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Yanes T, Blencoe M, Howard A, Tiller J, Wallingford C, Otlowski M, Keogh L, Lacaze P, McInerney-Leo A. Australian researcher's perspectives on the Australian industry-led moratorium on genetic tests in life insurance. Am J Med Genet A 2024; 194:e63565. [PMID: 38353314 DOI: 10.1002/ajmg.a.63565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 05/02/2024]
Abstract
Fear of insurance discrimination can inhibit genetic research participation. In 2019, an industry-led partial moratorium on using genetic results in Australian life insurance underwriting was introduced. This mixed-methods study used online surveys (n = 59 participants) and semi-structured interviews (n = 22 participants) to capture researchers' perceptions about the moratorium. 66% (n = 39/59) were aware of the moratorium before the survey. Of researchers returning genetic results, 56% (n = 22/39) reported that insurance implications were mentioned in consent forms, but a minority reported updating consent forms post-moratorium (n = 13/39, 33%). Most researchers reported that concerns regarding life insurers utilizing research results inhibited recruitment (35/59, 59%), and few perceived that the moratorium positively influenced participation (n = 9/39, 23%). These findings were supported by qualitative findings which revealed that genetic discrimination concerns were a major issue for some individuals, though these concerns could be eclipsed by the promise of a diagnosis through research participation. The majority thought a regulatory solution should be permanent (n = 34/51, 67%), have financial limits of at least ≥1,000,000 AUD (37/51, 73%), and involve government oversight/legislation (n = 44/51, 86%). In an era where an increasing number of research studies involve genomics as a primary or secondary objective, it is crucial that we have regulatory solutions to address participants' hesitation.
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Affiliation(s)
- Tatiane Yanes
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Marisa Blencoe
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Antonia Howard
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Tiller
- School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Courtney Wallingford
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | | | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
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Muller C, Gallacher L, Keogh L, McInerney-Leo A, Boughtwood T, Gleeson P, Barlow-Stewart K, Delatycki MB, Winship I, Nowak KJ, Otlowski M, Lacaze P, Tiller J. "Uninsurable because of a genetic test": a qualitative study of consumer views about the use of genetic test results in Australian life insurance. Eur J Hum Genet 2024:10.1038/s41431-024-01602-1. [PMID: 38637700 DOI: 10.1038/s41431-024-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Genetic testing can provide valuable information to mitigate personal disease risk, but the use of genetic results in life insurance underwriting is known to deter many consumers from pursuing genetic testing. In 2019, following Australian Federal Parliamentary Inquiry recommendations, the Financial Services Council (FSC) introduced an industry-led partial moratorium, prohibiting life insurance companies from using genetic test results for policies up to $AUD500,000. We used semi-structured interviews to explore genetic test consumers' experiences and views about the FSC moratorium and the use of genetic results by life insurers. Individuals who participated in an online survey and agreed to be re-contacted to discuss the issue further were invited. Interviews were 20-30-min long, conducted via video conference, transcribed verbatim and analysed using inductive content analysis. Twenty-seven participants were interviewed. Despite the moratorium, concerns about genetic discrimination in life insurance were prevalent. Participants reported instances where life insurers did not consider risk mitigation when assessing risk for policies based on genetic results, contrary to legal requirements. Most participants felt that the moratorium provided inadequate protection against discrimination, and that government legislation regulating life insurers' use of genetic results is necessary. Many participants perceived the financial limits to be inadequate, given the cost-of-living in Australia. Our findings indicate that from the perspective of participants, the moratorium has not been effective in allaying fears about genetic discrimination or ensuring adequate access to life insurance products. Concern about genetic discrimination in life insurance remains prevalent in Australia.
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Affiliation(s)
| | - Lyndon Gallacher
- University of Melbourne, Parkville, VIC, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | | | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, VIC, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, VIC, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristen J Nowak
- Office of Population Health Genomics, Western Australia Department of Health, Perth, WA, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Tiller
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Australian Genomics, Melbourne, VIC, Australia.
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Tiller J, Bakshi A, Dowling G, Keogh L, McInerney-Leo A, Barlow-Stewart K, Boughtwood T, Gleeson P, Delatycki MB, Winship I, Otlowski M, Lacaze P. Community concerns about genetic discrimination in life insurance persist in Australia: A survey of consumers offered genetic testing. Eur J Hum Genet 2024; 32:286-294. [PMID: 37169978 PMCID: PMC10923945 DOI: 10.1038/s41431-023-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Fears of genetic discrimination in life insurance continue to deter some Australians from genetic testing. In July 2019, the life insurance industry introduced a partial, self-regulated moratorium restricting the use of genetic results in underwriting, applicable to policies up to certain limits (eg AUD$500,000 for death cover).We administered an online survey to consumers who had taken, or been offered, clinical genetic testing for adult-onset conditions, to gather views and experiences about the moratorium and the use of genetic results in life insurance, including its regulation.Most respondents (n = 367) had undertaken a genetic test (89%), and had a positive test result (76%; n = 243/321). Almost 30% (n = 94/326) reported testing after 1 July 2019. Relatively few respondents reported knowing about the moratorium (16%; n = 54/340) or that use of genetic results in life insurance underwriting is legal (17%; n = 60/348). Only 4% (n = 14/350) consider this practice should be allowed. Some respondents reported ongoing difficulties accessing life insurance products, even after the moratorium. Further, discrimination concerns continue to affect some consumers' decision-making about having clinical testing and applying for life insurance products, despite the Moratorium being in place. Most respondents (88%; n = 298/340) support the introduction of legislation by the Australian government to regulate this issue.Despite the introduction of a partial moratorium in Australia, fears of genetic discrimination persist, and continue to deter people from genetic testing. Consumers overwhelmingly consider life insurers should not be allowed to use genetic results in underwriting, and that federal legislation is required to regulate this area.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Murdoch Children's Research Institute, Parkville, Australia.
- Australian Genomics, Melbourne, Australia.
| | - Andrew Bakshi
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Grace Dowling
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, Australia
- Australian Genomics, Melbourne, Australia
| | | | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Haining CM, Tiller J, Otlowski M, Gleeson P, Murawski C, Barlow-Stewart K, Lacaze P, McInerney-Leo A, Keogh LA. Financial Advisers' and Key Informants' Perspectives on the Australian Industry-Led Moratorium on Genetic Tests in Life Insurance. Public Health Genomics 2023; 26:123-134. [PMID: 37573782 PMCID: PMC10614474 DOI: 10.1159/000533532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Genetic discrimination (GD) in the context of life insurance is a perennial concern in Australia and internationally. To address such concerns in Australia, an industry self-regulated Moratorium on Genetic Tests in Life Insurance was introduced in 2019 to restrict life insurers from using genetic test results in underwriting for policies under certain limits. Financial advisers (FAs) are sometimes engaged by clients to provide financial advice and assist them to apply for life insurance. They are therefore well-placed to comment on GD and the operation of the Moratorium. Despite this, the financial advising sector in Australia has yet to be studied empirically with regards to GD and the Moratorium. This study aims to capture this perspective by reporting on interviews with the financial advising sector. METHODS Ten semi-structured qualitative interviews were conducted with FAs and key informants and were analysed using thematic analysis. CONCLUSION(S) Participants' level of awareness and understanding of the Moratorium varied. Participants reported mixed views on the Moratorium's effectiveness, how it operates in practice, and perceived industry compliance. Participants also provided reflections on Australia's current approach to regulating GD, with most participants supporting the concept of industry self-regulation but identifying a need for this to be supplemented with external oversight and meaningful recourse mechanisms for consumers. Our results suggest that there is scope to increase FAs' awareness of GD, and that further research, consultation, and policy consideration are required to identify an optimal regulatory response to GD in Australia.
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Affiliation(s)
- Casey Michelle Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia,
| | - Jane Tiller
- Public Health Genomics, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Carsten Murawski
- Department of Finance, Centre for Brain, Mind and Markets, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Louise Anne Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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McInerney-Leo AM, Ayres S, Boyle J, Jacobs C, Newson AJ. Human Genetics Society of Australasia Position Statement: Genetic Testing and Personal Insurance Products in Australia. Twin Res Hum Genet 2023; 26:184-187. [PMID: 37226735 DOI: 10.1017/thg.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The expansion of genetic and genomic testing in clinical practice and research, and the growing market for direct-to-consumer genomic testing has led to increased awareness about the impact of this form of testing on insurance. Genetic or genomic information can be requested by providers of mutually rated insurance products, who may then use it when setting premiums or determining eligibility for cover under a particular product. Australian insurers are subject to relevant legislation and an industry led standard that was updated in 2019 to introduce a moratorium on the use of genetic test results in life insurance underwriting for policies
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Affiliation(s)
- Aideen M McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Samantha Ayres
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jackie Boyle
- Genetics of Learning Disability Service, Waratah, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Ainsley J Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, New South Wales, Australia
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Lynch F, Prentice T, Gillam L, Stark Z, Gyngell C. Rapid Genome Sequencing: Consent for New Technologies in the Neonatal Intensive Care Context. Pediatrics 2022; 150:190125. [PMID: 36443237 DOI: 10.1542/peds.2022-058222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
The clinical utility of rapid genome sequencing (rGS) in critically unwell infants has been consistently demonstrated, and there are calls for rGS to be implemented as a first-line test in the NICU. A diagnosis from rGS can enable rapid initiation of precision treatment, making it potentially lifesaving. However, in many patients rGS leads to the diagnosis of severe and life-limiting conditions, prompting discussion with families about withdrawal of life-sustaining treatment. The complexity of information about rGS, together with the heightened emotions of parents in the NICU, poses significant challenges for informed decision making in this context. We present a case where both parents are unable to provide informed consent, and the treating team must decide whether to proceed with rGS. Our discussion highlights the important differences between genome sequencing and other types of genetic testing, and the crucial role played by pre-test counseling in facilitating informed consent and preparing parents for a range of possible outcomes. We then discuss the consent paradigms at play in NICUs; whereas admission generally comes with an understanding that the treating team will perform interventions thought to be in the best interest of the child, rGS is substantially different because of its long-term implications for patients and family members. Finally, we look at the ethical interplay between parental consent and the interests of the child. We conclude by showing how cases like this are resolved at our tertiary center and how they may be resolved differently in future.
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Affiliation(s)
- Fiona Lynch
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne Law School, The University of Melbourne, Melbourne, Australia
| | - Trisha Prentice
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Lynn Gillam
- The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Zornitza Stark
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,Australian Genomics Health Alliance, Melbourne, Australia
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Melbourne Law School, The University of Melbourne, Melbourne, Australia
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Tiller JM, Bakshi A, Brotchie AR, Green RC, Winship IM, Lacaze P. Public willingness to participate in population DNA screening in Australia. J Med Genet 2022:jmg-2022-108921. [DOI: 10.1136/jmg-2022-108921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022]
Abstract
BackgroundPopulation-based DNA screening for medically actionable conditions has the potential to improve public health by enabling early detection, treatment and/or prevention; however, public attitudes and willingness to participate in DNA screening have not been well investigated.MethodsWe presented a scenario to members of the Australian public, randomly selected from the electoral roll via the Australian Survey of Societal Attitudes, describing an adult population DNA screening programme currently under development, to detect risk of medically actionable cancers and heart disease. We asked questions regarding willingness to participate and pay, preferred delivery methods and concerns.ResultsWe received 1060 completed questionnaires (response rate 23%, mean age 58 years). The vast majority (>92%) expressed willingness to undertake DNA screening. When asked about the optimal age of screening, most (56%) favoured early adulthood (aged 18–40 years) rather than at birth or childhood. Many respondents would prefer samples and data be kept for re-screening (36%) or research use (43%); some preferred samples to be destroyed (21%). Issues that decrease likelihood of participation included privacy (75%) and insurance (86%) implications.ConclusionOur study demonstrates public willingness to participate in population DNA screening in Australia, and identifies barriers to participation, to be addressed in the design of screening programmes. Results are informing the development of a pilot national DNA screening programme.
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Dowling G, Tiller J, McInerney-Leo A, Belcher A, Haining C, Barlow-Stewart K, Boughtwood T, Gleeson P, Delatycki MB, Winship I, Otlowski M, Jacobs C, Keogh L, Lacaze P. Health professionals' views and experiences of the Australian moratorium on genetic testing and life insurance: A qualitative study. Eur J Hum Genet 2022; 30:1262-1268. [PMID: 35902697 PMCID: PMC9626480 DOI: 10.1038/s41431-022-01150-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023] Open
Abstract
Australian life insurance companies can legally use genetic test results in underwriting, which can lead to genetic discrimination. In 2019, the Financial Services Council (Australian life insurance industry governing body) introduced a partial moratorium restricting the use of genetic testing in underwriting policies ≤ $500,000 (active 2019-2024). Health professionals (HPs), especially clinical geneticists and genetic counsellors, often discuss the implications of genetic testing with patients, and provide critical insights into the effectiveness of the moratorium. Using a sequential explanatory mixed methods design, we interviewed 23 Australian HPs, who regularly discuss genetic testing with patients and had previously completed an online survey about genetic testing and life insurance. Interviews explored views and experiences about the moratorium, and regulation, in greater depth. Interview transcripts were analysed using thematic analysis. Two key themes emerged from views expressed by HPs during interviews (about matters reported to or observed by them): 1) benefits of the moratorium, and 2) concerns about the moratorium. While HPs reported that the moratorium reassures some consumers, concerns include industry self-regulation, uncertainty created by the temporary time period, and the inadequacy of the moratorium's financial limits for patients' financial needs. Although a minority of HPs felt the current industry self-regulated moratorium is an adequate solution to genetic discrimination, the vast majority (19/23) expressed concern with industry self-regulation and most felt government regulation is required to adequately protect consumers. HPs in Australia are concerned about the adequacy of the FSC moratorium with regards to consumer protections, and suggest government regulation is required.
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Affiliation(s)
- Grace Dowling
- grid.1002.30000 0004 1936 7857Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Tiller
- grid.1002.30000 0004 1936 7857Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, Australia
| | - Aideen McInerney-Leo
- grid.1003.20000 0000 9320 7537The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Andrea Belcher
- grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, Australia ,Australian Genomics, Melbourne, Australia
| | - Casey Haining
- grid.1008.90000 0001 2179 088XCentre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Kristine Barlow-Stewart
- grid.1013.30000 0004 1936 834XSydney Medical School, University of Sydney, Sydney, Australia
| | - Tiffany Boughtwood
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, Australia ,Australian Genomics, Melbourne, Australia
| | | | - Martin B. Delatycki
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, Australia ,grid.507857.8Victorian Clinical Genetics Services, Parkville, Australia
| | - Ingrid Winship
- grid.1008.90000 0001 2179 088XDepartment of Medicine, The University of Melbourne, Melbourne, Australia ,grid.416153.40000 0004 0624 1200Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Margaret Otlowski
- grid.1009.80000 0004 1936 826XFaculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Chris Jacobs
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Louise Keogh
- grid.1008.90000 0001 2179 088XCentre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Paul Lacaze
- grid.1002.30000 0004 1936 7857Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Primiero CA, Baker AM, Wallingford CK, Maas EJ, Yanes T, Fowles L, Janda M, Young MA, Nisselle A, Terrill B, Lodge JM, Tiller JM, Lacaze P, Andersen H, McErlean G, Turbitt E, Soyer HP, McInerney-Leo AM. Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma. Front Genet 2022; 13:919134. [PMID: 36353112 PMCID: PMC9638172 DOI: 10.3389/fgene.2022.919134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Melanoma genetic testing reportedly increases preventative behaviour without causing psychological harm. Genetic testing for familial melanoma risk is now available, yet little is known about dermatologists’ perceptions regarding the utility of testing and genetic testing ordering behaviours. Objectives: To survey Australasian Dermatologists on the perceived utility of genetic testing, current use in practice, as well as their confidence and preferences for the delivery of genomics education. Methods: A 37-item survey, based on previously validated instruments, was sent to accredited members of the Australasian College of Dermatologists in March 2021. Quantitative items were analysed statistically, with one open-ended question analysed qualitatively. Results: The response rate was 56% (256/461), with 60% (153/253) of respondents between 11 and 30 years post-graduation. While 44% (112/252) of respondents agreed, or strongly agreed, that genetic testing was relevant to their practice today, relevance to future practice was reported significantly higher at 84% (212/251) (t = -9.82, p < 0.001). Ninety three percent (235/254) of respondents reported rarely or never ordering genetic testing. Dermatologists who viewed genetic testing as relevant to current practice were more likely to have discussed (p < 0.001) and/or offered testing (p < 0.001). Respondents indicated high confidence in discussing family history of melanoma, but lower confidence in ordering genetic tests and interpreting results. Eighty four percent (207/247) believed that genetic testing could negatively impact life insurance, while only 26% (63/244) were aware of the moratorium on using genetic test results in underwriting in Australia. A minority (22%, 55/254) reported prior continuing education in genetics. Face-to-face courses were the preferred learning modality for upskilling. Conclusion: Australian Dermatologists widely recognise the relevance of genetic testing to future practice, yet few currently order genetic tests. Future educational interventions could focus on how to order appropriate genetic tests and interpret results, as well as potential implications on insurance.
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Affiliation(s)
- Clare A. Primiero
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Amy M. Baker
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Courtney K. Wallingford
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Ellie J. Maas
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Tatiane Yanes
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Lindsay Fowles
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Bronwyn Terrill
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jason M. Lodge
- School of Education, The University of Queensland, Brisbane, QLD, Australia
| | - Jane M. Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hayley Andersen
- Melanoma and Skin Cancer Advocacy Network, Carlton, VIC, Australia
| | - Gemma McErlean
- SWS Nursing and Midwifery Research Alliance, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Erin Turbitt
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - H. Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Aideen M. McInerney-Leo,
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Martin AC, Hooper AJ, Norman R, Nguyen LT, Burnett JR, Bell DA, Brett T, Garton-Smith J, Pang J, Nowak KJ, Watts GF. Pilot study of universal screening of children and child-parent cascade testing for familial hypercholesterolaemia in Australia. J Paediatr Child Health 2022; 58:281-287. [PMID: 34387892 DOI: 10.1111/jpc.15700] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 12/26/2022]
Abstract
AIM Familial hypercholesterolaemia (FH) is a common and treatable cause of premature coronary artery disease. However, the majority of individuals with FH remain undiagnosed. This study investigated the feasibility, acceptability and cost-effectiveness of screening children aged 1-2 years for FH at the time of an immunisation. METHODS Children 1-2 years of age were offered screening for FH with a point-of-care total cholesterol (TC) test by capillary-collected blood sample at the time of an immunisation. An additional blood sample was taken to allow genetic testing if the TC level was above the 95th percentile (>5.3 mmol/L). Parents of children diagnosed with FH were offered testing. Following detection of the affected parent, cascade testing of their first-degree blood relatives was performed. RESULTS We screened 448 children with 32 (7.1%) having a TC ≥ 5.3 mmol/L. The FH diagnosis was confirmed in three children (1:150 screened). Reverse cascade testing of other family members identified a further five individuals with FH; hence, eight new cases of FH were diagnosed from screening 448 children (1:56 screened). Ninety-six percent of parents would screen future children for FH. The approach was cost-effective, at $3979 per quality-adjusted life year gained. CONCLUSION In Western Australia, universal screening of children aged 1-2 years for FH, undertaken at the time of an immunisation, was a feasible and effective approach to detect children, parents and other blood relatives with FH. The approach was acceptable to parents and is potentially a highly cost-effective detection strategy for families at risk of FH.
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Affiliation(s)
- Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Amanda J Hooper
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Lan T Nguyen
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - John R Burnett
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Damon A Bell
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Tom Brett
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jacquie Garton-Smith
- Clinical Excellence Division, Department of Health, Health Networks, Perth, Western Australia, Australia
| | - Jing Pang
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Kristen J Nowak
- Public and Aboriginal Health Division, Department of Health, Office of Population Health Genomics, Perth, Western Australia, Australia
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital, Perth, Western Australia, Australia
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11
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Tiller JM, Keogh LA, McInerney-Leo AM, Belcher A, Barlow-Stewart K, Boughtwood T, Gleeson P, Dowling G, Prince A, Bombard Y, Joly Y, Delatycki M, Winship IM, Otlowski M, Lacaze P. A step forward, but still inadequate: Australian health professionals' views on the genetics and life insurance moratorium. J Med Genet 2021; 59:817-826. [PMID: 34544841 DOI: 10.1136/jmedgenet-2021-107989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2019, the Australian life insurance industry introduced a partial moratorium (ban) limiting the use of genetic test results in life insurance underwriting. The moratorium is industry self-regulated and applies only to policies below certain financial limits (eg, $500 000 of death cover). METHODS We surveyed Australian health professionals (HPs) who discuss genetic testing with patients, to assess knowledge of the moratorium; reported patient experiences since its commencement; and HP views regarding regulation of genetic discrimination (GD) in Australia. RESULTS Between April and June 2020, 166 eligible HPs responded to the online survey. Of these, 86% were aware of the moratorium, but <50% had attended related training/information sessions. Only 16% answered all knowledge questions correctly, yet 69% believed they had sufficient knowledge to advise patients. Genetics HPs' awareness and knowledge were better than non-genetics HPs' (p<0.05). There was some reported decrease in patients delaying/declining testing after the moratorium's introduction, however, 42% of HPs disagreed that patients were more willing to have testing post-moratorium. Although many (76%) felt the moratorium resolved some GD concerns, most (88%) still have concerns, primarily around self-regulation, financial limits and the moratorium's temporary nature. Almost half (49%) of HPs reported being dissatisfied with the moratorium as a solution to GD. The majority (95%) felt government oversight is required, and 93% felt specific Australian legislation regarding GD is required. CONCLUSION While the current Australian moratorium is considered a step forward, most HPs believe it falls short of an adequate long-term regulatory solution to GD in life insurance.
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Affiliation(s)
- Jane M Tiller
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia .,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aideen M McInerney-Leo
- Human Genomics Group, University of Queensland Diamantina Institute, Woolloongabba, Queensland, Australia
| | - Andrea Belcher
- The University of Queensland, Faculty of Medicine, Herston, Queensland, Australia.,Australian Genomics, Melbourne, Victoria, Australia
| | | | - Tiffany Boughtwood
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Australian Genomics, Melbourne, Victoria, Australia
| | - Penny Gleeson
- School of Law, Deakin University, Burwood, Victoria, Australia
| | - Grace Dowling
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Anya Prince
- The University of Iowa College of Law, Iowa City, Iowa, USA
| | - Yvonne Bombard
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Yann Joly
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Martin Delatycki
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services Ltd, Parkville, Victoria, Australia
| | - Ingrid M Winship
- Clinical Genetics, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
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12
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Tiller J, Delatycki MB. Genetic discrimination in life insurance: a human rights issue. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2021-107645. [PMID: 34131003 DOI: 10.1136/medethics-2021-107645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Jane Tiller
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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