ShareDNA: a smartphone app to facilitate family communication of genetic results

Securing Group Patient Communication in 6G-Aided Dynamic Ubiquitous Healthcare with Real-Time Mobile DNA Sequencing

(1) Background: With an advanced technique, third-generation sequencing (TGS) provides services with long deoxyribonucleic acid (DNA) reads and super short sequencing time. It enables onsite mobile DNA sequencing solutions for enabling ubiquitous healthcare (U-healthcare) services with modern mobile technology and smart entities in the internet of living things (IoLT). Due to some strict requirements, 6G technology can efficiently facilitate communications in a truly intelligent U-healthcare IoLT system. (2) Research problems: conventional single user-server architecture is not able to enable group conversations where "multiple patients-server" communication or "patient-patient" communication in the group is required. The communications are carried out via the open Internet, which is not a trusted channel. Since heath data and medical information are very sensitive, security and privacy concerns in the communication systems have become extremely important. (3) Purpose: the author aims to propose a dynamic group-based patient-authenticated key distribution protocol for 6G-aided U-healthcare services enabled by mobile DNA sequencing. In the protocol, an authenticated common session key is distributed by the server to the patients. Using the key, patients in a healthcare group are allowed to securely connect with the service provider or with each other for specific purposes of communication. (4) Results: the group key distribution process is protected by a secure three-factor authentication mechanism along with an efficient sequencing-device-based single sign-on (SD-SSO) solution. Based on traceable information stored in the server database, the proposed approach can provide patient-centered services which are available on multiple mobile devices. Security robustness of the proposed protocol is proven by well-known verification tools and a detailed semantic discussion. Performance evaluation shows that the protocol provides more functionality and incurs a reasonable overhead in comparison with the existing works.

The Impact of Proband Indication for Genetic Testing on the Uptake of Cascade Testing Among Relatives

Although multiple factors can influence the uptake of cascade genetic testing, the impact of proband indication has not been studied. We performed a retrospective, cross-sectional study comparing cascade genetic testing rates among relatives of probands who received either diagnostic germline testing or non-indication-based proactive screening via next-generation sequencing (NGS)-based multigene panels for hereditary cancer syndromes (HCS) and/or familial hypercholesterolemia (FH). The proportion of probands with a medically actionable (positive) finding were calculated based on genes associated with Centers for Disease Control and Prevention (CDC) Tier 1 conditions, HCS genes, and FH genes. Among probands with a positive finding, cascade testing rates and influencing factors were assessed. A total of 270,715 probands were eligible for inclusion in the study (diagnostic n = 254,281,93.9%; proactive n = 16,434, 6.1%). A positive result in a gene associated with a CDC Tier 1 condition was identified in 10,520 diagnostic probands (4.1%) and 337 proactive probands (2.1%), leading to cascade testing among families of 3,305 diagnostic probands (31.4%) and 36 proactive probands (10.7%) (p < 0.0001). A positive result in an HCS gene was returned to 23,272 diagnostic probands (9.4%) and 970 proactive probands (6.1%), leading to cascade testing among families of 6,611 diagnostic probands (28.4%) and 89 proactive probands (9.2%) (p < 0.0001). Cascade testing due to a positive result in an HCS gene was more commonly pursued when the diagnostic proband was White, had a finding in a gene associated with a CDC Tier 1 condition, or had a personal history of cancer, or when the proactive proband was female. A positive result in an FH gene was returned to 1,647 diagnostic probands (25.3%) and 67 proactive probands (0.62%), leading to cascade testing among families of 360 diagnostic probands (21.9%) and 4 proactive probands (6.0%) (p < 0.01). Consistently higher rates of cascade testing among families of diagnostic probands may be due to a perceived urgency because of personal or family history of disease. Due to the proven clinical benefit of cascade testing, further research on obstacles to systematic implementation and uptake of testing for relatives of any proband with a medically actionable variant is warranted.

Usefulness of mobile apps for communication of genetic test results to at-risk family members in a U.S. integrated health system: a qualitative approach from user-testing

Objective

To assess the usefulness a mobile based application to send genetic test results to at-risk family members in a U.S. integrated health system.

Methods

We conducted semi-structured in-person interviews with members of Kaiser Permanente Washington who had enrolled in a prospective study and received genetic test results. Participants were given the task to use the app and comment on the experience. The moderator asked participants to share perspectives on the usefulness of a mobile based app and their lived experiences of sharing their test results with family members.

Results

Fourteen study participants who had undergone genetic testing were interviewed. Four primary themes emerged as relevant to the use of mobile-based apps as a tool for communicating genetic test results to at-risk family members: (i) Participants felt a sense of obligation to share positive test results with relatives; (ii) Participants felt that the advantages of using email were similar to those of the app; (iii) Participants felt that younger individuals would be more comfortable with an app; and, (iv) Participants felt they could use the app independently and in their own time.

Conclusion

A mobile based app could be used as a tool to improve cascade screening for pathogenic/likely pathogenic test results. The benefits of such a tool are likely greatest among relatives still at the stage of family planning, as well as among family members with strained relationships. There would be minimal burden on the system to offer a mobile based app as a tool.