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30
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Hall MJ. Conflicted Confidence: Academic Oncologists' Views on Multiplex Pharmacogenomic Testing. J Clin Oncol 2014; 32:1290-2. [DOI: 10.1200/jco.2013.54.8016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Kampourakis K, Vayena E, Mitropoulou C, van Schaik RH, Cooper DN, Borg J, Patrinos GP. Key challenges for next-generation pharmacogenomics: Science & Society series on Science and Drugs. EMBO Rep 2014; 15:472-6. [PMID: 24723683 DOI: 10.1002/embr.201438641] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kostas Kampourakis
- University Teacher Training Institute and Section of Biology, University of Geneva, Geneva, Switzerland
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32
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Sturm AC, Sweet K, Manickam K. Implementation of a clinical research pharmacogenomics program at an academic medical center: role of the genetics healthcare professional. Pharmacogenomics 2014; 14:703-6. [PMID: 23651015 DOI: 10.2217/pgs.13.46] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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33
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Patel HN, Ursan ID, Zueger PM, Cavallari LH, Pickard AS. Stakeholder Views on Pharmacogenomic Testing. Pharmacotherapy 2013; 34:151-65. [DOI: 10.1002/phar.1364] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Haridarshan N. Patel
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Iulia D. Ursan
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Patrick M. Zueger
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Larisa H. Cavallari
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - A. Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
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34
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Abstract
Genomic technologies are reaching the point of being able to detect genetic variation in patients at high accuracy and reduced cost, offering the promise of fundamentally altering medicine. Still, although scientists and policy advisers grapple with how to interpret and how to handle the onslaught and ambiguity of genome-wide data, established and well-validated molecular technologies continue to have an important role, especially in regions of the world that have more limited access to next-generation sequencing capabilities. Here we review the range of methods currently available in a clinical setting as well as emerging approaches in clinical molecular diagnostics. In parallel, we outline implementation challenges that will be necessary to address to ensure the future of genetic medicine.
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35
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Mills R, Haga SB. Clinical delivery of pharmacogenetic testing services: a proposed partnership between genetic counselors and pharmacists. Pharmacogenomics 2013; 14:957-68. [PMID: 23746189 PMCID: PMC3731754 DOI: 10.2217/pgs.13.76] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services.
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Affiliation(s)
- Rachel Mills
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708
| | - Susanne B. Haga
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708
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36
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Haga SB, Burke W, Agans R. Primary-care physicians' access to genetic specialists: an impediment to the routine use of genomic medicine? Genet Med 2013; 15:513-4. [PMID: 23306802 DOI: 10.1038/gim.2012.168] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/15/2012] [Indexed: 11/09/2022] Open
Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy, Duke University, Durham, North Carolina, USA.
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37
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Newman WG, Murphy BF, Callard A, Payne K. A role for genetic counsellors and clinical geneticists in pharmacogenetics? Clin Genet 2012; 82:201-2; author reply 203. [DOI: 10.1111/j.1399-0004.2012.01872.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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38
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