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Cavallari LH, Hicks JK, Patel JN, Elchynski AL, Smith DM, Bargal SA, Fleck A, Aquilante CL, Killam SR, Lemke L, Ochi T, Ramsey LB, Haidar CE, Ho T, El Rouby N, Monte AA, Allen JD, Beitelshees AL, Bishop JR, Bousman C, Campbell R, Cicali EJ, Cook KJ, Duong B, Tsermpini EE, Girdwood ST, Gregornik DB, Grimsrud KN, Lamb N, Lee JC, Lopez RO, Mazhindu TA, Morris SA, Nagy M, Nguyen J, Pasternak AL, Petry N, van Schaik RHN, Schultz A, Skaar TC, Al Alshaykh H, Stevenson JM, Stone RM, Tran NK, Tuteja S, Woodahl EL, Yuan LC, Lee CR. The Pharmacogenomics Global Research Network Implementation Working Group: global collaboration to advance pharmacogenetic implementation. Pharmacogenet Genomics 2025; 35:1-11. [PMID: 39485373 DOI: 10.1097/fpc.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Pharmacogenetics promises to optimize treatment-related outcomes by informing optimal drug selection and dosing based on an individual's genotype in conjunction with other important clinical factors. Despite significant evidence of genetic associations with drug response, pharmacogenetic testing has not been widely implemented into clinical practice. Among the barriers to broad implementation are limited guidance for how to successfully integrate testing into clinical workflows and limited data on outcomes with pharmacogenetic implementation in clinical practice. The Pharmacogenomics Global Research Network Implementation Working Group seeks to engage institutions globally that have implemented pharmacogenetic testing into clinical practice or are in the process or planning stages of implementing testing to collectively disseminate data on implementation strategies, metrics, and health-related outcomes with the use of genotype-guided drug therapy to ultimately help advance pharmacogenetic implementation. This paper describes the goals, structure, and initial projects of the group in addition to implementation priorities across sites and future collaborative opportunities.
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Affiliation(s)
- Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville
| | - J Kevin Hicks
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Jai N Patel
- Atrium Health Levine Cancer Institute, Charlotte
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Amanda L Elchynski
- Department of Pharmacy, Arkansas Children's Hospital, Little Rock, Arkansas
| | - D Max Smith
- MedStar Health, Columbia, Maryland
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Salma A Bargal
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ashley Fleck
- Department of Pharmacy, Richard L. Roudebush Veterans Affairs Medical Center, Veteran Health Indiana, Indianapolis, Indiana
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shayna R Killam
- L.S. Skaggs Institute for Health Innovation and Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana
| | | | - Taichi Ochi
- Department of Pharmacotherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy; and University Library, University of Groningen, Groningen, The Netherlands
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri
| | - Cyrine E Haidar
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Teresa Ho
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Nihal El Rouby
- Department of Pharmacy, St. Elizabeth HealthCare, Edgewood, Kentucky
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Andrew A Monte
- Rocky Mountain Poison & Drug Safety, Denver Health & Hospital Authority, Denver, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | - Josiah D Allen
- Department of Pharmacy, St. Elizabeth HealthCare, Edgewood, Kentucky
| | - Amber L Beitelshees
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chad Bousman
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - Ronald Campbell
- Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Emily J Cicali
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville
| | - Kelsey J Cook
- Department of Pharmacy Education and Practice, University of Florida College of Pharmacy
- Nemours Children's Health, Jacksonville, Florida
| | - Benjamin Duong
- Precision Medicine Program, Nemours Children's Health Delaware Valley, Wilmington, Delaware, USA
| | - Evangelia Eirini Tsermpini
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sonya Tang Girdwood
- Divisions of Hospital Medicine and Translational and Clinical Pharmacology, Cincinnati Children's Hospital
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David B Gregornik
- Pharmacogenomics Program, Children's Minnesota, Minneapolis/St Paul, Minnesota
| | - Kristin N Grimsrud
- Department of Pathology and Laboratory Medicine, University of California Health, Sacramento, California
| | - Nathan Lamb
- Department of Pharmacy, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - James C Lee
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rocio Ortiz Lopez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico
| | | | - Sarah A Morris
- Atrium Health Levine Cancer Institute, Charlotte
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Mohamed Nagy
- Personalised Medication Management Unit, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | - Jenny Nguyen
- Personalized Care Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Amy L Pasternak
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Natasha Petry
- Sanford Imagenetics, Sanford Health, Sioux Falls, South Dakota
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - April Schultz
- Sanford Imagenetics, Sanford Health, Sioux Falls, South Dakota
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, South Dakota
| | - Todd C Skaar
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hana Al Alshaykh
- Pharmaceutical Care Department, King Faisal Specialist Hospital and Research Center, College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - James M Stevenson
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachael M Stone
- Department of Pharmacy, University of Virginia, Charlottesville, Virginia
| | - Nam K Tran
- Department of Pathology and Laboratory Medicine, University of California Health, Sacramento, California
| | - Sony Tuteja
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Erica L Woodahl
- L.S. Skaggs Institute for Health Innovation and Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana
| | - Li-Chi Yuan
- Providence Health and Services, Irvine, California
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bosic-Reiniger J, Martin JL, Brown KE, Anderson HD, Blackburn H, Kao DP, Trinkley KE, Woodahl EL, Aquilante CL. Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings. JAMIA Open 2024; 7:ooae101. [PMID: 39399271 PMCID: PMC11471000 DOI: 10.1093/jamiaopen/ooae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 10/15/2024] Open
Abstract
Objective Understand perceived barriers to and facilitators of using clinical informatics applications for pharmacogenomic (PGx) implementation in resource-limited settings. Materials and Methods We conducted a qualitative research study using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview questions assessed CFIR contextual determinants related to: electronic health record (EHR) infrastructure; clinical informatics personnel and resources; EHR integration of PGx test results; PGx clinical decision support (CDS) tools; institutional resources; and partner receptivity. Transcripts were coded and analyzed to identify themes. Results We interviewed 24 clinical informaticists and executive leaders working in rural or underserved health care settings in Montana (n = 15) and Colorado (n = 9) and identified three major themes: (1) EHR infrastructure limitations, (2) insufficient supporting resources, and (3) unique contextual considerations for resource-limited settings. EHR infrastructure limitations included limited agency related to EHR build and interoperability concerns. Theme 1 highlighted challenges associated with integrating structured data into the EHR and inadequate vendor support. Theme 2 included limited familiarity with PGx across the care team, cost concerns, and allocation of non-financial resources. Theme 3 highlighted perceptions about the clinical utility of PGx within rural and underrepresented populations. Potential facilitators, such as being able to act nimbly, were found to coexist among the reported barriers. Discussion and Conclusion Our results provide insight into the clinical informatics infrastructure in resource-limited settings and identify unique considerations for clinical informatics-facilitated PGx implementation. Future efforts in these settings should consider innovative partnerships and strategies to leverage facilitators and minimize barriers associated with integrating PGx CDS applications.
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Affiliation(s)
- Jade Bosic-Reiniger
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Pharmacy Practice, University of Montana, Missoula, MT 59812, United States
| | - James L Martin
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Karen E Brown
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Biomedical and Pharmaceutical Sciences, University of Montana Skaggs School of Pharmacy, Missoula, MT 59812, United States
| | - Heather D Anderson
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States
| | - Hayley Blackburn
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Pharmacy Practice, University of Montana, Missoula, MT 59812, United States
| | - David P Kao
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Katy E Trinkley
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Erica L Woodahl
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Biomedical and Pharmaceutical Sciences, University of Montana Skaggs School of Pharmacy, Missoula, MT 59812, United States
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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Lim CX, Bozkurt A, Chen ZY, Hird A, Wickens J, Lazarakis S, Hussainy SY, Alexander M. Healthcare professionals' and consumers' knowledge, attitudes, perspectives, and education needs in oncology pharmacogenomics: A systematic review. Clin Transl Sci 2023; 16:2467-2482. [PMID: 37991131 PMCID: PMC10719462 DOI: 10.1111/cts.13672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
Clinical implementation of pharmacogenomic (PGx)-guided prescribing in oncology lags behind research evidence generation. We aimed to identify healthcare professionals' (HCPs) and consumers' knowledge, attitudes, perspectives, and education needs to inform strategies for implementation of scalable and sustainable oncology PGx programs. Systematic review of original articles indexed in EMBASE, EMCARE, MEDLINE, and PsycInfo from January 2012 until June 2022, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and using the Mixed Methods Appraisal Tool. PROSPERO registration number CRD42022352348. Of 1442 identified studies; 23 met inclusion criteria with 87% assessed high quality. Of these, 52% reported on HCPs, 35% on consumers, and 13% on both HCPs and consumers. Most were conducted in the United States (70%) and included multiple cancer types (74%). Across studies, HCPs and consumers mostly perceived value in PGx, however, both groups reported barriers to utilization, including cost, lack of consistent recommendations across guidelines, and limited knowledge among HCPs; test accuracy, clear testing benefits, and genomic information confidentiality among consumers. HCPs and consumers value and want to engage in PGx strategies in oncology care, however, are inhibited by unmet needs and practice and knowledge gaps. Implementation strategies aimed at addressing these issues may best support increased PGx uptake in oncology practice.
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Affiliation(s)
- Chiao Xin Lim
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Alistair Bozkurt
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Zi Yue Chen
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Abbey Hird
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Joanne Wickens
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Safeera Y. Hussainy
- Pharmacy Department, Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of General Practice, School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
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Magavern EF, Durrani F, Raza M, Lerner R, Islam MR, Clinch M, Caulfield MJ. British South Asian ancestry participants views of pharmacogenomics clinical implementation and research: a thematic analysis. THE PHARMACOGENOMICS JOURNAL 2023; 23:185-194. [PMID: 37907686 PMCID: PMC10661738 DOI: 10.1038/s41397-023-00317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND South Asian ancestry populations are underrepresented in genomic studies and therapeutics trials. British South Asians suffer from multi-morbidity leading to polypharmacy. Our objective was to elucidate British South Asian ancestry community perspectives on pharmacogenomic implementation and sharing pharmacogenomic clinical data for research. METHODS Four focus groups were conducted (9-12 participants in each). Two groups were mixed gender, while one group was male only and one was female only. Simultaneous interpretation was available to participants in Urdu and Bengali. Focus groups were recorded and abridged transcription and thematic analysis were undertaken. RESULTS There were 42 participants, 64% female. 26% were born in the UK or Europe. 52% were born in Bangladesh and 17% in Pakistan. 36% reported university level education. Implementation of pharmacogenomics was perceived to be beneficial to individuals but pose a risk of overburdening resource limited systems. Pharmacogenomic research was perceived to be beneficial to the community, with concerns about data privacy and misuse. Data sharing was desirable if the researchers did not have a financial stake, and benefits would be shared. Trust was the key condition for the acceptability of both clinical implementation and research. Trust was linked with medication compliance. Education, outreach, and communication facilitate trust. CONCLUSIONS (SIGNIFICANCE AND IMPACT OF THE STUDY) Pharmacogenomics implementation with appropriate education and communication has the potential to enhance trust and contribute to increased medication compliance. Trust drives data sharing, which would enable enhanced representation in research. Representation in scientific evidence base could cyclically enhance trust and compliance.
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Grants
- Wellcome Trust
- This work forms part of the portfolio and was funded by the National Institute for Health Research Barts Biomedical Research Centre. EFM is funded by Barts Charity. Genes & Health is/has recently been core-funded by Wellcome (WT102627, WT210561), the Medical Research Council (UK) (M009017, MR/X009777/1, MR/X009920/1), Higher Education Funding Council for England Catalyst, Barts Charity (845/1796), Health Data Research UK (for London substantive site), and research delivery support from the NHS National Institute for Health Research Clinical Research Network (North Thames). Genes & Health is/has recently been funded by Alnylam Pharmaceuticals, Genomics PLC; and a Life Sciences Industry Consortium of Astra Zeneca PLC, Bristol-Myers Squibb Company, GlaxoSmithKline Research and Development Limited, Maze Therapeutics Inc, Merck Sharp & Dohme LLC, Novo Nordisk A/S, Pfizer Inc, Takeda Development Centre Americas Inc. We thank Social Action for Health, Centre of The Cell, members of our Community Advisory Group, and staff who have recruited and collected data from volunteers. We thank the NIHR National Biosample Centre (UK Biocentre), the Social Genetic & Developmental Psychiatry Centre (King’ College London), Wellcome Sanger Institute, and Broad Institute for sample processing, genotyping, sequencing and variant annotation.
- Genes & Health is/has recently been core-funded by Wellcome (WT102627, WT210561), the Medical Research Council (UK) (M009017, MR/X009777/1, MR/X009920/1), Higher Education Funding Council for England Catalyst, Barts Charity (845/1796), Health Data Research UK (for London substantive site), and research delivery support from the NHS National Institute for Health Research Clinical Research Network (North Thames). Genes & Health is/has recently been funded by Alnylam Pharmaceuticals, Genomics PLC; and a Life Sciences Industry Consortium of Astra Zeneca PLC, Bristol-Myers Squibb Company, GlaxoSmithKline Research and Development Limited, Maze Therapeutics Inc, Merck Sharp & Dohme LLC, Novo Nordisk A/S, Pfizer Inc, Takeda Development Centre Americas Inc. We thank Social Action for Health, Centre of The Cell, members of our Community Advisory Group, and staff who have recruited and collected data from volunteers. We thank the NIHR National Biosample Centre (UK Biocentre), the Social Genetic & Developmental Psychiatry Centre (King’ College London), Wellcome Sanger Institute, and Broad Institute for sample processing, genotyping, sequencing and variant annotation.
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Affiliation(s)
- Emma F Magavern
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Faiza Durrani
- Genes & Health, Blizard Institute, Queen Mary University of London, London, E1 2AB, UK
| | - Mehru Raza
- Genes & Health, Blizard Institute, Queen Mary University of London, London, E1 2AB, UK
| | - Robin Lerner
- Genes & Health, Blizard Institute, Queen Mary University of London, London, E1 2AB, UK
| | | | - Megan Clinch
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Mark J Caulfield
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
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Brown KE, Fohner AE, Woodahl EL. Beyond the Individual: Community-Centric Approaches to Increase Diversity in Biomedical Research. Clin Pharmacol Ther 2023; 113:509-517. [PMID: 36448873 DOI: 10.1002/cpt.2808] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Abstract
Community-centric approaches to engage underrepresented populations-including community engagement, community-level consent practices, and capacity development for research-are means to enhance diversity in biomedical research populations in a more ethical way. Low diversity is a known problem in biomedical research that presents challenges in translating the benefits of research to the global population. Through long-term partnerships built on trust and collaboration, communities who would otherwise avoid research may be more willing to participate. When communities are engaged in research as partners and research questions are motivated by community health priorities, research is more meaningful and research methods are more respectful. Conversely, a lack of consultation throughout the research process can further alienate the very communities that these efforts are designed to engage. A number of underserved populations-for example American Indian and Alaska Native peoples-may value the benefits of research to a community equally or more than individual benefits. A community's autonomy must be considered, particularly when that community is not adequately protected by traditional informed consent processes. Opportunities for capacity development to support collaborative partnerships between communities and researchers are required to support engagement and understanding of the research process. Changes to research processes and infrastructure that encourage a higher level of research oversight within the community should be supported. In this paper, we present approaches that may improve diversity and equitable access to research and the delivery of health innovations for people that have historically been left out of biomedical research.
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Affiliation(s)
- Karen E Brown
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, Montana, USA
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, USA
| | - Alison E Fohner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Institute of Public Health Genetics, University of Washington, Seattle, Washington, USA
| | - Erica L Woodahl
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, Montana, USA
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, USA
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Brown JT, McGonagle E, Seifert R, Speedie M, Jacobson PA. Addressing disparities in pharmacogenomics through rural and underserved workforce education. Front Genet 2023; 13:1082985. [PMID: 36726715 PMCID: PMC9884975 DOI: 10.3389/fgene.2022.1082985] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction: While pharmacogenomic (PGx) testing is routine in urban healthcare institutions or academic health centers with access to existing expertise, uptake in medically-underserved areas is lagging. The primary objective of this workforce education program is to extend access to didactic, case-based and clinical PGx training for pharmacists serving rural Minnesota and populations experiencing health disparities in Minnesota. Methods: A PGx workforce training program funded through the Minnesota Department of Health was offered through the University of Minnesota College of Pharmacy (COP) to pharmacists working in rural and/or underserved areas in the state of Minnesota. Learning activities included a 16-week, asynchronous PGx didactic course covering PGx topics, a 15-min recorded presentation, an in-person PGx case-based workshop, and a live international PGx Conference hosted by the University of Minnesota COP and attendance at our PGx Extension of Community Health Outcomes (ECHO). Results: Twenty-nine pharmacists applied for the initial year of the program, with 12 (41%) being accepted. Four (33%) practiced in a hospital setting, four (33%) in retail pharmacy, two (17%) in managed care, and two (17%) in other areas. The majority had not implemented a PGx program as part of their practice, although nearly all responded definitely or probably yes when asked if they expected their organization to increase its use of PGx testing services over the next three years. All participants either strongly or somewhat agreed that this program helped them identify how and where to access clinical PGx guidelines and literature and improved their ability to read and interpret PGx test results. Eight participants (67%) strongly or somewhat agreed that they expected to increase the number of PGx consultations in their practice, while ten (83%) strongly or somewhat agreed they would be able to apply what they learned in this program to their practice in the next six months to a year. Discussion: This novel PGx training program focused exclusively on pharmacists in rural and/or underserved areas with a delivery method that could be accomplished conveniently and remotely. Although most participants' organizations had yet to implement PGx testing routinely, most anticipated this to change in the next few years.
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Affiliation(s)
- Jacob T. Brown
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, MN, United States,*Correspondence: Jacob T. Brown,
| | - Erin McGonagle
- Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Randall Seifert
- Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Marilyn Speedie
- Medicinal Chemistry, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Pamala A. Jacobson
- Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
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Leitch TM, Killam SR, Brown KE, Katseanes KC, George KM, Schwanke C, Loveland J, Elias AF, Haney K, Krebsbach K, Muzquiz LI, Trinidad SB, Woodahl EL. Ensuring equity: Pharmacogenetic implementation in rural and tribal communities. Front Pharmacol 2022; 13:953142. [PMID: 36176435 PMCID: PMC9514788 DOI: 10.3389/fphar.2022.953142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Implementation strategies for pharmacogenetic testing have been largely limited to major academic medical centers and large health systems, threatening to exacerbate healthcare disparities for rural and tribal populations. There exists a need in Montana (United States)-a state where two-thirds of the population live in rural areas and with a large proportion of tribal residents-to develop novel strategies to make pharmacogenetic testing more broadly available. We established partnerships between University of Montana (UM) and three early adopter sites providing patient-centered care to historically neglected populations. We conducted 45 semi-structured interviews with key stakeholders at each site and solicited participant feedback on the utility of a centralized pharmacogenetic service at UM offering consultations to patients and providers statewide via telehealth. For settings serving rural patients-tribal and non-tribal-participants described healthcare facilities without adequate infrastructure, personnel, and funding to implement pharmacogenetic services. Participants serving tribal communities stressed the need for ethical practices for collecting biospecimens and returning genetic results to patients, largely due to historical and contemporary traumas experienced by tribal populations with regard to genetic research. Participants expressed that pharmacogenetic testing could benefit patients by achieving therapeutic benefit sooner, reducing the risk of side effects, and improving adherence outcomes for patients with limited access to follow-up services in remote areas. Others expressed concern that financial barriers to pharmacogenetic testing for patients of lower socioeconomic status would further exacerbate inequities in care. Participants valued the role of telehealth to deliver pharmacogenetic consults from a centralized service at UM, describing the ability to connect providers and patients to resources and expertise as imperative to driving successful pharmacogenetic implementation. Our results support strategies to improve access to pharmacogenetic testing for neglected patient populations and create opportunities to reduce existing healthcare inequities. By exploring critical challenges for pharmacogenetic implementation focused on serving underserved communities, this work can help guide equitable frameworks to serve as a model for other resource-limited settings looking to initiate pharmacogenetic testing.
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Affiliation(s)
- Tianna M. Leitch
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
| | - Shayna R. Killam
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
| | - Karen E. Brown
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
| | - Kirk C. Katseanes
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
| | - Kathleen M. George
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
| | | | | | | | - Kerry Haney
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
- Partnership Health Center, Missoula, MT, United States
| | | | - LeeAnna I. Muzquiz
- Tribal Health Department of the Confederated Salish and Kootenai Tribes, St. Ignatius, MT, United States
| | - Susan B. Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - Erica L. Woodahl
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT, United States
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Beans JA, Trinidad SB, Blacksher E, Hiratsuka VY, Spicer P, Woodahl EL, Boyer BB, Lewis CM, Gaffney PM, Garrison NA, Burke W. Communicating Precision Medicine Research: Multidisciplinary Teams and Diverse Communities. Public Health Genomics 2022; 25:1-9. [PMID: 35998578 PMCID: PMC9947193 DOI: 10.1159/000525684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Precision medicine research investigates the differences in individuals' genetics, environment, and lifestyle to tailor health prevention and treatment options as part of an emerging model of health care delivery. Advancing precision medicine research will require effective communication across a wide range of scientific and health care disciplines and with research participants who represent diverse segments of the population. METHODS A multidisciplinary group convened over the course of a year and developed precision medicine research case examples to facilitate precision medicine research discussions with communities. RESULTS A shared definition of precision medicine research as well as six case examples of precision medicine research involving genetic risk, pharmacogenetics, epigenetics, the microbiome, mobile health, and electronic health records were developed. DISCUSSION/CONCLUSION The precision medicine research definition and case examples can be used as planning tools to establish a shared understanding of the scope of precision medicine research across multidisciplinary teams and with the diverse communities in which precision medicine research will take place. This shared understanding is vital for successful and equitable progress in precision medicine.
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Affiliation(s)
- Julie A. Beans
- Southcentral Foundation Research Department, Anchorage, Alaska, United States of America
| | - Susan B. Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, United States of America
| | - Erika Blacksher
- Department of History and Philosophy of Medicine, University of Kansas City Medical Center, Kansas City, Kansas, United States of America Center for Practical Bioethics, Kansas City, Missouri, United States of America
| | - Vanessa Y. Hiratsuka
- Southcentral Foundation Research Department, Anchorage, Alaska, United States of America
- Center for Human Development, University of Alaska Anchorage, Anchorage, Alaska, United States of America
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Erica L. Woodahl
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, United States of America
| | - Bert B. Boyer
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, Oregon, United States of America
| | - Cecil M. Lewis
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, United States of America
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Patrick M. Gaffney
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America
| | - Nanibaa’ A. Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, California, United States of America
- Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, United States of America
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Blacksher E, Trinidad SB, Woodbury RB, Hopkins SE, Woodahl EL, Boyer BB, Burke W, Hiratsuka V. Tribal Deliberations about Precision Medicine Research: Addressing Diversity and Inequity in Democratic Deliberation Design and Evaluation. J Empir Res Hum Res Ethics 2022; 17:304-316. [PMID: 35225705 PMCID: PMC9173705 DOI: 10.1177/15562646221081267] [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] [Indexed: 11/17/2022]
Abstract
Deliberative democratic engagement is used around the globe to gather informed public input on contentious collective questions. Yet, rarely has it been used to convene individuals exclusively from Indigenous communities. The relative novelty of using this approach to engage tribal communities and concerns about diversity and inequities raise important methodological questions. We describe the design and quality outcomes for a 2.5-day deliberation that elicited views of American Indian and Alaska Native (AIAN) leaders about the potential value and ethical conduct of precision medicine research (PMR), an emerging approach to research that investigates the health effects of individual genetic variation in tandem with variation in health-relevant practices, social determinants, and environmental exposures. The event met key goals, such as relationship and rapport formation, cross-site learning, equality of opportunity to participate, and respect among participants in the context of disagreement.
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Best S, Vidic N, An K, Collins F, White SM. A systematic review of geographical inequities for accessing clinical genomic and genetic services for non-cancer related rare disease. Eur J Hum Genet 2022; 30:645-652. [PMID: 35046503 DOI: 10.1038/s41431-021-01022-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
Place plays a significant role in our health. As genetic/genomic services evolve and are increasingly seen as mainstream, especially within the field of rare disease, it is important to ensure that where one lives does not impede access to genetic/genomic services. Our aim was to identify barriers and enablers of geographical equity in accessing clinical genomic or genetic services. We undertook a systematic review searching for articles relating to geographical access to genetic/genomic services for rare disease. Searching the databases Medline, EMBASE and PubMed returned 1803 papers. Screening led to the inclusion of 20 articles for data extraction. Using inductive thematic analysis, we identified four themes (i) Current service model design, (ii) Logistical issues facing clinicians and communities, (iii) Workforce capacity and capability and iv) Rural culture and consumer beliefs. Several themes were common to both rural and urban communities. However, many themes were exacerbated for rural populations due to a lack of clinician access to/relationships with genetic specialist staff, the need to provide more generalist services and a lack of genetic/genomic knowledge and skill. Additional barriers included long standing systemic service designs that are not fit for purpose due to historically ad hoc approaches to delivery of care. There were calls for needs assessments to clarify community needs. Enablers of geographically equitable care included the uptake of new innovative models of care and a call to raise both community and clinician knowledge and awareness to demystify the clinical offer from genetics/genomics services.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia. .,Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Nada Vidic
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Kim An
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Felicity Collins
- Clinical Genetics Service, Institute of Precision Medicine and Bioinformatics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Divisions of Genomic Medicine, Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Susan M White
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Melbourne, VIC, Australia
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Zubiaur P, Prósper-Cuesta DN, Novalbos J, Mejía-Abril G, Navares-Gómez M, Villapalos-García G, Soria-Chacartegui P, Abad-Santos F. Patients’ Perceptions of Pharmacogenetic Testing and Access to Their Results: State of the Art in Spain and Systematic Review. J Pers Med 2022; 12:jpm12020270. [PMID: 35207758 PMCID: PMC8879541 DOI: 10.3390/jpm12020270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022] Open
Abstract
The process of clinical pharmacogenetics implementation depends on patients’ and general population’s perceptions. To date, no study has been published addressing Spanish patients’ opinions on pharmacogenetic testing, the availability of the results, and the need for signing informed consent. In this work, we contacted 146 patients that had been previously genotyped at our laboratory and 46 healthy volunteers that had participated in a bioequivalence clinical trial at the Clinical Pharmacology Department of Hospital Universitario de La Princesa and consented to pharmacogenetic testing for research purposes. From the latter, 108 and 34, respectively, responded to the questionnaire (i.e., a response rate of 74%); Participants were scheduled for a face-to-face, telephone, or videoconference interview and were asked a total of 27 questions in Spanish. Great or almost complete acceptance of pharmacogenetic testing was observed (99.3%), age and university education level being the main predictors of acceptance rates and understanding (multivariate analysis, p = 0.004, R2 = 0.17, age being inversely proportional to acceptance rates and understanding and university level being related to higher acceptance rates and understanding compared to other education levels). Mixed perceptions were observed on the requirement of written informed consent (55.6% in favor); therefore, it seems recommendable to continue requesting it for the upcoming years until more perceptions are collected. The majority of participants (95.8%) preferred storing pharmacogenetic results in medical records rather than in electronic sources (55.6%) and highly agreed with the possibility of carrying their results on a portable card (91.5%). Patients agreed to broad genetic testing, including biomarkers unrelated to their disease (93.7%) or with little clinically relevant evidence (94.4%). Patients apparently rely on clinician’s or pharmacogeneticist’s interpretation and seem, therefore, open to the generation of ethically challenging information. Finally, although most patients (68.3%) agreed with universal population testing, some were reluctant, probably due to the related costs and sustainability of the Spanish Health System. This was especially evident in the group of patients who were older and with a likely higher proportion of pensioners.
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Affiliation(s)
- Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28006 Madrid, Spain
- Correspondence: (P.Z.); (F.A.-S.); Tel.: +34-915202425 (P.Z. & F.A.-S.); Fax: +34-915202540 (P.Z. & F.A.-S.)
| | - David Nicolás Prósper-Cuesta
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Jesús Novalbos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Gina Mejía-Abril
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Marcos Navares-Gómez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Gonzalo Villapalos-García
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Paula Soria-Chacartegui
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (D.N.P.-C.); (J.N.); (G.M.-A.); (M.N.-G.); (G.V.-G.); (P.S.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28006 Madrid, Spain
- Correspondence: (P.Z.); (F.A.-S.); Tel.: +34-915202425 (P.Z. & F.A.-S.); Fax: +34-915202540 (P.Z. & F.A.-S.)
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12
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Lau-Min KS, Varughese LA, Nelson MN, Cambareri C, Reddy NJ, Oyer RA, Teitelbaum UR, Tuteja S. Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies: a qualitative study of barriers to implementation. BMC Cancer 2022; 22:47. [PMID: 34996412 PMCID: PMC8742388 DOI: 10.1186/s12885-022-09171-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Pharmacogenetic (PGx) testing for germline variants in the DPYD and UGT1A1 genes can be used to guide fluoropyrimidine and irinotecan dosing, respectively. Despite the known association between PGx variants and chemotherapy toxicity, preemptive testing prior to chemotherapy initiation is rarely performed in routine practice. Methods We conducted a qualitative study of oncology clinicians to identify barriers to using preemptive PGx testing to guide chemotherapy dosing in patients with gastrointestinal malignancies. Each participant completed a semi-structured interview informed by the Consolidated Framework for Implementation Research (CFIR). Interviews were analyzed using an inductive content analysis approach. Results Participants included sixteen medical oncologists and nine oncology pharmacists from one academic medical center and two community hospitals in Pennsylvania. Barriers to the use of preemptive PGx testing to guide chemotherapy dosing mapped to four CFIR domains: intervention characteristics, outer setting, inner setting, and characteristics of individuals. The most prominent themes included 1) a limited evidence base, 2) a cumbersome and lengthy testing process, and 3) a lack of insurance coverage for preemptive PGx testing. Additional barriers included clinician lack of knowledge, difficulty remembering to order PGx testing for eligible patients, challenges with PGx test interpretation, a questionable impact of preemptive PGx testing on clinical care, and a lack of alternative therapeutic options for some patients found to have actionable PGx variants. Conclusions Successful adoption of preemptive PGx-guided chemotherapy dosing in patients with gastrointestinal malignancies will require a multifaceted effort to demonstrate clinical effectiveness while addressing the contextual factors identified in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09171-6.
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Affiliation(s)
- Kelsey S Lau-Min
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Varughese
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, Smilow Center for Translational Research, University of Pennsylvania, 3400 Civic Center Boulevard, Bldg. 421 11th Floor, Room 143, Philadelphia, PA, 19104-5158, USA
| | | | - Christine Cambareri
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nandi J Reddy
- Ann B. Barshinger Cancer Institute, Penn Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Randall A Oyer
- Ann B. Barshinger Cancer Institute, Penn Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Ursina R Teitelbaum
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sony Tuteja
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, Smilow Center for Translational Research, University of Pennsylvania, 3400 Civic Center Boulevard, Bldg. 421 11th Floor, Room 143, Philadelphia, PA, 19104-5158, USA.
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13
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Minvielle E, Fourcade A, Ricketts T, Waelli M. Current developments in delivering customized care: a scoping review. BMC Health Serv Res 2021; 21:575. [PMID: 34120603 PMCID: PMC8201906 DOI: 10.1186/s12913-021-06576-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care. METHODS Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included "care customization", "personalized service and health care", individualized care" and "targeting population" in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. RESULTS We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. CONCLUSIONS There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.
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Affiliation(s)
- Etienne Minvielle
- i3-Centre de Recherche en Gestion, Institut Interdisciplinaire de l’Innovation (UMR 9217), École polytechnique, Batiment Ensta, 828, Boulevard des Maréchaux, 91762 Palaiseau Cedex, France
- Institut Gustave Roussy, 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - Aude Fourcade
- Institut Gustave Roussy, 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - Thomas Ricketts
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Mathias Waelli
- MOS (EA 7418), French School of Public Health, Rennes, France
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Abstract
Genomic information is poised to play an increasing role in clinical care, extending beyond highly penetrant genetic conditions to less penetrant genotypes and common disorders. But with this shift, the question of clinical utility becomes a major challenge. A collaborative effort is necessary to determine the information needed to evaluate different uses of genomic information and then acquire that information. Another challenge must also be addressed if that process is to provide equitable benefits: the lack of diversity of genomic data. Current genomic knowledge comes primarily from populations of European descent, which poses the risk that most of the human population will be shortchanged when health benefits of genomics emerge. These two challenges have defined my career as a geneticist and have taught me that solutions must start with dialogue across disciplinary and social divides.
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Affiliation(s)
- Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington 98195, USA;
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15
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Liko I, Corbin L, Tobin E, Aquilante CL, Lee YM. Implementation of a pharmacist-provided pharmacogenomics service in an executive health program. Am J Health Syst Pharm 2021; 78:1094-1103. [PMID: 33772264 DOI: 10.1093/ajhp/zxab137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center. SUMMARY As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient's current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement. CONCLUSION The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.
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Affiliation(s)
- Ina Liko
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
| | - Lisa Corbin
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO,USA
| | - Eric Tobin
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
| | - Yee Ming Lee
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
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Stegelmeier J, Nartker C, Barnes C, Rayo H, Hoover R, Boyle J, O’Connor S, Barrott J. Rural Community Perceptions and Interests in Pharmacogenomics. Healthcare (Basel) 2020; 8:E159. [PMID: 32516951 PMCID: PMC7348789 DOI: 10.3390/healthcare8020159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
Pharmacogenomics testing is a rapidly expanding field with increasing importance to individualized patient care. However, it remains unclear whether the general public in rural areas would be willing to engage in this service. The objective of this survey was to determine rural community-dwelling members' perceptions of pharmacogenomics. A questionnaire was developed consisting of five Likert-style questions on knowledge and perceptions of pharmacogenomics, a single multiple-choice question on cost of testing, and a free-response question. Two cohorts received the same questionnaire: attendees at a university-sponsored health fair and patients presenting to two independent community pharmacies in southeastern Idaho. While both showed positive reception to the implementation and value of pharmacogenomics, those at the health fair were more in favor of pharmacogenomics, suggesting a need for greater outreach and education to the general public. The findings suggest that interest of rural community-dwelling individuals may be amenable to the expansion of pharmacogenomics testing.
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Affiliation(s)
| | | | | | | | | | | | | | - Jared Barrott
- College of Pharmacy, Idaho State University, 921 S. 8th Ave., Pocatello, ID 83201, USA; (J.S.); (C.N.); (C.B.); (H.R.); (R.H.); (J.B.); (S.O.)
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17
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Fohner AE, Volk KG, Woodahl EL. Democratizing Precision Medicine Through Community Engagement. Clin Pharmacol Ther 2019; 106:488-490. [PMID: 31206610 DOI: 10.1002/cpt.1508] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Alison E Fohner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Institute of Public Health Genetics, University of Washington, Seattle, Washington, USA
| | - Kyle G Volk
- Department of History, University of Montana, Missoula, Montana, USA
| | - Erica L Woodahl
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, USA
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Olander M, Waring S, Stenehjem DD, Taran A, Ranelli P, Brown JT. Primary Care Clinicians Attitudes and Knowledge of Pharmacogenetics in a Large, Multi-state, Healthcare System. Innov Pharm 2018; 9:1-12. [PMID: 34007697 PMCID: PMC6438554 DOI: 10.24926/iip.v9i2.970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Considerable progress has been made in the way of pharmacogenetic research and the development of clinical recommendations; however, its implementation into clinical practice has been slower than anticipated. We sought to better understand its lack of clinical uptake within primary care. AIM The primary objective of this survey was to ascertain primary care clinicians' perceptions of pharmacogenetic use and implementation in an integrated health system of metropolitan and rural settings across several states. METHODS Primary care clinicians (including MDs, DOs, NPs, and PAs) were invited to participate in a survey via email. Questions about pharmacogenetics knowledge and perceptions were presented to assess current understanding and usage of pharmacogenetics in practice. RESULTS The rate of response for the survey was 17%. Of the 90 respondents, 58% were female, 69% were MDs/DOs, 20% were NPs, and 11% were PAs. Fifty-eight percent of respondents received their clinical degree in or after 2000. Ninety percent of respondents noted that they were uncomfortable ordering a pharmacogenetics test, with 76% stating they were uncomfortable applying the results of a pharmacogenetic test. Notably, 78% of respondents were interested in having pharmacogenetic testing available through Medication Therapy Management (MTM) services, although PAs were significantly less interested as compared to NPs and MD/DOs. Ninety-five percent of respondents were interested in a clinical decision support tool relevant to pharmacogenetic results. CONCLUSIONS As a whole, prescribing clinicians in primary care clinics are uncomfortable in the ordering, interpreting, and applying pharmacogenetic results to individual patients. However, favorable attitudes towards providing pharmacogenetic testing through existing MTM clinics provides the opportunity for pharmacists to advance existing practices.
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Moyer AM, Rohrer Vitek CR, Giri J, Caraballo PJ. Challenges in Ordering and Interpreting Pharmacogenomic Tests in Clinical Practice. Am J Med 2017; 130:1342-1344. [PMID: 28757317 DOI: 10.1016/j.amjmed.2017.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
| | | | - Jyothsna Giri
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minn
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McKillip RP, Borden BA, Galecki P, Ham SA, Patrick-Miller L, Hall JP, Hussain S, Danahey K, Siegler M, Sorrentino MJ, Sacro Y, Davis AM, Rubin DT, Lipstreuer K, Polonsky TS, Nanda R, Harper WR, Koyner JL, Burnet DL, Stadler WM, Ratain MJ, Meltzer DO, O'Donnell PH. Patient Perceptions of Care as Influenced by a Large Institutional Pharmacogenomic Implementation Program. Clin Pharmacol Ther 2017; 102:106-114. [PMID: 27981566 DOI: 10.1002/cpt.586] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/14/2016] [Accepted: 11/18/2016] [Indexed: 12/21/2022]
Abstract
Despite growing clinical use of genomic information, patient perceptions of genomic-based care are poorly understood. We prospectively studied patient-physician pairs who participated in an institutional pharmacogenomic implementation program. Trust/privacy/empathy/medical decision-making (MDM)/personalized care dimensions were assessed through patient surveys after clinic visits at which physicians had access to preemptive pharmacogenomic results (Likert scale, 1 = minimum/5 = maximum; mean [SD]). From 2012-2015, 1,261 surveys were issued to 507 patients, with 792 (62.8%) returned. Privacy, empathy, MDM, and personalized care scores were significantly higher after visits when physicians considered pharmacogenomic results. Importantly, personalized care scores were significantly higher after physicians used pharmacogenomic information to guide medication changes (4.0 [1.4] vs. 3.0 [1.6]; P < 0.001) compared with prescribing visits without genomic guidance. Multivariable modeling controlling for clinical factors confirmed personalized care scores were more favorable after visits with genomic-influenced prescribing (odds ratio [OR] = 3.26; 95% confidence interval [CI] = (1.31-8.14); P < 0.05). Physicians seem to individualize care when utilizing pharmacogenomic results and this decision-making augmentation is perceived positively by patients.
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Affiliation(s)
- R P McKillip
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - B A Borden
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA
| | - P Galecki
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA
| | - S A Ham
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois, USA
| | - L Patrick-Miller
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - J P Hall
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA
| | - S Hussain
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA
| | - K Danahey
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Center for Research Informatics, The University of Chicago, Chicago, Illinois, USA
| | - M Siegler
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA.,MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA
| | - M J Sorrentino
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Y Sacro
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - A M Davis
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - D T Rubin
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - K Lipstreuer
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - T S Polonsky
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - R Nanda
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - W R Harper
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - J L Koyner
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - D L Burnet
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - W M Stadler
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - M J Ratain
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA
| | - D O Meltzer
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - P H O'Donnell
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine, The University of Chicago, Chicago, Illinois, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA
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Morales CT, Muzquiz LI, Howlett K, Azure B, Bodnar B, Finley V, Incashola T, Mathias C, Laukes C, Beatty P, Burke W, Pershouse MA, Putnam EA, Trinidad SB, James R, Woodahl EL. Partnership with the Confederated Salish and Kootenai Tribes: Establishing an Advisory Committee for Pharmacogenetic Research. Prog Community Health Partnersh 2016; 10:173-83. [PMID: 27346763 DOI: 10.1353/cpr.2016.0035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inclusion of American Indian and Alaska Native (AI/AN) populations in pharmacogenetic research is key if the benefits of pharmacogenetic testing are to reach these communities. Community-based participatory research (CBPR) offers a model to engage these communities in pharmacogenetics. OBJECTIVES An academic-community partnership between the University of Montana (UM) and the Confederated Salish and Kootenai Tribes (CSKT) was established to engage the community as partners and advisors in pharmacogenetic research. METHODS A community advisory committee, the Community Pharmacogenetics Advisory Council (CPAC), was established to ensure community involvement in the research process. To promote bidirectional learning, researchers gave workshops and presentations about pharmacogenetic research to increase research capacity and CPAC members trained researchers in cultural competencies. As part of our commitment to a sustainable relationship, we conducted a self-assessment of the partnership, which included surveys and interviews with CPAC members and researchers. RESULTS Academic and community participants agree that the partnership has promoted a bidirectional exchange of knowledge. Interviews showed positive feedback from the perspectives of both the CPAC and researchers. CPAC members discussed their trust in and support of the partnership, as well as having learned more about research processes and pharmacogenetics. Researchers discussed their appreciation of CPAC involvement in the project and guidance the group provided in understanding the CSKT community and culture. DISCUSSION We have created an academic-community partnership to ensure CSKT community input and to share decision making about pharmacogenetic research. Our CBPR approach may be a model for engaging AI/AN people, and other underserved populations, in genetic research.
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Trinidad SB, Coffin TB, Fullerton SM, Ralston J, Jarvik GP, Larson EB. "Getting off the Bus Closer to Your Destination": Patients' Views about Pharmacogenetic Testing. Perm J 2015; 19:21-7. [PMID: 26057686 DOI: 10.7812/tpp/15-046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors conducted focus groups with patients prescribed antidepressants (pilot session plus 2 focus groups, n = 27); patients prescribed carbamazepine (2 focus groups, n = 17); and healthy patients (2 focus groups, n = 17). Although participants understood the potential advantages of pharmacogenetic testing, many felt that the risks (discrimination, stigmatization, physician overreliance on genomic results, and denial of certain medications) may outweigh the benefits. These concerns were shared across groups but were more strongly expressed among participants with chronic mental health diagnoses.
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Affiliation(s)
- Susan Brown Trinidad
- Research Scientist in Bioethics and Humanities at the University of Washington in Seattle.
| | - Tara B Coffin
- Doctoral Candidate in the Institute for Public Health Genetics at the University of Washington in Seattle.
| | - Stephanie M Fullerton
- Associate Professor in Bioethics and Humanities at the University of Washington in Seattle.
| | - James Ralston
- Associate Investigator at the Group Health Research Institute in Seattle, WA.
| | - Gail P Jarvik
- Professor and Head of the Division of Medical Genetics at the University of Washington in Seattle.
| | - Eric B Larson
- Executive Director and Senior Investigator at the Group Health Research Institute in Seattle, WA.
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