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Okah E, Glover L, Donahue KE, Corbie-Smith G, Dave G. Physicians' Perceptions of Race and Engagement in Race-Based Clinical Practice: a Mixed-Methods Systematic Review and Narrative Synthesis. J Gen Intern Med 2022; 37:3989-3998. [PMID: 35867305 PMCID: PMC9640482 DOI: 10.1007/s11606-022-07737-5] [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: 01/24/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Using race-a socially assigned identity that does not adequately capture human genetic variation-to guide clinical care can result in poor outcomes for racially minoritized patients. This study assessed (1) how physicians conceptualize and use race in their clinical care (race-based care) and (2) physician characteristics associated with race-based care. METHODS PubMed, CINAHL, EMBASE, and Scopus databases were searched. Qualitative, quantitative, and mixed-methods studies written in peer-reviewed, English-language journal articles evaluating US physicians' perceptions of race and physician factors associated with race-based care were included. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were evaluated using thematic analysis, and quantitative findings were summarized and combined with qualitative findings in a narrative synthesis. RESULTS A total of 1149 articles were identified; 9 (4 qualitative, 5 quantitative) studies met inclusion criteria. Five themes emerged: (1) the belief in race as biological; (2) the use of race to contextualize patients' health; (3) the use of race to counsel patients and determine care; (4) justifications for race-based practice (evidence-based, personal experience, addresses disparities, provides personalized care, increases compliance); and (5) concerns with race-based practice (poorly characterizes patients, normalizes disparities, patient distrust, clinician discomfort, legitimized biological race). In quantitative studies, older age was positively associated with race-based care. DISCUSSION Physicians had varied perceptions of race, but many believed race was biological. Concern and support for race-based practice were related to beliefs regarding the evidence for using race in care and the appropriateness of race as a variable in medical research. Older physicians were more likely to use race, which could be due to increased exposure to race-based medical literature, in addition to generational differences in conceptualizations of race. Additional research on the evolution of physicians' perceptions of race, and the role of medical literature in shaping these perceptions, is needed.
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Affiliation(s)
- Ebiere Okah
- Department of Family Medicine, School of Medicine, University of North Carolina, NC, , Chapel Hill, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, NC, , Chapel Hill, USA.
| | - LáShauntá Glover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, NC, , Chapel Hill, USA
| | - Katrina E Donahue
- Department of Family Medicine, School of Medicine, University of North Carolina, NC, , Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, NC, , Chapel Hill, USA
| | - Giselle Corbie-Smith
- Department of Medicine, School of Medicine, University of North Carolina, NC, , Chapel Hill, USA
- Department of Social Medicine, School of Medicine, University of North Carolina, NC, , Chapel Hill, USA
- Center for Health Equity Research, School of Medicine, University of North Carolina, Chapel Hill,, NC, USA
| | - Gaurav Dave
- Department of Medicine, School of Medicine, University of North Carolina, NC, , Chapel Hill, USA
- Department of Social Medicine, School of Medicine, University of North Carolina, NC, , Chapel Hill, USA
- Center for Health Equity Research, School of Medicine, University of North Carolina, Chapel Hill,, NC, USA
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Esplin ED, Nielsen SM, Bristow SL, Garber JE, Hampel H, Rana HQ, Samadder NJ, Shore ND, Nussbaum RL. Universal Germline Genetic Testing for Hereditary Cancer Syndromes in Patients With Solid Tumor Cancer. JCO Precis Oncol 2022; 6:e2100516. [PMID: 36108258 PMCID: PMC9489188 DOI: 10.1200/po.21.00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | | | - Heather Hampel
- Division of Clinical Cancer Genomics, Department of Medical Oncology & Therapeutic Research, City of Hope National Cancer Center, Duarte, CA
| | | | - N Jewel Samadder
- Center for Individualized Medicine, Mayo Clinic, Phoenix, AZ.,Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, AZ.,Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
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Schaibley VM, Ramos IN, Woosley RL, Curry S, Hays S, Ramos KS. Limited Genomics Training Among Physicians Remains a Barrier to Genomics-Based Implementation of Precision Medicine. Front Med (Lausanne) 2022; 9:757212. [PMID: 35372454 PMCID: PMC8971187 DOI: 10.3389/fmed.2022.757212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/18/2022] [Indexed: 01/12/2023] Open
Abstract
The field of precision medicine has undergone significant growth over the past 10 years. Despite increasing applications of clinical genetic and genomic testing, studies consistently report limited knowledge of genetics and genomics among healthcare providers. This study explored barriers to the implementation of precision medicine by surveying physicians working in a large academic medical center. We assessed prior training in genetics, use of genetic testing in the clinic, desire for additional resources in genetics and genomic medicine and perceived barriers to successful integration of precision medicine. Only 20% of respondents reported moderate or extensive training in genetics. Physicians with limited or no training in genetics were less likely to have ordered a genetic test for any purpose. Furthermore, 41% of physicians responded that their lack of training identifying appropriate genetic tests and how to interpret genetic testing results was the most significant barrier to ordering genetic testing for their patients. These findings suggest that future efforts to realize the promise of precision medicine should focus on the integration of training programs for non-genetics trained healthcare providers.
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Affiliation(s)
- Valerie M. Schaibley
- Center for Applied Genetics and Genomic Medicine, The University of Arizona Health Sciences, Tucson, AZ, United States
- Genetic Counseling Graduate Program, University of Arizona College of Medicine – Tucson, Tucson, AZ, United States
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine – Tucson, Tucson, AZ, United States
| | - Irma N. Ramos
- Center for Applied Genetics and Genomic Medicine, The University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, United States
| | - Raymond L. Woosley
- Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Steven Curry
- Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Sean Hays
- SciPinion, Bozeman, MT, United States
| | - Kenneth S. Ramos
- Center for Applied Genetics and Genomic Medicine, The University of Arizona Health Sciences, Tucson, AZ, United States
- Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
- Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, United States
- *Correspondence: Kenneth S. Ramos,
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Cooper KE, Abdallah KE, Angove RS, Gallagher KD, Bonham VL. Navigating Access to Cancer Care: Identifying Barriers to Precision Cancer Medicine. Ethn Dis 2022; 32:39-48. [PMID: 35106043 PMCID: PMC8785861 DOI: 10.18865/ed.32.1.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Precision medicine is revolutionizing cancer treatment. However, there has been limited investigation of barriers patients endure to access precision cancer medicine. This study aims to report the experiences of underserved patient populations with limited access to genomic testing, clinical trials, and precision cancer treatment. METHODS A mixed-method study was employed to quantitatively evaluate patients (N=300) seeking precision cancer medicine between January 2014- August 2017. Qualitatively, we conducted semi-structured interviews with eight case managers who navigate the health care and health insurance systems to provide patients with access to precision cancer medicine care. All interviews were analyzed to identify themes. RESULTS Within our patient cohort, 69% were diagnosed in stage I of cancer disease. Overall, 27 patients (9%) were denied treatment as a final outcome of their case due to insurance denials, 35 patients (12%) died before gaining access to precision cancer medicine, and 6 patients (2%) received precision cancer medicine through clinical trials. Four broad thematic areas emerged from the qualitative analysis: 1) lack of patient, provider and insurer knowledge of precision cancer medicine; 2) barriers to clinical trial participation; 3) lack of patient health literacy; and 4) barriers to timely access to care. CONCLUSION Our combined analyses suggest that both system-level and patient-level barriers limit patient access to precision cancer medicine options. Additionally, we found that these barriers may exist not only for traditionally underserved patients, but also for resourced and insured patients trying to access precision cancer medicine.
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Affiliation(s)
- Kayla E. Cooper
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Khadijah E. Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Rebekah S.M. Angove
- Department of Research and Evaluation, Patient Advocate Foundation, Hampton, VA
| | | | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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Erdmann A, Rehmann-Sutter C, Bozzaro C. Patients' and professionals' views related to ethical issues in precision medicine: a mixed research synthesis. BMC Med Ethics 2021; 22:116. [PMID: 34465328 PMCID: PMC8406914 DOI: 10.1186/s12910-021-00682-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Precision medicine development is driven by the possibilities of next generation sequencing, information technology and artificial intelligence and thus, raises a number of ethical questions. Empirical studies have investigated such issues from the perspectives of health care professionals, researchers and patients. We synthesize the results from these studies in this review. METHODS We used a systematic strategy to search, screen and assess the literature for eligibility related to our research question. The initial search for empirical studies in five data bases provided 665 different records and we selected 92 of these publications for inclusion in this review. Data were extracted in a spreadsheet and categorized into different topics representing the views on ethical issues in precision medicine. RESULTS Many patients and professionals expect high benefits from precision medicine and have a positive attitude towards it. However, patients and professionals also perceive some risks. Commonly perceived risks include: lack of evidence for accuracy of tests and efficacy of treatments; limited knowledge of patients, which makes informed consent more difficult; possible unavailability of access to precision medicine for underprivileged people and ethnic minorities; misuse of data by insurance companies and employers, potential of racial stigmatization due to genetic information; unwanted communication of incidental findings; changes in doctor-patient-relationship through focusing on data; and the problem that patients could feel under pressure to optimize their health. CONCLUSIONS National legislation and guidelines already minimize many risks associated with precision medicine. However, from our perspective some problems require more attention. Should hopes for precision medicine's benefits be fulfilled, then the ethical principle of justice would require an unlimited access to precision medicine for all people. The potential for autonomous patients' decisions must be greatly enhanced by improvements in patient education. Harm from test results must be avoided in any case by the highest possible data security level and communication guidelines. Changes in the doctor-patient relationship and the impact of precision medicine on the quality of life should be further investigated. Additionally, the cost-effectiveness of precision medicine should be further examined, in order to avoid malinvestment.
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Affiliation(s)
- Anke Erdmann
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University (CAU), Kiel, Germany.
| | | | - Claudia Bozzaro
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University (CAU), Kiel, Germany
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Knowledge, Attitudes, and Perceived Barriers toward Genetic Testing and Pharmacogenomics among Healthcare Workers in the United Arab Emirates: A Cross-Sectional Study. J Pers Med 2020; 10:jpm10040216. [PMID: 33182317 PMCID: PMC7711841 DOI: 10.3390/jpm10040216] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
In order to successfully translate the scientific models of genetic testing and pharmacogenomics into clinical practice, empowering healthcare workers with the right knowledge and functional understanding on the subject is essential. Limited research in the United Arab Emirates (UAE) have assessed healthcare worker stances towards genomics. This study aimed to assess healthcare workers’ knowledge and attitudes on genetic testing. A cross-sectional study was conducted among healthcare workers practicing in either public or private hospitals or clinics as pharmacists, nurses, physicians, managers, and allied health. Participants were recruited randomly and via snowball techniques. Surveys were collected between April and September 2019; out of 552 respondents, 63.4% were female, the mean age was 38 (±9.6) years old. The mean knowledge score was 5.2 (±2.3) out of nine, which shows a fair level of knowledge. The scores of respondents of pharmacy were 5.1 (±2.5), medicine 6.0 (±2.0), and nursing 4.8 (±2.1). All participants exhibited a fair knowledge level about genetic testing and pharmacogenomics. Of the respondents, 91.9% showed a positive attitude regarding availability of genetic testing. The top identified barrier to implementation was the cost of testing (62%), followed by lack of training or education and insurance coverage (57.8% and 57.2%, respectively). Building upon the positive attitudes and tackling the barriers and challenges will pave the road for full implementation of genetic testing and pharmacogenomics in the UAE. We recommend empowering healthcare workers by improving needed and tailored competencies related to their area of practice. We strongly urge the stakeholders to streamline and benchmark the workflow, algorithm, and guidelines to standardize the health and electronic system. Lastly, we advocate utilizing technology and electronic decision support as well as the translational report to back up healthcare workers in the UAE.
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Rosso A, Pitini E, D’Andrea E, Di Marco M, Unim B, Baccolini V, De Vito C, Marzuillo C, Barnhoorn F, Zeegers Paget D, Villari P. Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey. PLoS One 2020; 15:e0230749. [PMID: 32240206 PMCID: PMC7117699 DOI: 10.1371/journal.pone.0230749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services. Methods EUPHA members were invited via monthly newsletter and e-mail to take part in an online survey from February 2017 to January 2018. A descriptive analysis of knowledge and attitudes was conducted, along with a univariate and multivariate analysis of their determinants. Results Five hundred and two people completed the questionnaire, 17.9% were involved in PHG activities. Only 28.9% correctly identified all medical conditions for which there is (or not) evidence for implementing genetic testing; over 60% thought that investing in genomics may divert economic resources from social and environmental determinants of health. The majority agreed that PH professionals may play different roles in incorporating genomics into their activities. Better knowledge was associated with positive attitudes towards the use of genetic testing and the delivery of genetic services in PH (OR = 1.48; 95% CI 1.01–2.18). Conclusions Our study revealed quite positive attitudes, but also a need to increase awareness on genomics among European PH professionals. Those directly involved in PHG activities tend to have a more positive attitude and better knowledge; however, gaps are also evident in this group, suggesting the need to harmonize practice and encourage greater exchange of knowledge among professionals.
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Affiliation(s)
- Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit-Azienda Sanitaria Locale Roma 2, Rome, Italy
- * E-mail:
| | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Elvira D’Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Marco Di Marco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Floris Barnhoorn
- European Public Health Association (EUPHA), Utrecht, the Netherlands
| | | | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Huey RW, Hawk E, Offodile AC. Mind the Gap: Precision Oncology and Its Potential to Widen Disparities. J Oncol Pract 2019; 15:301-304. [PMID: 31112478 DOI: 10.1200/jop.19.00102] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ryan W Huey
- 1 University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ernest Hawk
- 1 University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anaeze C Offodile
- 1 University of Texas MD Anderson Cancer Center, Houston, TX.,2 Baker Institute for Public Policy, Rice University, Houston, TX
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The clinical impact of using complex molecular profiling strategies in routine oncology practice. Oncotarget 2018; 9:20282-20293. [PMID: 29755651 PMCID: PMC5945513 DOI: 10.18632/oncotarget.24757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/12/2018] [Indexed: 11/25/2022] Open
Abstract
Molecular profiling and functional assessment of signalling pathways of advanced solid tumours are becoming increasingly available. However, their clinical utility in guiding patients’ treatment remains unknown. Here, we assessed whether molecular profiling helps physicians in therapeutic decision making by analysing the molecular profiles of 1057 advanced cancer patient samples after failing at least one standard of care treatment using a combination of next-generation sequencing (NGS), immunohistochemistry (IHC) and other specific tests. The resulting information was interpreted and personalized treatments for each patient were suggested. Our data showed that NGS alone provided the oncologist with useful information in 10–50% of cases (depending on cancer type), whereas the addition of IHC/other tests increased extensively the usefulness of the information provided. Using internet surveys, we investigated how therapy recommendations influenced treatment choice of the oncologist. For patients who were still alive after the provision of the molecular information (76.8%), 60.4% of their oncologists followed report recommendations. Most treatment decisions (93.4%) were made based on the combination of NGS and IHC/other tests, and an approved drug- rather than clinical trial enrolment- was the main treatment choice. Most common reasons given by physicians to explain the non-adherence to recommendations were drug availability and cost, which remain barriers to personalised precision medicine. Finally, we observed that 27% of patients treated with the suggested therapies had an overall survival > 12 months. Our study demonstrates that the combination of NGS and IHC/other tests provides the most useful information in aiding treatment decisions by oncologists in routine clinical practice.
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Wright S, Daker-White G, Newman W, Payne K. Understanding barriers to the introduction of precision medicines in non-small cell lung cancer: A qualitative interview protocol. Wellcome Open Res 2018; 3:24. [PMID: 29780892 PMCID: PMC5934686 DOI: 10.12688/wellcomeopenres.13976.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 12/14/2022] Open
Abstract
Background: While precision medicines targeting genetic mutations and alterations in non-small cell lung cancer (NSCLC) have been available since 2010, their adoption into clinical practice has been slow. Evidence suggests that a number of barriers, such as insufficient clinician knowledge, a need for training of test providers, or a lack of specific clinical guidelines, may slow the implementation of precision in general. However, little attention has been given to the barriers to providing precision medicines in NSCLC. The purpose of this protocol is to outline the design for a qualitative interview study to identify the barriers and facilitators to the provision of precision medicines for NSCLC. Methods: This study will use semi-structured interviews with clinicians (n=10), test providers (n=10), and service commissioners (n=10) to identify the perceived barriers and facilitators to providing historical, current, and future precision medicines in NSCLC. Participants will be identified through mailing list advertisements and snowball sampling. Recruitment will continue until data saturation, indicated by no new themes arising from the data. Interviews will be conducted by telephone to facilitate geographical diversity. The qualitative data will be analysed using a framework analysis with themes anticipated to relate to; relevant barriers to providing precision medicines, the impact of different barriers on medicine provision, changes in the ability to provide precision medicines over time, and strategies to facilitate the provision of precision medicines. Ethics: This study has been approved by the University of Manchester Proportionate Review Research Ethics Committee (Reference number: 2017-1885-3619). Written consent will be obtained from all participants. Conclusion: This study is the first to explore the barriers and facilitators to providing precision medicines for NSCLC in the English NHS. The findings will inform strategies to improve the implementation of future precision medicines. These findings will be disseminated in peer-reviewed publications and national and international conferences.
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Affiliation(s)
- Stuart Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
| | - Gavin Daker-White
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
| | - William Newman
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
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Unim B, Lagerberg T, Pitini E, De Vito C, Vacchio MR, Adamo G, Rosso A, D'Andrea E, Marzuillo C, Villari P. Identification of Delivery Models for the Provision of Predictive Genetic Testing in Europe: Protocol for a Multicentre Qualitative Study and a Systematic Review of the Literature. Front Public Health 2017; 5:223. [PMID: 28879178 PMCID: PMC5572240 DOI: 10.3389/fpubh.2017.00223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/08/2017] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community's readiness to incorporate public health genomics into their practice. MATERIALS AND EQUIPMENT The project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members' knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000-2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries' government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops. EXPECTED IMPACT OF THE STUDY ON PUBLIC HEALTH The transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services.
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Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Vacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Elvira D'Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Gupta S, Smith TR, Broekman ML. Ethical considerations of neuro-oncology trial design in the era of precision medicine. J Neurooncol 2017; 134:1-7. [PMID: 28555425 PMCID: PMC5543186 DOI: 10.1007/s11060-017-2502-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/20/2017] [Indexed: 12/29/2022]
Abstract
The field of oncology is currently undergoing a paradigm shift. Advances in the understanding of tumor biology and in tumor sequencing technology have contributed to the shift towards precision medicine, the therapeutic framework of targeting the individual oncogenic changes each tumor harbors. The success of precision medicine therapies, such as targeted kinase inhibitors and immunotherapies, in other cancers have motivated studies in brain cancers. The high specificity and cost of these therapies also encourage a shift in clinical trial design away from randomized control trials towards smaller, more exclusive early phase clinical trials. While these new trials advance the clinical application of increasingly precise and individualized therapies, their design brings ethical challenges . We review the pertinent ethical considerations for clinical trials of precision medicine in neuro-oncology and discuss methods to protect patients in this new era of trial design.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Timothy R Smith
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Marike L Broekman
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. .,Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
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13
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Chen LS, Chang FW, Kim M, Talwar D, Zhao S. Genomic medicine practice among physicians in Taiwan. Per Med 2017; 14:109-121. [DOI: 10.2217/pme-2016-0067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aim: To examine genomic medicine (GM) practice and associated factors (i.e., attitudes, intention, self-efficacy, previous training in genomics, and demographic characteristics) among Taiwanese physicians. Methods: A survey was distributed to physicians attending an internal training workshop at a large medical center in Taiwan. Data were analyzed using structural equation modeling. Results: A total of 137 physicians comprised our final sample; less than a third of them had practiced GM. Yet, participants overall had positive intention, favorable attitudes, and high self-efficacy in GM practice. Moreover, intention, attitudes, self-efficacy, educational level, and continuing education in GM were positively and significantly associated with participants’ GM practice. Conclusion: Offering continuing education for Taiwanese physicians is needed to enhance their practice in GM.
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Affiliation(s)
- Lei-Shih Chen
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Minjung Kim
- Department of Psychology, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Divya Talwar
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shixi Zhao
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
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14
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Talwar D, Tseng TS, Foster M, Xu L, Chen LS. Genetics/genomics education for nongenetic health professionals: a systematic literature review. Genet Med 2016; 19:725-732. [PMID: 27763635 DOI: 10.1038/gim.2016.156] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/25/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The completion of the Human Genome Project has enhanced avenues for disease prevention, diagnosis, and management. Owing to the shortage of genetic professionals, genetics/genomics training has been provided to nongenetic health professionals for years to establish their genomic competencies. We conducted a systematic literature review to summarize and evaluate the existing genetics/genomics education programs for nongenetic health professionals. METHODS Five electronic databases were searched from January 1990 to June 2016. RESULTS Forty-four studies met our inclusion criteria. There was a growing publication trend. Program participants were mainly physicians and nurses. The curricula, which were most commonly provided face to face, included basic genetics; applied genetics/genomics; ethical, legal, and social implications of genetics/genomics; and/or genomic competencies/recommendations in particular professional fields. Only one-third of the curricula were theory-based. The majority of studies adopted a pre-/post-test design and lacked follow-up data collection. Nearly all studies reported participants' improvements in one or more of the following areas: knowledge, attitudes, skills, intention, self-efficacy, comfort level, and practice. However, most studies did not report participants' age, ethnicity, years of clinical practice, data validity, and data reliability. CONCLUSION Many genetics/genomics education programs for nongenetic health professionals exist. Nevertheless, enhancement in methodological quality is needed to strengthen education initiatives.Genet Med advance online publication 20 October 2016.
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Affiliation(s)
- Divya Talwar
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Tung-Sung Tseng
- Department of Behavioral &Community Health Sciences, School of Public Health, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Margaret Foster
- Medical Science Library, Texas A&M University, College Station, Texas, USA
| | - Lei Xu
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
| | - Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
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15
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Maglo KN, Mersha TB, Martin LJ. Population Genomics and the Statistical Values of Race: An Interdisciplinary Perspective on the Biological Classification of Human Populations and Implications for Clinical Genetic Epidemiological Research. Front Genet 2016; 7:22. [PMID: 26925096 PMCID: PMC4756148 DOI: 10.3389/fgene.2016.00022] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 02/02/2016] [Indexed: 01/14/2023] Open
Abstract
The biological status and biomedical significance of the concept of race as applied to humans continue to be contentious issues despite the use of advanced statistical and clustering methods to determine continental ancestry. It is thus imperative for researchers to understand the limitations as well as potential uses of the concept of race in biology and biomedicine. This paper deals with the theoretical assumptions behind cluster analysis in human population genomics. Adopting an interdisciplinary approach, it demonstrates that the hypothesis that attributes the clustering of human populations to "frictional" effects of landform barriers at continental boundaries is empirically incoherent. It then contrasts the scientific status of the "cluster" and "cline" constructs in human population genomics, and shows how cluster may be instrumentally produced. It also shows how statistical values of race vindicate Darwin's argument that race is evolutionarily meaningless. Finally, the paper explains why, due to spatiotemporal parameters, evolutionary forces, and socio-cultural factors influencing population structure, continental ancestry may be pragmatically relevant to global and public health genomics. Overall, this work demonstrates that, from a biological systematic and evolutionary taxonomical perspective, human races/continental groups or clusters have no natural meaning or objective biological reality. In fact, the utility of racial categorizations in research and in clinics can be explained by spatiotemporal parameters, socio-cultural factors, and evolutionary forces affecting disease causation and treatment response.
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Affiliation(s)
- Koffi N Maglo
- Department of Philosophy, Center for Clinical and Translational Science and Training, University of Cincinnati Cincinnati, OH, USA
| | - Tesfaye B Mersha
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, OH, USA
| | - Lisa J Martin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati, OH, USA
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