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Brothers KB, Cooper GM, McNamara KC, Lemke AA, Timmons J, Rich CA, Cadigan RJ, Ponsaran RS, Goldenberg AJ. Moving to the Middle Ground: Redefining Genomic Utility to Expand Understanding of Familial Benefit. Ethics Hum Res 2024; 46:43-48. [PMID: 38240400 DOI: 10.1002/eahr.500199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Translational research has tended to ignore the question of whether receiving a genomic diagnosis provides utility in community care contexts outside of doctors' offices and hospitals. However, empirical research with parents has highlighted numerous ways that a genomic diagnosis might be of practical value in the care provided by teachers, physical or occupational therapists, speech-language pathologists, behavior analysts, and nonphysician mental health providers. In this essay, we propose a new conceptual model of genomic utility that offers the opportunity to better capture a broad range of potential implications of genomic technologies for families in various social and organizational systems. We explore crucial research directions to better understand how redefined utility might affect families and nonphysician professionals.
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Affiliation(s)
- Kyle B Brothers
- Professor of pediatrics at the University of Louisville and the chief scientific officer for the Norton Children's Research Institute
| | - Greg M Cooper
- Faculty investigator at the HudsonAlpha Institute for Biotechnology
| | - Katelyn C McNamara
- Research coordinator at Norton Children's Research Institute and a physical therapist at Norton Children's Hospital
| | - Amy A Lemke
- Associate professor of pediatrics at the University of Louisville and the director for community engaged research at Norton Children's Research Institute
| | - Josie Timmons
- Graduate student in the Women's, Gender and Sexuality Studies program at the University of Louisville
| | - Carla A Rich
- Senior research coordinator at Norton Children's Research Institute
| | - R Jean Cadigan
- Professor of social medicine and a core faculty member in the Center for Bioethics at the University of North Carolina, Chapel Hill
| | - Roselle S Ponsaran
- Senior research associate and assistant research director for the Department of Bioethics at Case Western Reserve University School of Medicine
| | - Aaron J Goldenberg
- Professor, the research director, and the vice chair in the Department of Bioethics & Medical Humanities at Case Western Reserve University School of Medicine
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2
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Taber JM, Peters E, Klein WMP, Cameron LD, Turbitt E, Biesecker BB. Motivations to learn genomic information are not exceptional: Lessons from behavioral science. Clin Genet 2023; 104:397-405. [PMID: 37491896 DOI: 10.1111/cge.14401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023]
Abstract
Whether to undergo genome sequencing in a clinical or research context is generally a voluntary choice. Individuals are often motivated to learn genomic information even when clinical utility-the possibility that the test could inform medical recommendations or health outcomes-is low or absent. Motivations to seek one's genomic information can be cognitive, affective, social, or mixed (e.g., cognitive and affective) in nature. These motivations are based on the perceived value of the information, specifically, its clinical utility and personal utility. We suggest that motivations to learn genomic information are no different from motivations to learn other types of personal information, including one's health status and disease risk. Here, we review behavioral science relevant to motivations that may drive engagement with genome sequencing, both in the presence of varying degrees of clinical utility and in the absence of clinical utility. Specifically, we elucidate 10 motivations that are expected to underlie decisions to undergo genome sequencing. Recognizing these motivations to learn genomic information will guide future research and ultimately help clinicians to facilitate informed decision making among individuals as genome sequencing becomes increasingly available.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Ellen Peters
- Center for Science Communication Research and Psychology Department, University of Oregon, Eugene, Oregon, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Linda D Cameron
- Department of Psychological Sciences, University of California, Merced, California, USA
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Barbara B Biesecker
- Genomics, Bioinformatics and Translational Science, RTI International, Research Triangle Park, North Carolina, USA
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3
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Halley MC, Young JL, Fernandez L, Kohler JN, Bernstein JA, Wheeler MT, Tabor HK. Perceived utility and disutility of genomic sequencing for pediatric patients: Perspectives from parents with diverse sociodemographic characteristics. Am J Med Genet A 2022; 188:1088-1101. [PMID: 34981646 DOI: 10.1002/ajmg.a.62619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/04/2021] [Accepted: 12/05/2021] [Indexed: 12/30/2022]
Abstract
Given the limited therapeutic options for most rare diseases diagnosed through genomic sequencing (GS) and the proportion of patients who remain undiagnosed even after GS, it is important to characterize a broader range of benefits and potential harms of GS from the perspectives of families with diverse sociodemographic characteristics. We recruited parents of children enrolled in the Undiagnosed Diseases Network. Parents completed an in-depth interview, and we conducted a comparative content analysis of the data. Parents (n = 30) were demographically diverse, with 43.3% identifying as Hispanic, 33.3% primarily Spanish-speaking, and widely variable household income and education. Parents reported minimal changes in their child's health status following GS but did report a range of other forms of perceived utility, including improvements in their child's healthcare management and access, in their own psychological well-being, and in disease-specific social connections and research opportunities. Parents who received a diagnosis more frequently perceived utility across all domains; however, disutility also was reported by both those with and without a diagnosis. Impacts depended on multiple mediating factors, including parents' underlying expectations and beliefs, family sociodemographic characteristics, individual disease characteristics, and prior healthcare access. Our study suggests that the perceived utility of GS varies widely among parents and may depend on multiple individual, sociodemographic, and contextual factors that are relevant for pre- and post-GS counseling, for value assessment of GS, and for policymaking related to access to new genomic technologies.
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Affiliation(s)
- Meghan C Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer L Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Liliana Fernandez
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California, USA
| | - Jennefer N Kohler
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California, USA
| | | | - Jonathan A Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine (and by courtesy, Department of Epidemiology), Stanford University, Stanford, California, USA
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4
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Tutty E, Amor DJ, Jarmolowicz A, Paton K, Downie L. Personal utility of genomic sequencing for infants with congenital deafness. Am J Med Genet A 2021; 185:3634-3643. [PMID: 34184819 DOI: 10.1002/ajmg.a.62411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 06/12/2021] [Indexed: 11/08/2022]
Abstract
Decisions about genetic testing have traditionally been based on clinical utility and cost, but personal utility is increasingly recognized when assessing the value of testing. Whole exome sequencing (WES) was offered to a population cohort of 106 infants diagnosed with congenital hearing loss. Parents could choose to receive results relating to hearing loss only or also learn additional information about childhood-onset conditions (medically nonactionable and/or actionable). This study aimed to quantify the personal utility of WES for parents after a diagnosis of hearing loss in their child. Parents completed surveys pretest (63/106), after hearing loss results (52/106) and after receiving additional information (47/72). Open-ended responses from all three surveys (N = 67) were analyzed using inductive content analysis. Answers to questions regarding the value of sequencing to parents were analyzed and collated. Parents placed high value on diagnostic WES for hearing loss but had different perspectives on the personal utility of additional information. Diagnostic results provided certainty while the choice to learn additional information about childhood-onset disorders was associated with empowerment. WES also represented an opportunity to promote their child's best interests. Results provide insights into the utility of WES for the indication of congenital deafness and for genomic newborn screening broadly.
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Affiliation(s)
- Erin Tutty
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Victorian Clinical Genetics Service, Melbourne, Victoria, Australia
| | - Anna Jarmolowicz
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Kate Paton
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lilian Downie
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Wain KE, Tolwinski K, Palen E, Heidlebaugh AR, Holdren K, Walsh LK, Oetjens MT, Ledbetter DH, Martin CL. Population Genomic Screening for Genetic Etiologies of Neurodevelopmental/Psychiatric Disorders Demonstrates Personal Utility and Positive Participant Responses. J Pers Med 2021; 11:365. [PMID: 34062946 DOI: 10.3390/jpm11050365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Genomic variants that cause neurodevelopmental/psychiatric disorders (NPD) are relatively prevalent and highly penetrant. This study aimed to understand adults’ immediate responses to receiving NPD-related results to inform inclusion in population-based genomic screening programs. Nine recurrent, pathogenic copy number variants (CNVs) were identified from research exome data, clinically confirmed, and disclosed to adult participants of the Geisinger MyCode Community Health Initiative DiscovEHR cohort by experienced genetic counselors. A subset of in-person genetic counseling sessions (n = 27) were audio-recorded, transcribed, and coded using a grounded theory approach. Participant reactions were overwhelmingly positive and indicated that an NPD genetic etiology was highly valuable and personally useful. Participants frequently reported learning disabilities or other NPD that were not documented in their electronic health records and noted difficulties obtaining support for NPD needs. Most intended to share their genetic result with family members and health care providers and were interested in how their result could improve their healthcare. This study indicates that results from population-based NPD genomic screening can provide personal value for adults with NPD, were viewed positively by participants, and could improve clinical outcomes by informing symptom monitoring for NPD and co-morbidities, promoting improved health behaviors, and enhancing psychotherapeutic approaches.
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6
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Brett GR, Martyn M, Lynch F, de Silva MG, Ayres S, Gallacher L, Boggs K, Baxendale A, Schenscher S, King-Smith S, Fowles L, Springer A, Lunke S, Vasudevan A, Krzesinski E, Pinner J, Sandaradura SA, Barnett C, Patel C, Wilson M, Stark Z. Parental experiences of ultrarapid genomic testing for their critically unwell infants and children. Genet Med 2020; 22:1976-1985. [PMID: 32719395 DOI: 10.1038/s41436-020-0912-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To explore parental experiences of ultrarapid genomic testing for their critically unwell infants and children. METHODS Parents of critically unwell children who participated in a national ultrarapid genomic diagnosis program were surveyed >12 weeks after genomic results return. Surveys consisted of custom questions and validated scales, including the Decision Regret Scale and Genomics Outcome Scale. RESULTS With 96 survey invitations sent, the response rate was 57% (n = 55). Most parents reported receiving enough information during pretest (n = 50, 94%) and post-test (n = 44, 83%) counseling. Perceptions varied regarding benefits of testing, however most parents reported no or mild decision regret (n = 45, 82%). The majority of parents (31/52, 60%) were extremely concerned about the condition recurring in future children, regardless of actual or perceived recurrence risk. Parents whose child received a diagnostic result reported higher empowerment. CONCLUSION This study provides valuable insight into parental experiences of ultrarapid genomic testing in critically unwell children, including decision regret, empowerment, and post-test reproductive planning, to inform design and delivery of rapid diagnosis programs. The findings suggest considerations for pre- and post-test counseling that may influence parental experiences during the testing process and beyond, such as the importance of realistically conveying the likelihood for clinical and/or personal utility.
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Affiliation(s)
- Gemma R Brett
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia. .,The University of Melbourne, Melbourne, Australia.
| | - Melissa Martyn
- The University of Melbourne, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Lynch
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Australian Genomics Health Alliance, Melbourne, Australia
| | - Michelle G de Silva
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Australian Genomics Health Alliance, Melbourne, Australia
| | - Samantha Ayres
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,Australian Genomics Health Alliance, Melbourne, Australia
| | - Lyndon Gallacher
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Kirsten Boggs
- Australian Genomics Health Alliance, Melbourne, Australia.,Sydney Children's Hospitals Network-Randwick, Sydney, Australia.,Sydney Children's Hospitals Network-Westmead, Sydney, Australia
| | - Anne Baxendale
- Australian Genomics Health Alliance, Melbourne, Australia.,Paediatric and Reproductive Genetics Unit, South Australian Clinical Genetics Service, Adelaide, Australia
| | - Sarah Schenscher
- Australian Genomics Health Alliance, Melbourne, Australia.,Paediatric and Reproductive Genetics Unit, South Australian Clinical Genetics Service, Adelaide, Australia
| | - Sarah King-Smith
- Australian Genomics Health Alliance, Melbourne, Australia.,Centre for Cancer Biology, SA Pathology, University of South Australia, Adelaide, Australia
| | - Lindsay Fowles
- Australian Genomics Health Alliance, Melbourne, Australia.,Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Amanda Springer
- Monash Genetics, Monash Health, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Australian Genomics Health Alliance, Melbourne, Australia
| | | | - Emma Krzesinski
- Monash Genetics, Monash Health, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Jason Pinner
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - Sarah A Sandaradura
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Christopher Barnett
- Paediatric and Reproductive Genetics Unit, South Australian Clinical Genetics Service, Adelaide, Australia
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Meredith Wilson
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
| | - Zornitza Stark
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Australian Genomics Health Alliance, Melbourne, Australia
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7
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Mollison L, O'Daniel JM, Henderson GE, Berg JS, Skinner D. Parents' perceptions of personal utility of exome sequencing results. Genet Med 2020; 22:752-757. [PMID: 31857707 PMCID: PMC7192542 DOI: 10.1038/s41436-019-0730-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 12/04/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Clinical genome or exome sequencing (GS/ES) provides a diagnosis for many individuals with suspected genetic disorders, but also yields negative or uncertain results for the majority. This study examines how parents of a child with an undiagnosed condition attribute personal utility to all types of ES results. METHODS Return of 31 exome sequencing results was observed during clinic sessions, followed by semistructured interviews with parents one month later. Observations and interviews were recorded and transcribed. Data display matrices were used for content analysis and systematic comparisons of parents' perceptions of utility. RESULTS ES results could not provide all the answers to parents' questions, especially in cases of clinically uninformative results, but parents nonetheless attributed utility to the knowledge gained. Parents across all results categories used the genomic information to rule out possible causes, end or postpone the diagnostic odyssey, and shift focus to treatment and management of symptoms. CONCLUSION This study suggests that parents value even uninformative ES results while expressing hope for future discoveries. As pediatric genetics moves toward GS/ES as a first-tier test, how parents perceive the personal utility of negative or uncertain results is an important topic for genetic counseling and further research.
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Affiliation(s)
- Lonna Mollison
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Julianne M O'Daniel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail E Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Debra Skinner
- FPG Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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Halverson CM, Jones SH, Novak L, Simpson C, Velez Edwards DR, Zhao SK, Clayton EW. What Results Should Be Returned from Opportunistic Screening in Translational Research? J Pers Med 2020; 10:E13. [PMID: 32121581 DOI: 10.3390/jpm10010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022] Open
Abstract
Increasingly, patients without clinical indications are undergoing genomic tests. The purpose of this study was to assess their appreciation and comprehension of their test results and their clinicians' reactions. We conducted 675 surveys with participants from the Vanderbilt Electronic Medical Records and Genomics (eMERGE) cohort. We interviewed 36 participants: 19 had received positive results, and 17 were self-identified racial minorities. Eleven clinicians who had patients who had participated in eMERGE were interviewed. A further 21 of these clinicians completed surveys. Participants spontaneously admitted to understanding little or none of the information returned to them from the eMERGE study. However, they simultaneously said that they generally found testing to be "helpful," even when it did not inform their health care. Primary care physicians expressed discomfort in being asked to interpret the results for their patients and described it as an undue burden. Providing genetic testing to otherwise healthy patients raises a number of ethical issues that warrant serious consideration. Although our participants were enthusiastic about enrolling and receiving their results, they express a limited understanding of what the results mean for their health care. This fact, coupled the clinicians' concern, urges greater caution when educating and enrolling participants in clinically non-indicated testing.
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9
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Farrell RM, Agatisa PK, Michie MM, Greene A, Ford PJ. The personal utility of cfDNA screening: Pregnant patients' experiences with cfDNA screening and views on expanded cfDNA panels. J Genet Couns 2019; 29:88-96. [PMID: 31680382 DOI: 10.1002/jgc4.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 01/13/2023]
Abstract
Prenatal cell-free DNA screening (cfDNA) provides more genetic risk information about the fetus than has ever been possible. At the same time, the rapid expansion of new cfDNA panels raises important questions about how to structure patient-centered discussions that best support patients' decision-making about its use. To address this question, we conducted interviews with pregnant patients to identify decision-making needs and preferences with respect to cfDNA in patient-centered healthcare discussions, given its evolving capability to identify a range of fetal variants. Personal utility was a core concept guiding decision-making. Participants spoke of how their deeply personal values and beliefs about maternal responsibility, actionability, and tolerance of uncertainty framed their view of the personal utility of cfDNA screening. While discussing their notions of personal utility with their healthcare provider, participants also had concerns about potential ramifications for the provider-patient relationship and shared decision-making when disclosing values and preferences regarding disability, quality of life, and termination-particularly as it becomes possible to identify variants with different disease-associated severity and outcomes. The complexities associated with the introduction of genomics in prenatal care present unique challenges to structuring effective shared decision-making discussions between patients and their healthcare providers. While efforts are underway to determine how to best educate patients about the medical aspects of cfDNA, it is equally important to develop approaches in healthcare communication that enable patients to make informed, values-based decisions about the use of cfDNA and its impact on their pregnancy.
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Affiliation(s)
- Ruth M Farrell
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
| | | | - Marsha M Michie
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio
| | - Amy Greene
- Center for Spiritual Care, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Ford
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
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10
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Regier DA, Weymann D, Buchanan J, Marshall DA, Wordsworth S. Valuation of Health and Nonhealth Outcomes from Next-Generation Sequencing: Approaches, Challenges, and Solutions. Value Health 2018; 21:1043-1047. [PMID: 30224107 DOI: 10.1016/j.jval.2018.06.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Next-generation sequencing (NGS) technologies have seen variable adoption in the clinic. This is partly due to a lack of clinical and economic studies, with the latter increasingly challenged to examine patient preferences for health and nonhealth outcomes (e.g., false-positive rate). OBJECTIVES To conduct a structured review of studies valuing patients' preference-based utility for NGS outcomes, to highlight identified methodological challenges, and to consider how studies addressed identified challenges. METHODS We searched MEDLINE (PubMed), Embase (Ovid), and Web of Science for published studies examining outcomes from health care decisions informed by NGS. We focused our search on direct elicitations of preference-based utility. We reviewed included studies and qualitatively grouped and summarized stated challenges and solutions by theme. RESULTS Eleven studies were included. Most of them (n = 6) used discrete choice experiments to value utility. We categorized challenges into four themes: 1) valuing the full range of NGS outcomes, 2) accounting for accuracy and uncertainty surrounding effectiveness, 3) allowing for simultaneous multiple and cascading risks, and 4) incorporating downstream consequences. Studies found strong evidence of utility for NGS information, regardless of health improvement. Investigators addressed challenges by simplifying complex choices, by including health outcomes alongside nonhealth outcomes, and by using multiple elicitation techniques. CONCLUSIONS The breadth and complexity of NGS-derived information makes the technology a unique and challenging application for utility valuation. Failing to account for the utility or disutility of NGS-related nonhealth outcomes may lead to overinvestment or underinvestment in NGS, and so there is a need for research addressing unresolved challenges.
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Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
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11
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Kohler JN, Turbitt E, Lewis KL, Wilfond BS, Jamal L, Peay HL, Biesecker LG, Biesecker BB. Defining personal utility in genomics: A Delphi study. Clin Genet 2017; 92:290-297. [PMID: 28218387 DOI: 10.1111/cge.12998] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Individual genome sequencing results are valued by patients in ways distinct from clinical utility. Such outcomes have been described as components of "personal utility," a concept that broadly encompasses patient-endorsed benefits, that is operationally defined as non-clinical outcomes. No empirical delineation of these outcomes has been reported. AIM To address this gap, we administered a Delphi survey to adult participants in a National Institute of Health (NIH) clinical exome study to extract the most highly endorsed outcomes constituting personal utility. MATERIALS AND METHODS Forty research participants responded to a Delphi survey to rate 35 items identified by a systematic literature review of personal utility. RESULTS Two rounds of ranking resulted in 24 items that represented 14 distinct elements of personal utility. Elements most highly endorsed by participants were: increased self-knowledge, knowledge of "the condition," altruism, and anticipated coping. DISCUSSION Our findings represent the first systematic effort to delineate elements of personal utility that may be used to anticipate participant expectation and inform genetic counseling prior to sequencing. The 24 items reported need to be studied further in additional clinical genome sequencing studies to assess generalizability in other populations. Further research will help to understand motivations and to predict the meaning and use of results.
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Affiliation(s)
- J N Kohler
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - E Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - K L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - B S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - L Jamal
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - H L Peay
- RTI International, Research Triangle Park, Durham, North Carolina
| | - L G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
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12
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Lupo PJ, Robinson JO, Diamond PM, Jamal L, Danysh HE, Blumenthal-Barby J, Lehmann LS, Vassy JL, Christensen KD, Green RC, McGuire AL. Patients' perceived utility of whole-genome sequencing for their healthcare: findings from the MedSeq project. Per Med 2016; 13:13-20. [PMID: 27019659 DOI: 10.2217/pme.15.45] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM To evaluate patients' expectations regarding the perceived utility of whole-genome sequencing (WGS). MATERIALS & METHODS We used latent class analysis to characterize individuals enrolled in the MedSeq Project based on their perceived utility of WGS. Multinomial logistic regression was used to evaluate associations between participant characteristics and latent classes. RESULTS Findings characterized participants into one of three perceived utility groups: enthusiasts, who had a high probability of agreement with all utility items (23%); health conscious, who perceived utility in medically related areas (60%) or skeptics, who had a low probability of agreement with utility items (17%). Trust significantly predicted latent class. CONCLUSION Understanding differences in perceived utility of WGS may inform strategies for uptake of this technology.
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Affiliation(s)
- Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jill O Robinson
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Pamela M Diamond
- Division of Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Leila Jamal
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Heather E Danysh
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Lisa Soleymani Lehmann
- Harvard Medical School, Boston, MA 02115, USA; Division of General Medicine & Primary Care, Department of Medicine, Brigham & Women's Hospital, Boston, MA 20115, USA
| | - Jason L Vassy
- Harvard Medical School, Boston, MA 02115, USA; Division of General Medicine & Primary Care, Department of Medicine, Brigham & Women's Hospital, Boston, MA 20115, USA; Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Kurt D Christensen
- Harvard Medical School, Boston, MA 02115, USA; Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA
| | - Robert C Green
- Harvard Medical School, Boston, MA 02115, USA; Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA
| | - Amy L McGuire
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
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13
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Vorderstrasse AA, Cho A, Voils CI, Orlando LA, Ginsburg GS. Clinical utility of genetic risk testing in primary care: the example of Type 2 diabetes. Per Med 2013; 10:549-563. [PMID: 29776196 DOI: 10.2217/pme.13.47] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Genetic advances in Type 2 diabetes (T2D) have led to the discovery and validation of multiple markers for this complex disease. Despite low predictive value of current T2D markers beyond clinical risk factors and family history, researchers are exploring the clinical utility and outcomes of implementation in practice, and testing is available via direct-to-consumer markets. Clinical utility research demonstrates high hypothetical utility to patients for motivating behavior change and potentially reducing risk. However, trials to date have not demonstrated improvements in behavioral and clinical outcomes over and above counseling based on traditional risk factors. Ongoing research in T2D genetics and associated risk-prediction models is necessary to refine genetic risk pathways, algorithms for risk prediction and use of this information in clinical care. Further research is also needed to explore care models and support interventions that address the needs of personalized risk information and sustainable preventive behaviors to reduce the rising prevalence of T2D.
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Affiliation(s)
- Allison A Vorderstrasse
- Duke University School of Nursing, Duke University Medical Center 3322, 307 Trent Drive, Durham, NC 27710, USA.,Duke Center for Personalized & Precision Medicine, Duke University Health System, Durham, NC 27710, USA.
| | - Alex Cho
- Duke Center for Personalized & Precision Medicine, Duke University Health System, Durham, NC 27710, USA.,Duke Department of Medicine, Duke School of Medicine, Durham, NC 27710, USA
| | - Corrine I Voils
- Durham VA Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
| | - Lori A Orlando
- Duke Center for Personalized & Precision Medicine, Duke University Health System, Durham, NC 27710, USA.,Duke Department of Medicine, Duke School of Medicine, Durham, NC 27710, USA
| | - Geoffrey S Ginsburg
- Duke Center for Personalized & Precision Medicine, Duke University Health System, Durham, NC 27710, USA.,Duke Department of Medicine, Duke School of Medicine, Durham, NC 27710, USA
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