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Dunlop KLA, Singh N, Robbins HA, Zahed H, Johansson M, Rankin NM, Cust AE. Implementation considerations for risk-tailored cancer screening in the population: A scoping review. Prev Med 2024; 181:107897. [PMID: 38378124 PMCID: PMC11106520 DOI: 10.1016/j.ypmed.2024.107897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Risk-tailored screening has emerged as a promising approach to optimise the balance of benefits and harms of existing population cancer screening programs. It tailors screening (e.g., eligibility, frequency, interval, test type) to individual risk rather than the current one-size-fits-all approach of most organised population screening programs. However, the implementation of risk-tailored cancer screening in the population is challenging as it requires a change of practice at multiple levels i.e., individual, provider, health system levels. This scoping review aims to synthesise current implementation considerations for risk-tailored cancer screening in the population, identifying barriers, facilitators, and associated implementation outcomes. METHODS Relevant studies were identified via database searches up to February 2023. Results were synthesised using Tierney et al. (2020) guidance for evidence synthesis of implementation outcomes and a multilevel framework. RESULTS Of 4138 titles identified, 74 studies met the inclusion criteria. Most studies in this review focused on the implementation outcomes of acceptability, feasibility, and appropriateness, reflecting the pre-implementation stage of most research to date. Only six studies included an implementation framework. The review identified consistent evidence that risk-tailored screening is largely acceptable across population groups, however reluctance to accept a reduction in screening frequency for low-risk informed by cultural norms, presents a major barrier. Limited studies were identified for cancer types other than breast cancer. CONCLUSIONS Implementation strategies will need to address alternate models of delivery, education of health professionals, communication with the public, screening options for people at low risk of cancer, and inequity in outcomes across cancer types.
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Affiliation(s)
- Kate L A Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - Nehal Singh
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Hilary A Robbins
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Ambagtsheer RC, Hurley CJ, Lawless M, Braunack-Mayer A, Visvanathan R, Beilby J, Stewart S, Cornell V, Leach MJ, Taylor D, Thompson M, Dent E, Whiteway L, Archibald M, O'Rourke HM, Williams K, Chudecka A. IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol. BMJ Open 2024; 14:e075501. [PMID: 38216190 PMCID: PMC10806720 DOI: 10.1136/bmjopen-2023-075501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Rapid population ageing is a demographic trend being experienced and documented worldwide. While increased health screening and assessment may help mitigate the burden of illness in older people, issues such as misdiagnosis may affect access to interventions. This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens' Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and practice. Conditions were chosen to reflect common health conditions characterised by increasing prevalence with age, but which have been underexamined through a Citizens' Jury methodology. METHODS AND ANALYSIS This study will be conducted in three Phases-(1) Citizens' Juries, (2) Policy Roundtables and (3) Production of Knowledge Translation resources. First, older people aged 50+ (n=80), including those from traditionally hard-to-reach and diverse groups, will be purposively recruited to four Citizen Juries. Second, representatives from a range of key stakeholder groups, including consumers and carers, health and aged care policymakers, general practitioners, practice nurses, geriatricians, allied health practitioners, pharmaceutical companies, private health insurers and community and aged care providers (n=40) will be purposively recruited for two Policy Roundtables. Finally, two researchers and six purposively recruited consumers will co-design Knowledge Translation resources. Thematic analysis will be performed on documentation and transcripts. ETHICS AND DISSEMINATION Ethical approval has been obtained through the Torrens University Human Research Ethics Committee. Participants will give written informed consent. Findings will be disseminated through development of a policy brief and lay summary, peer-reviewed publications, conference presentations and seminars.
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Affiliation(s)
- Rachel C Ambagtsheer
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Catherine J Hurley
- Health Vertical, Torrens University Australia, Adelaide, South Australia, Australia
| | - Michael Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Annette Braunack-Mayer
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), University of Wollongong, Wollongong, New South Wales, Australia
| | - Renuka Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Justin Beilby
- Health Vertical, Torrens University Australia, Adelaide, South Australia, Australia
| | - Simon Stewart
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Victoria Cornell
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew J Leach
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Danielle Taylor
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Thompson
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Woodville, South Australia, Australia
| | - Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Lyn Whiteway
- Lynda Whiteway, Consumer co-researcher, Kensington Gardens, South Australia, Australia
| | - Mandy Archibald
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathy Williams
- Office for Ageing Well, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Agnieszka Chudecka
- Multicultural Aged Care SA Inc, Torrensville, South Australia, Australia
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Abstract
ELSI (Ethical, Legal, and Social Issues) is a widely used acronym in the bioethics literature that encompasses a broad range of research examining the various impacts of science and technology on society. In Canada, GE3LS (Genetics, Ethical, Economic, Environmental, Legal, Social issues) is the term used to describe ELSI studies in the context of genetics and genomics research. It is intentionally more expansive in that GE3LS explicitly brings economic and environmental issues under its purview. ELSI/GE3LS research is increasingly relevant in recent years as there has been a greater emphasis on "translational research" that moves genomic discoveries from the bench to the clinic. The purpose of this chapter is to outline a range of ELSI-related work that might be conducted as part of a large scale genetics or genomics research project, and to provide some practical insights on how a scientific research team might incorporate a strong and effective ELSI program within its broader research mandate. We begin by describing the historical context of ELSI research and the development of GE3LS research in the Canadian context. We then illustrate how some ELSI research might unfold by outlining a variety of GE3LS research questions or content domains and the methodologies that might be employed in studying them. We conclude with some practical suggestions about how to build an effective ELSI/GE3LS team and focus within a broader scientific research program.
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4
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Calabrò GE, Sassano M, Tognetto A, Boccia S. Citizens' Attitudes, Knowledge, and Educational Needs in the Field of Omics Sciences: A Systematic Literature Review. Front Genet 2020; 11:570649. [PMID: 33193671 PMCID: PMC7644959 DOI: 10.3389/fgene.2020.570649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/22/2020] [Indexed: 01/07/2023] Open
Abstract
Background: The huge development of omics sciences is changing the classical medical approach and making new technologies available. In this context, education of citizens is essential to allow appropriate decisions about their own health. Hence, we aimed to summarize existing literature regarding citizens' knowledge, attitudes, and educational needs on omics sciences. Methods: We performed a systematic literature review (SLR) using Pubmed, ISI Web of Science, and Embase databases. The eligibility criteria for inclusion in this review required that the studies investigated knowledge, attitudes, or educational needs regarding omics sciences among the general population. Results: We included 54 studies, published between 2006 and 2020. Most of the included studies (72%) investigated citizens' knowledge, half of them (56%) attitudes, and 20% educational needs in the field of omics sciences, while 52% investigated attitudes and perceptions about genetic and/or omics tests. Most studies (64%) reported a limited knowledge level among citizens, even though most (59%) reported participants understood the benefits of the use of omics sciences into medicine. As for omics tests, a controversial opinion toward their use into practice was reported among citizens. Most of the studies (82%) investigating citizens' educational needs highlighted a clear gap to be filled. Conclusions: Our SLR summarizes current knowledge on citizens' literacy, attitudes, and educational needs on omics science, underlining the need for strengthening public engagement on this topic. Further research is needed, however, to identify appropriate methods and models to achieve such an improvement.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessia Tognetto
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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5
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Smit AK, Reyes-Marcelino G, Keogh L, Dunlop K, Newson AJ, Cust AE. Implementation considerations for offering personal genomic risk information to the public: a qualitative study. BMC Public Health 2020; 20:1028. [PMID: 32600382 PMCID: PMC7325160 DOI: 10.1186/s12889-020-09143-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background Genomic risk information, based on common genomic susceptibility variants associated with risk of complex diseases such as cancer, may be incorporated into personalised prevention and screening strategies. We aimed to engage with members of the public, who are important stakeholders in this process, to further inform program development and other implementation outcomes such as acceptability and appropriateness. Methods Semi-structured interviews were undertaken with 30 participants (aged 24–69 years, 50% female) recruited from a pilot trial in which they received personalised genomic risk information for melanoma. We explored participants’ views and attitudes towards offering general personal genomic risk information to the broader population. The data were analysed thematically. Results Two overarching themes relevant to implementation considerations were identified. Firstly, participants’ preferences for accepting an offer of genomic risk information were based on family history, disease incidence and the possibility of prevention. Secondly, participants felt that the processes for offering risk information should be based on individual preferences, triaged according to risk and be supported by a health professional trained in genomics. Conclusions Participants felt that offering personal genomic risk information to the general population to inform prevention and early detection recommendations is acceptable, particularly for common, complex conditions such as cancer. Understanding participants’ preferences for receiving genomic risk information will assist with communication strategies and health workforce planning. We anticipate that these findings will contribute to the development of implementation strategies for incorporating genomic risk information into routine clinical practice.
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Affiliation(s)
- Amelia K Smit
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia. .,Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, Australia. .,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
| | - Gillian Reyes-Marcelino
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Kate Dunlop
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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6
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Cenin DR, Naber SK, de Weerdt AC, Jenkins MA, Preen DB, Ee HC, O'Leary PC, Lansdorp-Vogelaar I. Cost-Effectiveness of Personalized Screening for Colorectal Cancer Based on Polygenic Risk and Family History. Cancer Epidemiol Biomarkers Prev 2019; 29:10-21. [PMID: 31748260 DOI: 10.1158/1055-9965.epi-18-1123] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/20/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is growing evidence for personalizing colorectal cancer screening based on risk factors. We compared the cost-effectiveness of personalized colorectal cancer screening based on polygenic risk and family history to uniform screening. METHODS Using the MISCAN-Colon model, we simulated a cohort of 100 million 40-year-olds, offering them uniform or personalized screening. Individuals were categorized based on polygenic risk and family history of colorectal cancer. We varied screening strategies by start age, interval and test and estimated costs, and quality-adjusted life years (QALY). In our analysis, we (i) assessed the cost-effectiveness of uniform screening; (ii) developed personalized screening scenarios based on optimal screening strategies by risk group; and (iii) compared the cost-effectiveness of both. RESULTS At a willingness-to-pay threshold of $50,000/QALY, the optimal uniform screening scenario was annual fecal immunochemical testing (FIT) from ages 50 to 74 years, whereas for personalized screening the optimal screening scenario consisted of annual and biennial FIT screening except for those at highest risk who were offered 5-yearly colonoscopy from age 50 years. Although these scenarios gained the same number of QALYs (17,887), personalized screening was not cost-effective, costing an additional $428,953 due to costs associated with determining risk (assumed to be $240 per person). Personalized screening was cost-effective when these costs were less than ∼$48. CONCLUSIONS Uniform colorectal cancer screening currently appears more cost-effective than personalized screening based on polygenic risk and family history. However, cost-effectiveness is highly dependent on the cost of determining risk. IMPACT Personalized screening could become increasingly viable as costs for determining risk decrease.
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Affiliation(s)
- Dayna R Cenin
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands. .,Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Steffie K Naber
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Anne C de Weerdt
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Hooi C Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Peter C O'Leary
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Clinical Biochemistry, PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - Iris Lansdorp-Vogelaar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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7
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Almomani BA, Al-Keilani MS, Al-Sawalha NA. Knowledge and views about genetics: a public-based cross-sectional study. Eur J Hum Genet 2019; 28:417-423. [PMID: 31659251 DOI: 10.1038/s41431-019-0532-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/26/2019] [Accepted: 10/13/2019] [Indexed: 11/09/2022] Open
Abstract
This study aimed to explore the knowledge, factors affecting knowledge, and views of the Jordanian population on genetics-related issues. A cross-sectional questionnaire study was conducted in Jordan. The questionnaire was administered by face-to-face interview to the participants who were recruited from different public places. In total, 5000 questionnaires were collected from public population in Jordan and 43.4% (2171/5000) of them were knowledgeable. The public's knowledge was found to be associated with female gender (OR = 1.493, 95% CI = 1.280-1.741, p < 0.001), bachelor degree (OR = 1.853, 95% CI = 1.592-2.157, p < 0.001), having children (OR = 1.433, 95% CI = 1.162-1.768, p = 0.001), and having first-degree relatives with comorbid conditions (OR = 1.669, 95% CI = 1.431-1.946, p < 0.001). Although public in Jordan had positive genetic attitudes, they raised several concerns about the applications of genetics in clinical practice. Genetic knowledge was significantly associated with all positive public attitudes and most of their concerns (p < 0.001). These findings suggested that female gender, educational level, having children, and having first-degree relatives with comorbid conditions were good predictors for public's knowledge about genetics-related issues. Public education about the value of participation in genetic research as well as educational and training programs for healthcare professionals are recommended to assist in establishing genetics-related services in Jordan.
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Affiliation(s)
- Basima A Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Maha S Al-Keilani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour A Al-Sawalha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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8
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Bowman FL, Molster CM, Lister KJ, Bauskis AT, Garton-Smith J, Vickery AW, Watts GF, Martin AC. Identifying Perceptions and Preferences of the General Public Concerning Universal Screening of Children for Familial Hypercholesterolaemia. Public Health Genomics 2019; 22:25-35. [PMID: 31330524 DOI: 10.1159/000501463] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Familial hypercholesterolaemia (FH) is a common genetic disorder that, if untreated, predisposes individuals to premature coronary heart disease. As most individuals with FH remain undiagnosed, new approaches to detection are needed and should be considered a priority in public health genomics. Universal screening of children for FH has been proposed, and this study explores public perspectives on the acceptability of this approach. METHODS A one-day deliberative public forum was held in Perth, WA, Australia. Thirty randomly selected individuals were recruited, with self-reported sociodemographic characteristics used to obtain discursive representation. Participants were presented with information from a variety of perspectives and asked to discuss the information provided to identify points of consensus and disagreement. The data collected were analysed using thematic analysis. RESULTS Of the 17 participants at the forum, 16 deemed universal screening of children for FH to be acceptable. Fifteen of these 16 believed this was best performed at the time of an immunisation. Participants proposed a number of conditions that should be met to reduce the likelihood of unintended harm resulting from the screening process. DISCUSSION/CONCLUSION The outcomes of the forum suggest that establishing a universal screening programme for FH in childhood is acceptable to the general public in WA.
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Affiliation(s)
- Faye L Bowman
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, Washington, Australia,
| | - Caron M Molster
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, Washington, Australia
| | - Karla J Lister
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, Washington, Australia
| | - Alicia T Bauskis
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, Washington, Australia
| | - Jacquie Garton-Smith
- Health Networks, Clinical Excellence Division, Western Australian Department of Health, East Perth, Washington, Australia
| | - Alistair W Vickery
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Washington, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Washington, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Washington, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Washington, Australia.,School of Paediatrics and Child Health, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Washington, Australia
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9
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Cenin DR, Naber SK, Lansdorp‐Vogelaar I, Jenkins MA, Buchanan DD, Preen DB, Ee HC, O'Leary P. Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population. J Gastroenterol Hepatol 2018; 33:1737-1744. [PMID: 29645364 PMCID: PMC6403824 DOI: 10.1111/jgh.14154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/22/2018] [Accepted: 03/24/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Individuals with Lynch syndrome (LS) are at increased risk of LS-related cancers including colorectal cancer (CRC). CRC tumor screening for mismatch repair (MMR) deficiency is recommended in Australia to identify LS, although its cost-effectiveness has not been assessed. We aim to determine the cost-effectiveness of screening individuals with CRC for LS at different age-at-diagnosis thresholds. METHODS We developed a decision analysis model to estimate yield and costs of LS screening. Age-specific probabilities of LS diagnosis were based on Australian data. Two CRC tumor screening pathways were assessed (MMR immunohistochemistry followed by MLH1 methylation (MLH1-Pathway) or BRAF V600E testing (BRAF-Pathway) if MLH1 expression was lost) for four age-at-diagnosis thresholds-screening < 50, screening < 60, screening < 70, and universal screening. RESULTS Per 1000 CRC cases, screening < 50 identified 5.2 LS cases and cost $A7041 per case detected in the MLH1-Pathway. Screening < 60 increased detection by 1.5 cases for an incremental cost of $A25 177 per additional case detected. Screening < 70 detected 1.6 additional cases at an incremental cost of $A40 278 per additional case detected. Compared with screening < 70, universal screening detected no additional LS cases but cost $A158 724 extra. The BRAF-Pathway identified the same number of LS cases for higher costs. CONCLUSIONS The MLH1-Pathway is more cost-effective than BRAF-Pathway for all age-at-diagnosis thresholds. MMR immunohistochemistry tumor screening in individuals diagnosed with CRC aged < 70 years resulted in higher LS case detection at a reasonable cost. Further research into the yield of LS screening in CRC patients ≥ 70 years is needed to determine if universal screening is justified.
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Affiliation(s)
- Dayna R Cenin
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands,Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia,Centre for Health Services Research, School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Steffie K Naber
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | | | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Daniel D Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia,Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of PathologyUniversity of MelbourneParkvilleVictoriaAustralia,Genetic Medicine and Familial Cancer CentreThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Victorian Comprehensive Cancer CentreUniversity of Melbourne Centre for Cancer ResearchParkvilleVictoriaAustralia
| | - David B Preen
- Centre for Health Services Research, School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Hooi C Ee
- Department of GastroenterologySir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Peter O'Leary
- Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia,School of Women's and Infants' HealthThe University of Western AustraliaPerthWestern AustraliaAustralia,PathWest Laboratory MedicineQE2 Medical CentreNedlandsWestern AustraliaAustralia
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10
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Balicza P, Terebessy A, Grosz Z, Varga NA, Gal A, Fekete BA, Molnar MJ. Implementation of personalized medicine in Central-Eastern Europe: pitfalls and potentials based on citizen's attitude. EPMA J 2018. [PMID: 29515690 DOI: 10.1007/s13167-017-0125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Next-generation sequencing is increasingly utilized worldwide as a research and diagnostic tool and is anticipated to be implemented into everyday clinical practice. Since Central-Eastern European attitude toward genetic testing, especially broad genetic testing, is not well known, we performed a survey on this issue among Hungarian participants. Methods A self-administered questionnaire was distributed among patients and patient relatives at our neurogenetic outpatient clinic. Members of the general population were also recruited via public media. We used chi-square testing and binary logistic regression to examine factors influencing attitude. Results We identified a mixed attitude toward genetic testing. Access to physician consultation positively influenced attitude. A higher self-determined genetic familiarity score associated with higher perceived genetic influence score, which in turn associated with greater willingness to participate in genetic testing. Medical professionals constituted a skeptical group. Conclusions We think that given the controversies and complexities of the next-generation sequencing field, the optimal clinical translation of NGS data should be performed in institutions which have the unique capability to provide interprofessional health education, transformative biomedical research, and crucial patient care. With optimization of the clinical translational process, improvement of genetic literacy may increase patient engagement and empowerment. Relevance of the article for predictive preventive and personalized medicine The paper highlights that in countries with relatively low-genetic literacy, a special strategy is needed to enhance the implementation of personalized medicine.
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Affiliation(s)
- Peter Balicza
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Andras Terebessy
- 2Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Grosz
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Noemi Agnes Varga
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Aniko Gal
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Balint Andras Fekete
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
| | - Maria Judit Molnar
- 1Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tomo Street 25-29, Budapest, 1083 Hungary
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Yang L, Chen J, Shen B. Newborn Screening in the Era of Precision Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1005:47-61. [DOI: 10.1007/978-981-10-5717-5_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Nicholls SG, Etchegary H, Carroll JC, Castle D, Lemyre L, Potter BK, Craigie S, Wilson BJ. Attitudes to incorporating genomic risk assessments into population screening programs: the importance of purpose, context and deliberation. BMC Med Genomics 2016; 9:25. [PMID: 27215612 PMCID: PMC4878078 DOI: 10.1186/s12920-016-0186-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/12/2016] [Indexed: 12/31/2022] Open
Abstract
Background The use of an overall risk assessment based on genomic information is consistent with precision medicine. Despite the enthusiasm, there is a need for public engagement on the appropriate use of such emerging technologies in order to frame meaningful evaluations of utility, including the practical implementation and acceptability issues that might emerge. Doing so requires the involvement of the end users of these services, including patients, and sections of the public who are the target group for population based screening. In the present study we sought to explore public attitudes to the potential integration of personal genomic profiling within existing population screening programs; and to explore the evolution of these attitudes as part of a deliberative process. Methods We conducted a mixed methods study presented in the format of a deliberative workshop. Participants were drawn from communities in Ottawa, Ontario (ON) and St John’s, Newfoundland and Labrador (NL), Canada. Individuals were approached to take part in a workshop on the incorporation of genomic risk profiling for either colorectal cancer screening (CRC), or newborn screening for type 1 diabetes mellitus (T1DM). Results A total of N = 148 (N = 65 ON, N = 83 NL) participants provided data for analysis. Participants in both groups were supportive of public funding for genomic risk profiling, although participants in the T1DM groups expressed more guarded positive attitudes than participants in the CRC groups. These views were stable throughout the workshop (CRC, p = 0.15, T1DM, p =0.39). Participants were less positive about individual testing, with a significant decrease in support over the course of the workshop (CRC p = 0.02, T1DM, p = 0.003). Common concerns related to access to test results by third parties. Conclusions The findings of this study suggest that members of the target populations for potential genomic profiling tests (designed for screening or risk prediction purposes) can engage in meaningful deliberation about their general acceptability and personal utility. Evaluations of whether a test would be personally useful may depend on the experience of the participants in personal health decision making, the purpose of the test, and the availability of interventions to reduce disease risk. Electronic supplementary material The online version of this article (doi:10.1186/s12920-016-0186-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stuart G Nicholls
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University, St John's, NL, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada.,Sydney G. Frankfort Chair in Family Medicine, Toronto, ON, Canada
| | - David Castle
- Vice-President Research, University of Victoria, Victoria, BC, Canada
| | - Louise Lemyre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Samantha Craigie
- Michael G DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada.
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Christensen KD, Dukhovny D, Siebert U, Green RC. Assessing the Costs and Cost-Effectiveness of Genomic Sequencing. J Pers Med 2015; 5:470-86. [PMID: 26690481 PMCID: PMC4695866 DOI: 10.3390/jpm5040470] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022] Open
Abstract
Despite dramatic drops in DNA sequencing costs, concerns are great that the integration of genomic sequencing into clinical settings will drastically increase health care expenditures. This commentary presents an overview of what is known about the costs and cost-effectiveness of genomic sequencing. We discuss the cost of germline genomic sequencing, addressing factors that have facilitated the decrease in sequencing costs to date and anticipating the factors that will drive sequencing costs in the future. We then address the cost-effectiveness of diagnostic and pharmacogenomic applications of genomic sequencing, with an emphasis on the implications for secondary findings disclosure and the integration of genomic sequencing into general patient care. Throughout, we ground the discussion by describing efforts in the MedSeq Project, an ongoing randomized controlled clinical trial, to understand the costs and cost-effectiveness of integrating whole genome sequencing into cardiology and primary care settings.
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Affiliation(s)
- Kurt D Christensen
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA.
| | - Uwe Siebert
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol 6060, Austria.
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Robert C Green
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Partners Personalized Medicine, Boston, MA 02115, USA.
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Weber KS, Jensen JL, Johnson SM. Anticipation of Personal Genomics Data Enhances Interest and Learning Environment in Genomics and Molecular Biology Undergraduate Courses. PLoS One 2015; 10:e0133486. [PMID: 26241308 PMCID: PMC4524698 DOI: 10.1371/journal.pone.0133486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 11/18/2022] Open
Abstract
An important discussion at colleges is centered on determining more effective models for teaching undergraduates. As personalized genomics has become more common, we hypothesized it could be a valuable tool to make science education more hands on, personal, and engaging for college undergraduates. We hypothesized that providing students with personal genome testing kits would enhance the learning experience of students in two undergraduate courses at Brigham Young University: Advanced Molecular Biology and Genomics. These courses have an emphasis on personal genomics the last two weeks of the semester. Students taking these courses were given the option to receive personal genomics kits in 2014, whereas in 2015 they were not. Students sent their personal genomics samples in on their own and received the data after the course ended. We surveyed students in these courses before and after the two-week emphasis on personal genomics to collect data on whether anticipation of obtaining their own personal genomic data impacted undergraduate student learning. We also tested to see if specific personal genomic assignments improved the learning experience by analyzing the data from the undergraduate students who completed both the pre- and post-course surveys. Anticipation of personal genomic data significantly enhanced student interest and the learning environment based on the time students spent researching personal genomic material and their self-reported attitudes compared to those who did not anticipate getting their own data. Personal genomics homework assignments significantly enhanced the undergraduate student interest and learning based on the same criteria and a personal genomics quiz. We found that for the undergraduate students in both molecular biology and genomics courses, incorporation of personal genomic testing can be an effective educational tool in undergraduate science education.
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Affiliation(s)
- K. Scott Weber
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Jamie L. Jensen
- Department of Biology, Brigham Young University, Provo, Utah, United States of America
| | - Steven M. Johnson
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
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Regier DA, Peacock SJ, Pataky R, van der Hoek K, Jarvik GP, Hoch J, Veenstra D. Societal preferences for the return of incidental findings from clinical genomic sequencing: a discrete-choice experiment. CMAJ 2015; 187:E190-E197. [PMID: 25754703 DOI: 10.1503/cmaj.140697] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/15/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND An important challenge with the application of next-generation sequencing technology is the possibility of uncovering incidental genomic findings. A paucity of evidence on personal utility for incidental findings has hindered clinical guidelines. Our objective was to estimate personal utility for complex information derived from incidental genomic findings. METHODS We used a discrete-choice experiment to evaluate participants' personal utility for the following attributes: disease penetrance, disease treatability, disease severity, carrier status and cost. Study participants were drawn from the Canadian public. We analyzed the data with a mixed logit model. RESULTS In total, 1200 participants completed our questionnaire (available in English and French). Participants valued receiving information about high-penetrance disorders but expressed disutility for receiving information on low-penetrance disorders. The average willingness to pay was $445 (95% confidence interval [CI] $322-$567) to receive incidental findings in a scenario where clinicians returned information about high-penetrance, medically treatable disorders, but only 66% of participants (95% CI 63%-71%) indicated that they would choose to receive information in that scenario. On average, participants placed an important value ($725, 95% CI $600-$850) on having a choice about what type of findings they would receive, including receipt of information about high-penetrance, treatable disorders or receipt of information about high-penetrance disorders with or without available treatment. The predicted uptake of that scenario was 76% (95% CI 72%-79%). INTERPRETATION Most participants valued receiving incidental findings, but personal utility depended on the type of finding, and not all participants wanted to receive incidental results, regardless of the potential health implications. These results indicate that to maximize benefit, participant-level preferences should inform the decision about whether to return incidental findings.
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Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont.
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Reka Pataky
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Kimberly van der Hoek
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Gail P Jarvik
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Jeffrey Hoch
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - David Veenstra
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
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Wilson BJ, Nicholls SG. The Human Genome Project, and recent advances in personalized genomics. Risk Manag Healthc Policy 2015; 8:9-20. [PMID: 25733939 PMCID: PMC4337712 DOI: 10.2147/rmhp.s58728] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The language of “personalized medicine” and “personal genomics” has now entered the common lexicon. The idea of personalized medicine is the integration of genomic risk assessment alongside other clinical investigations. Consistent with this approach, testing is delivered by health care professionals who are not medical geneticists, and where results represent risks, as opposed to clinical diagnosis of disease, to be interpreted alongside the entirety of a patient’s health and medical data. In this review we consider the evidence concerning the application of such personalized genomics within the context of population screening, and potential implications that arise from this. We highlight two general approaches which illustrate potential uses of genomic information in screening. The first is a narrowly targeted approach in which genetic profiling is linked with standard population-based screening for diseases; the second is a broader targeting of variants associated with multiple single gene disorders, performed opportunistically on patients being investigated for unrelated conditions. In doing so we consider the organization and evaluation of tests and services, the challenge of interpretation with less targeted testing, professional confidence, barriers in practice, and education needs. We conclude by discussing several issues pertinent to health policy, namely: avoiding the conflation of genetics with biological determinism, resisting the “technological imperative”, due consideration of the organization of screening services, the need for professional education, as well as informed decision making and public understanding.
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Affiliation(s)
- Brenda J Wilson
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stuart G Nicholls
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Pullman D, Etchegary H. Clinical genetic research 3: Genetics ELSI (Ethical, Legal, and Social Issues) research. Methods Mol Biol 2015; 1281:369-382. [PMID: 25694322 DOI: 10.1007/978-1-4939-2428-8_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
ELSI (Ethical, Legal, and Social Issues) is a widely used acronym in the bioethics literature that encompasses a broad range of research areas involved in examining the various impacts of science and technology on society. In Canada, GE3LS (Genetics, Ethical, Economic, Environmental, Legal, Social issues) is the term used to describe ELSI studies. It is intentionally more expansive in that GE3LS explicitly brings economic and environmental issues under its purview. ELSI/GE3LS research has become increasingly important in recent years as there has been a greater emphasis on "translational research" that moves genomics from the bench to the clinic. The purpose of this chapter is to outline a range of ELSI-related work that might be conducted as part of a large scale genetics or genomics research project, and to provide some practical insights on how a scientific research team might incorporate a strong and effective ELSI program within its broader research mandate. We begin by describing the historical context of ELSI research and the development of GE3LS research in the Canadian context. We then illustrate how some ELSI research might unfold by outlining a variety of research questions and the various methodologies that might be employed in addressing them in an area of ELSI research that is encompassed under the term "public engagement." We conclude with some practical pointers about how to build an effective ELSI/GE3LS team and focus within a broader scientific research program.
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Affiliation(s)
- Daryl Pullman
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Abstract
Developments in genomics continue to increase the number of disorders for which genetic testing is available, whether in the primary healthcare system, through direct-to-consumer testing, or as part of expanded newborn screening panels. This paper reviews a robust literature on public attitudes toward genetics and genetic testing. In general, attitudes are positive about genetic research and new genomic technologies, with majorities indicating an interest in genetic testing. However, complex beliefs comprise the public's thinking about genetics. Attitudes are driven by beliefs about the type of genetic research, the personal and clinical utility of tests, and the area of genetics in which testing is applied. Limitations of current research are noted and suggestions made for future research.
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Affiliation(s)
- Holly Etchegary
- Clinical Epidemiology, Division of Medicine, Faculty of Medicine, Memorial University, Room H1407, Level 1, Health Sciences Centre, 300 Prince Phillip Drive, St John's, NL A1B 3V6, Canada
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