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Abanmy NO, Alghamdi SA, Aljudaie RK, Almohammed OA. Clinical pharmacists' knowledge, attitude, perception, and beliefs about the role of pharmacogenetic testing for genes polymorphisms when prescribing mercaptopurine. Saudi Pharm J 2024; 32:102022. [PMID: 38497085 PMCID: PMC10940172 DOI: 10.1016/j.jsps.2024.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Single nucleotide polymorphisms in the gene encoding proteins involved in mercaptopurine metabolism can influence drug efficacy and safety. This study aims to assess clinical pharmacists' knowledge about mercaptopurine-related genes and their polymorphisms and investigate their attitudes, perceptions, and beliefs about the need for and importance of pharmacogenetic testing for mercaptopurine. Methods A cross-sectional descriptive study was conducted among oncology/hematology clinical pharmacists in Saudi Arabia using an online-questionnaire developed by experts in the field. The questionnaire consists of four-sections exploring clinical pharmacists' knowledge, attitudes, perceptions, and beliefs about the importance of gene testing and genes polymorphism when prescribing mercaptopurine. Descriptive statistics were used to analyze the data in the study. Results A total of 41 oncology/hematology clinical pharmacists responded to the survey invitation. Almost half of them had more than 10 years of work experience, but only 17 % of them received formal training in pharmacogenetics. The overall level of knowledge about pharmacogenetics among participants was low, with a mean score of 2.8 points (1.7) out of 8 items. However, around 76 % agreed that it is important to perform pharmacogenetic screening prior to prescribing mercaptopurine, and almost 93 % state that it will influence their dosage recommendation. Most of the participants had a good perception (95.1 %) of their role in genetic testing for medication selection, dosing, and monitoring; however, about 10 % of surveyed pharmacists reported not being completely responsible about recommending pharmacogenetic testing. The surveyed pharmacists had a good belief in the importance of pharmacogenetic testing and their overall attitude was positive toward the use of pharmacogenetic testing, with emphasis on the importance of training on the proper assessment and interpretation of pharmacogenetic tests. Conclusions Pharmacists demonstrated good perception and positive attitude toward pharmacogenetic testing, despite the low level of knowledge and limited formal training. Thus, more attention to developing national guidelines on pharmacogenetic testing is warranted to ensure successful pharmacogenetic testing implementation.
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Affiliation(s)
- Norah O. Abanmy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sara A. Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Raneem K. Aljudaie
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Reno JE, Ong TC, Voong C, Morse B, Ytell K, Koren R, Kwan BM. Engaging Patients and Other Stakeholders in "Designing for Dissemination" of Record Linkage Methods and Tools. Appl Clin Inform 2023; 14:670-683. [PMID: 37276886 PMCID: PMC10446912 DOI: 10.1055/a-2105-6505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/01/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Novel record linkage (RL) methods have the potential to enhance clinical informatics by integrating patient data from multiple sources-including electronic health records, insurance claims, and digital health devices-to inform patient-centered care. Engaging patients and other stakeholders in the use of RL methods in patient-centered outcomes research (PCOR) is a key step in ensuring RL methods are viewed as acceptable, appropriate, and useful. The University of Colorado Record Linkage (CURL) platform empowers the use of RL in PCOR. OBJECTIVES This study aimed to describe the process of engaging patients and other stakeholders in the design of an RL dissemination package to support the use of RL methods in PCOR. METHODS Customer discovery, value proposition design, and user experience methods were used to iteratively develop an RL dissemination package that includes animated explainer videos for patients and an RL research planning workbook for researchers. Patients and other stakeholders (researchers, data managers, and regulatory officials) were engaged in the RL dissemination package design. RESULTS Patient partners emphasized the importance of conveying how RL methods may benefit patients and the rules researchers must follow to protect the privacy and security of patient data. Other stakeholders described accuracy, flexibility, efficiency, and data security compared with other available RL solutions. Dissemination package communication products reflect the value propositions identified by key stakeholders. As prioritized by patients, the animated explainer videos emphasize the data privacy and security processes and procedures employed when performing research using RL. The RL workbook addresses researchers' and data managers' needs to iteratively design RL projects and provides accompanying resources to alleviate leadership and regulatory officials' concerns about data regulation compliance. CONCLUSION Dissemination products to promote adoption and use of CURL include materials to facilitate patient engagement in RL research and investigator step-by-step decision-making materials about the integration of RL methods in PCOR.
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Affiliation(s)
- Jenna E. Reno
- RTI International, Center for Communication and Engagement Research, Research Triangle Park, North Carolina, United States
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Toan C. Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Chan Voong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Brad Morse
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Kate Ytell
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Ramona Koren
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bethany M. Kwan
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Clayton EW, Smith ME, Anderson KC, Chung WK, Connolly JJ, Fullerton SM, McGowan ML, Peterson JF, Prows CA, Sabatello M, Holm IA. Studying the impact of translational genomic research: Lessons from eMERGE. Am J Hum Genet 2023; 110:1021-1033. [PMID: 37343562 PMCID: PMC10357472 DOI: 10.1016/j.ajhg.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Two major goals of the Electronic Medical Record and Genomics (eMERGE) Network are to learn how best to return research results to patient/participants and the clinicians who care for them and also to assess the impact of placing these results in clinical care. Yet since its inception, the Network has confronted a host of challenges in achieving these goals, many of which had ethical, legal, or social implications (ELSIs) that required consideration. Here, we share impediments we encountered in recruiting participants, returning results, and assessing their impact, all of which affected our ability to achieve the goals of eMERGE, as well as the steps we took to attempt to address these obstacles. We divide the domains in which we experienced challenges into four broad categories: (1) study design, including recruitment of more diverse groups; (2) consent; (3) returning results to participants and their health care providers (HCPs); and (4) assessment of follow-up care of participants and measuring the impact of research on participants and their families. Since most phases of eMERGE have included children as well as adults, we also address the particular ELSI posed by including pediatric populations in this research. We make specific suggestions for improving translational genomic research to ensure that future projects can effectively return results and assess their impact on patient/participants and providers if the goals of genomic-informed medicine are to be achieved.
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Affiliation(s)
- Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
| | - Maureen E Smith
- Department of Medicine, Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Katherine C Anderson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY 10032, USA
| | - John J Connolly
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Stephanie M Fullerton
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Michelle L McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Josh F Peterson
- Center for Precision Medicine, Department of Biomedical Informatics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Cynthia A Prows
- Divisions of Human Genetics and Patient Services, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Maya Sabatello
- Center for Precision Medicine & Genomics, Department of Medicine, and Division of Ethics, Department of Medical Humanities & Ethics Columbia University Vagelos College of Physicians and Surgeons, NY, NY 10032, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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Bangash H, Elsekaily O, Saadatagah S, Sutton J, Johnsen P, Gundelach JH, Kamzabek A, Freimuth R, Caraballo PJ, Kullo IJ. Clinician Perspectives on Clinical Decision Support for Familial Hypercholesterolemia. J Pers Med 2023; 13:929. [PMID: 37373918 DOI: 10.3390/jpm13060929] [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: 03/30/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
Familial Hypercholesterolemia (FH) is underdiagnosed in the United States. Clinical decision support (CDS) could increase FH detection once implemented in clinical workflows. We deployed CDS for FH at an academic medical center and sought clinician insights using an implementation survey. In November 2020, the FH CDS was deployed in the electronic health record at all Mayo Clinic sites in two formats: a best practice advisory (BPA) and an in-basket alert. Over three months, 104 clinicians participated in the survey (response rate 11.1%). Most clinicians (81%) agreed that CDS implementation was a good option for identifying FH patients; 78% recognized the importance of implementing the tool in practice, and 72% agreed it would improve early diagnosis of FH. In comparing the two alert formats, clinicians found the in-basket alert more acceptable (p = 0.036) and more feasible (p = 0.042) than the BPA. Overall, clinicians favored implementing the FH CDS in clinical practice and provided feedback that led to iterative refinement of the tool. Such a tool can potentially increase FH detection and optimize patient management.
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Affiliation(s)
- Hana Bangash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Omar Elsekaily
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Joseph Sutton
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Paul Johnsen
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Justin H Gundelach
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Arailym Kamzabek
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert Freimuth
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Pedro J Caraballo
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55905, USA
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Kabbani D, Akika R, Wahid A, Daly AK, Cascorbi I, Zgheib NK. Pharmacogenomics in practice: a review and implementation guide. Front Pharmacol 2023; 14:1189976. [PMID: 37274118 PMCID: PMC10233068 DOI: 10.3389/fphar.2023.1189976] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Considerable efforts have been exerted to implement Pharmacogenomics (PGx), the study of interindividual variations in DNA sequence related to drug response, into routine clinical practice. In this article, we first briefly describe PGx and its role in improving treatment outcomes. We then propose an approach to initiate clinical PGx in the hospital setting. One should first evaluate the available PGx evidence, review the most relevant drugs, and narrow down to the most actionable drug-gene pairs and related variant alleles. This is done based on data curated and evaluated by experts such as the pharmacogenomics knowledge implementation (PharmGKB) and the Clinical Pharmacogenetics Implementation Consortium (CPIC), as well as drug regulatory authorities such as the US Food and Drug Administration (FDA) and European Medicinal Agency (EMA). The next step is to differentiate reactive point of care from preemptive testing and decide on the genotyping strategy being a candidate or panel testing, each of which has its pros and cons, then work out the best way to interpret and report PGx test results with the option of integration into electronic health records and clinical decision support systems. After test authorization or testing requirements by the government or drug regulators, putting the plan into action involves several stakeholders, with the hospital leadership supporting the process and communicating with payers, the pharmacy and therapeutics committee leading the process in collaboration with the hospital laboratory and information technology department, and healthcare providers (HCPs) ordering the test, understanding the results, making the appropriate therapeutic decisions, and explaining them to the patient. We conclude by recommending some strategies to further advance the implementation of PGx in practice, such as the need to educate HCPs and patients, and to push for more tests' reimbursement. We also guide the reader to available PGx resources and examples of PGx implementation programs and initiatives.
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Affiliation(s)
- Danya Kabbani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Reem Akika
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ahmed Wahid
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Ann K. Daly
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ingolf Cascorbi
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nathalie Khoueiry Zgheib
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Rasmussen LV, Agrawal AH, Botsford P, Powers A, Schnoebelen J, Xinos S, Harper G, Thanner J, McCabe S, Moore S, Wicklund CA, Duquette D, Gordon EJ. Challenges of Integrating APOL1 Genetic Test Results into the Electronic Health Record. Appl Clin Inform 2023; 14:321-325. [PMID: 37186083 PMCID: PMC10132929 DOI: 10.1055/s-0043-1767680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/12/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Integrating genetic test results into the electronic health record (EHR) is essential for integrating genetic testing into clinical practice. This article describes the organizational challenges of integrating discrete apolipoprotein L1 (APOL1) genetic test results into the EHR for a research study on culturally sensitive genetic counseling for living kidney donors. METHODS We convened a multidisciplinary team across three institutions (Northwestern University, Northwestern Memorial HealthCare [NMHC], and OHSU Knight Diagnostic Laboratories [KDL]), including researchers, physicians, clinical information technology, and project management. Through a series of meetings over a year between the team and the genetic testing laboratory, we explored and adjusted our EHR integration plan based on regulatory and budgetary constraints. RESULTS Our original proposal was to transmit results from KDL to NMHC as structured data sent via Health Level Seven (HL7) v2 message. This was ultimately deemed infeasible given the time and resources required to establish the interface, and the low number of samples to be processed for the study (n = 316). We next explored the use of Epic's Care Everywhere interoperability platform, but learned it was not possible as a laboratory test ordered for a research study; even though our intent was to study the APOL1 genetic test result's clinical use and impact, test results were still considered "research results." Faced with two remaining options-downloading a PDF from the KDL laboratory portal or scanning a faxed result from KDL-only a PDF of the APOL1 test result could be integrated into the EHR, reinforcing the status quo. CONCLUSION Even with early and ongoing stakeholder engagement, dedicated project management, and funding, unanticipated implementation challenges-especially for research projects-can result in drastic design tradeoffs.
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Affiliation(s)
- Luke V. Rasmussen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Akansha H. Agrawal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Paul Botsford
- Information Services, Digital Solutions, Northwestern Medicine, Chicago, Illinois, United States
| | - Andrew Powers
- Information Services, Clinical Applications, Northwestern Medicine, Chicago, Illinois, United States
| | - Jeffrey Schnoebelen
- Information Services, Business Relationship Management, Northwestern Medicine, Chicago, Illinois, United States
| | - Stavroula Xinos
- Information Services, Digital Administration, Northwestern Medicine, Chicago, Illinois, United States
| | - Gail Harper
- Business Development and Strategic Outreach, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon, United States
| | - Jane Thanner
- Information Technology Group, Oregon Health & Science University, Portland, Oregon, United States
| | - Sarah McCabe
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon, United States
| | - Stephen Moore
- Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon, United States
| | - Catherine A. Wicklund
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Debra Duquette
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Elisa J. Gordon
- Department of Surgery, Section of Surgical Sciences, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Cicali EJ, Lemke L, Al Alshaykh H, Nguyen K, Cavallari LH, Wiisanen K. How to Implement a Pharmacogenetics Service at your Institution. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:1161-1175. [PMID: 36589694 PMCID: PMC9799247 DOI: 10.1002/jac5.1699] [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: 01/31/2022] [Accepted: 07/29/2022] [Indexed: 01/05/2023]
Abstract
The vast majority of patients possess one or more pharmacogenetic variants that can influence optimal medication use. When pharmacogenetic data are used to guide drug choice and dosing, evidence points to improved disease outcomes, fewer adverse effects, and lower healthcare spending. Although its science is well established, clinical use of pharmacogenetic data to guide drug therapy is still in its infancy. Pharmacogenetics essentially involves the intersection of an individual's genetic data with their medications, which makes pharmacists uniquely qualified to provide clinical support and education in this field. In fact, most pharmacogenetics implementations, to date, have been led by pharmacists as leaders or members of a multidisciplinary team or as individual practitioners. A successful large-scale pharmacogenetics implementation requires coordination and synergy among administrators, clinicians, informatics teams, laboratories, and patients. Because clinical implementation of pharmacogenetics is in its early stages, there is an urgent need for guidance and dissemination of shared experiences to provide a framework for clinicians. Many early adopters of pharmacogenetics have explored various strategies among diverse practice settings. This article relies on the experiences of early adopters to provide guidance for critical steps along the pathway to implementation, including strategies to engage stakeholders; evaluate pharmacogenetic evidence; coordinate laboratory testing, results interpretation and their integration into the electronic health record; identify reimbursement avenues; educate providers and patients; and maintain a successful program. Learning from early adopters' published experiences and strategies can allow clinicians leading a new pharmacogenetics implementation to avoid pitfalls and adapt and apply lessons learned by others to their own practice.
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Affiliation(s)
- Emily J Cicali
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Fl, USA
| | - Lauren Lemke
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Fl, USA
| | - Hana Al Alshaykh
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Fl, USA
| | - Khoa Nguyen
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, Gainesville, FL, USA
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Fl, USA
| | - Kristin Wiisanen
- Department of Pharmacotherapy and Translational Research, University of Florida, College of Pharmacy, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Fl, USA
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Clinicians' Perceptions towards Precision Medicine Tools for Cardiovascular Disease Risk Stratification in South Africa. J Pers Med 2022; 12:jpm12091360. [PMID: 36143145 PMCID: PMC9505828 DOI: 10.3390/jpm12091360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of mortality and morbidity in South Africa. Risk stratification is the preferred approach to disease prevention, but identifying patients at high risk for CVD remains challenging. Assessing genetic risk could improve stratification and inform a clinically relevant precision medicine (PM) approach. Clinicians are critical to PM adoption, thus, this study explores practicing clinicians’ perceptions of PM-based CVD risk stratification in South Africa’s public health setting. Practicing clinicians (n = 109) at four teaching hospitals in Johannesburg, South Africa, completed an electronic self-administered survey. The effect of demographic and professional characteristics on PM-based CVD risk stratification perceptions was assessed. Fewer than 25% of respondents used clinical genetic testing, and 14% had formal genetics training. 78% had a low mean knowledge score, with higher scores associated with genetic training (p < 0.0005) and research involvement (p < 0.05). Despite limited knowledge and resources, 84% perceived PM approaches positively. 57% felt confident in applying the PM-based approach, with those already undertaking CVD risk stratification more confident (p < 0.001). High cost and limited access to genetics services are key barriers. Integrating genetic information into established clinical tools will likely increase confidence in using PM approaches. Addressing the genetics training gap and investment into the country’s genomics capacity is needed to advance PM in South Africa.
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McCormick JB, Hopkins M, Lehman EB, Green MJ. Mining the Data: Exploring Rural Patients' Attitudes about the Use of Their Personal Information in Research. AJOB Empir Bioeth 2022; 13:89-106. [PMID: 35271430 PMCID: PMC10038193 DOI: 10.1080/23294515.2022.2040644] [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: 10/18/2022]
Abstract
BACKGROUND This study examines rural patients' perceived importance of knowing or being consulted about researchers' access and use of their personal data (identifiable and de-identified health information, and identifiable and de-identified non-health information) across five scenarios. This study also examines their views on stewardship or governance of their personal information by researchers in their healthcare systems. METHODS We conducted a survey by mail. Data were analyzed using descriptive statistics. Multivariable regression analyses were conducted across each scenario and type of personal data with the same variables included in each model. RESULTS The majority of participants said it was "very important/absolutely essential" to know the purpose of the study, to be asked every time, and to know the policies governing researcher access and use of their identifiable health information. Just over two-thirds of respondents thought it "very important/absolutely essential" to know who serves on the data governance committee and to have a community member serve. Distrust in healthcare organizations was positively correlated with the scenarios while willingness to give permission to donate leftover biological specimens was negatively correlated. CONCLUSION Our study findings indicate that the type of personal information being accessed and used generally matters to 1,407 patients living in rural Pennsylvania. We also demonstrate that knowing their healthcare organizations' governance policies and practices for managing their personal data is important to many rural Pennsylvania patients. Biomedical researchers need to recognize and attend to those differences as much as possible in order to expand opportunities for and participation in research by residents of these rural communities. Supplemental data for this article is available online at.
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Affiliation(s)
- Jennifer B McCormick
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Willis AM, Terrill B, Pearce A, McEwen A, Ballinger ML, Young MA. My Research Results: a program to facilitate return of clinically actionable genomic research findings. Eur J Hum Genet 2022; 30:363-366. [PMID: 34602610 PMCID: PMC8904822 DOI: 10.1038/s41431-021-00973-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Researchers and research participants increasingly support returning clinically actionable genetic research findings to participants, but researchers may lack the skills and resources to do so. In response, a genetic counsellor-led program to facilitate the return of clinically actionable findings to research participants was developed to fill the identified gap in research practice and meet Australian research guidelines. A steering committee of experts reviewed relevant published literature and liaised with researchers, research participants and clinicians to determine the scope of the program, as well as the structure, protocols and infrastructure. A program called My Research Results (MyRR) was developed, staffed by genetic counsellors with input from the steering committee, infrastructure services and a genomic advisory committee. MyRR is available to Human Research Ethics Committee approved studies Australia-wide and comprises genetic counselling services to notify research participants of clinically actionable research findings, support for researchers with developing an ethical strategy for managing research findings and an online information platform. The results notification strategy is an evidence-based two-step model, which has been successfully used in other Australian studies. MyRR is a translational program supporting researchers and research participants to access clinically actionable research findings.
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Affiliation(s)
- Amanda M. Willis
- grid.415306.50000 0000 9983 6924Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW 2010 Australia ,grid.1005.40000 0004 4902 0432St Vincent’s Clinical School, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052 Australia
| | - Bronwyn Terrill
- grid.415306.50000 0000 9983 6924Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW 2010 Australia ,grid.1005.40000 0004 4902 0432St Vincent’s Clinical School, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052 Australia
| | - Angela Pearce
- grid.415306.50000 0000 9983 6924Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW 2010 Australia
| | - Alison McEwen
- grid.117476.20000 0004 1936 7611Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Mandy L. Ballinger
- grid.1005.40000 0004 4902 0432St Vincent’s Clinical School, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052 Australia ,grid.415306.50000 0000 9983 6924Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, NSW 2010 Australia
| | - Mary-Anne Young
- grid.415306.50000 0000 9983 6924Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW 2010 Australia ,grid.1005.40000 0004 4902 0432St Vincent’s Clinical School, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052 Australia
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Mukherjee SK, Olivieri DJ, Madhani SI, Bonfield CM, Mbabazi E, Arman DM, Dewan MC, Ekramullah SM. EMR adoption in Dhaka, Bangladesh: a template to index pediatric central nervous system tumor care and a review of preliminary neuro-oncologic observations. Childs Nerv Syst 2022; 38:1497-1504. [PMID: 35588333 PMCID: PMC9118804 DOI: 10.1007/s00381-022-05450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the design, implementation, and adoption of a simplified electronic medical record (EMR) and its use in documenting pediatric central nervous system (CNS) tumors at a tertiary care referral hospital in South-East Asia. METHODS A novel EMR, cataloguing pediatric CNS tumors was used to collect data from August 2017 to March 2020 at National Institute of Neurosciences and Hospital (NINS&H) in Dhaka, Bangladesh. RESULTS Two hundred forty-nine pediatric patients with a CNS tumor were admitted to NINS&H. Fifty-eight percent of patients were male, and the median age was 8 years. A total of 188/249 patients (76%) underwent surgery during their index admission. Radiographic locations were known for 212/249 (85%) of cases; the most common radiographic locations were infratentorial (81/212; 38%), suprasellar (45/212; 21%), and supratentorial (29/212; 14%). A histopathological classification was reported on 156/249 (63%) of patients' cytology. The most common infratentorial pathologies were medulloblastoma (22/47; 47%) and pilocytic astrocytoma (14/47; 30%). The median time between admission and surgery was 36 days, while the median post-operation stay was 19.5 days. CONCLUSIONS The feasibility of a basic EMR platform for a busy pediatric neurosurgery department in a lower-middle income country is demonstrated, and preliminary clinical data is reviewed. A wide variety of pediatric CNS tumors were observed, spanning the spectrum of anatomic locations and histopathologic subtypes. Surgical intervention was performed for the majority of patients. Barriers to care include limited molecular diagnostics and unavailable data on adjuvant therapy. Future targets include improvement of clinical documentation in the pre-operative and post-operative period.
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Affiliation(s)
- Sudipta Kumer Mukherjee
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
| | - Daniel J. Olivieri
- grid.40263.330000 0004 1936 9094Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Sarosh Irfan Madhani
- grid.7147.50000 0001 0633 6224Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Christopher M. Bonfield
- grid.412807.80000 0004 1936 9916Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, 2200 Children’s Way 9th Floor , Nashville, TN 37232 USA
| | - Edith Mbabazi
- grid.461319.8CURE Children’s Hospital of Uganda, Mbale, Uganda
| | - D. M. Arman
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
| | - Michael C. Dewan
- grid.412807.80000 0004 1936 9916Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, 2200 Children’s Way 9th Floor , Nashville, TN 37232 USA
| | - Sheikh Muhammad Ekramullah
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
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12
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Rajamani G, Rodriguez Espinosa P, Rosas LG. Intersection of Health Informatics Tools and Community Engagement in Health-Related Research to Reduce Health Inequities: Scoping Review. J Particip Med 2021; 13:e30062. [PMID: 34797214 PMCID: PMC8663666 DOI: 10.2196/30062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background The exponential growth of health information technology has the potential to facilitate community engagement in research. However, little is known about the use of health information technology in community-engaged research, such as which types of health information technology are used, which populations are engaged, and what are the research outcomes. Objective The objectives of this scoping review were to examine studies that used health information technology for community engagement and to assess (1) the types of populations, (2) community engagement strategies, (3) types of health information technology tools, and (4) outcomes of interest. Methods We searched PubMed and PCORI Literature Explorer using terms related to health information technology, health informatics, community engagement, and stakeholder involvement. This search process yielded 967 papers for screening. After inclusion and exclusion criteria were applied, a total of 37 papers were analyzed for key themes and for approaches relevant to health information technology and community engagement research. Results This analysis revealed that the communities engaged were generally underrepresented populations in health-related research, including racial or ethnic minority communities such as Black/African American, American Indian/Alaska Native, Latino ethnicity, and communities from low socioeconomic backgrounds. The studies focused on various age groups, ranging from preschoolers to older adults. The studies were also geographically spread across the United States and the world. Community engagement strategies included collaborative development of health information technology tools and partnerships to promote use (encompassing collaborative development, use of community advisory boards, and focus groups for eliciting information needs) and use of health information technology to engage communities in research (eg, through citizen science). The types of technology varied across studies, with mobile or tablet-based apps being the most common platform. Outcomes measured included eliciting user needs and requirements, assessing health information technology tools and prototypes with participants, measuring knowledge, and advocating for community change. Conclusions This study illustrates the current landscape at the intersection of health information technology tools and community-engaged research approaches. It highlights studies in which various community-engaged research approaches were used to design culturally centered health information technology tools, to promote health information technology uptake, or for engagement in health research and advocacy. Our findings can serve as a platform for generating future research upon which to expand the scope of health information technology tools and their use for meaningful stakeholder engagement. Studies that incorporate community context and needs have a greater chance of cocreating culturally centered health information technology tools and better knowledge to promote action and improve health outcomes.
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Affiliation(s)
- Geetanjali Rajamani
- Department of Human Biology, Stanford University, Stanford, CA, United States
| | - Patricia Rodriguez Espinosa
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
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13
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Queensland Genomics: an adaptive approach for integrating genomics into a public healthcare system. NPJ Genom Med 2021; 6:71. [PMID: 34408148 PMCID: PMC8373904 DOI: 10.1038/s41525-021-00234-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
The establishment of genomics in health care systems has been occurring for the past decade. It is recognised that implementing genomics within a health service is challenging without a system-wide approach. Globally, as clinical genomics implementation programs have matured there is a growing body of information around program design and outcomes. Program structures vary depending on local ecosystems including the health system, politics and funding availability, however, lessons from other programs are important to the design of programs in different jurisdictions. Here we describe an adaptive approach to the implementation of genomics into a publicly funded health care system servicing a population of 5.1 million people. The adaptive approach enabled flexibility to facilitate substantial changes during the program in response to learnings and external factors. We report the benefits and challenges experienced by the program, particularly in relation to the engagement of people and services, and the design of both individual projects and the program as a whole.
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14
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Pezzullo AM, Sassano M, Hoxhaj I, Pastorino R, Boccia S. Citizen engagement initiatives in precision health in the European Union member states: a scoping review. BMJ Open 2021; 11:e045846. [PMID: 34244258 PMCID: PMC8273469 DOI: 10.1136/bmjopen-2020-045846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Precision health requires citizens that are empowered to orient health decisions towards their personal values, aware of the benefits and risks, and committed to sharing their personal data to trustful institutions. Effective citizen engagement initiatives are fundamental for the success of a precision health approach. OBJECTIVE To provide an overview of citizen engagement initiatives in precision health in European Union (EU) member states. DESIGN Scoping review. METHODS The electronic databases PubMed, Web of Science, CINAHL and Embase were searched to include articles published in English. Furthermore, desk research was conducted in English, Dutch, French, Italian and Spanish. Articles or reports regarding ongoing initiatives of citizen engagement in precision health conducted in EU member states and published from January 2015 to July 2020 were considered eligible. A quality assessment of the retrieved entries using Critical Appraisal Skills Programme tool was conducted. RESULTS We identified nine documents, which reported eight ongoing citizen engagement initiatives, with substantial variability. Government agencies, non-governmental organisations and scientific societies were the main organisers and funders. Most of the initiatives were conducted in the UK. Genomics was the most emphasised aspect of precision health in these initiatives. Among the identified initiatives, both in-person and digital means were reported. CONCLUSION Our work provides an overview of current citizen engagement initiatives in the EU that can be useful for stakeholders interested in designing and developing precision health projects enriched by meaningful citizen participation. PROSPERO REGISTRATION NUMBER CRD42020193866.
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Affiliation(s)
- Angelo Maria Pezzullo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ilda Hoxhaj
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health - Public Health Area, Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Etchegary H, Winsor M, Power A, Simmonds C. Public engagement with genomic medicine: a summary of town hall discussions. J Community Genet 2021; 12:27-35. [PMID: 32865775 PMCID: PMC7846649 DOI: 10.1007/s12687-020-00485-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022] Open
Abstract
Engaging with the public for their input about genomic medicine is critical before it is implemented into routine healthcare practice. In order to inform discussion and planning for the introduction of genome sequencing into clinical care in an Eastern Canadian province, we implemented a program of public engagement activities. Here, we report a qualitative summary of two town hall discussions utilizing a hybrid information-consultation approach with 20 residents of the province of Newfoundland and Labrador, Canada. Discussion revealed largely positive attitudes towards genomic medicine; however, critical reflection around informed consent models, the return of sequencing findings, and access to qualified healthcare professionals revealed numerous public concerns. Public support will be important to realize the potential benefits of genomics and precision medicine to health outcomes. Our findings highlight public concerns that must be addressed in educational and informed consent documents related to sequencing. Town hall attendees endorsed ongoing public education and awareness-building initiatives which could help foster transparency and trust as genomics is integrated into healthcare systems.
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Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
| | - Mercy Winsor
- Health Research Unit, Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
| | - Angela Power
- Newfoundland and Labrador Centre for Health Information, St. John’s, NL A1B 2C7 Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Craig Dobbin Centre for Genetics, Memorial University, St. John’s, NL A1B 3V6 Canada
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Griesemer I, Staley BS, Lightfoot AF, Bain L, Byrd D, Conway C, Grant TL, Leach B, Milko L, Mollison L, Porter N, Reid S, Smith G, Waltz M, Berg JS, Rini C, O'Daniel JM. Engaging community stakeholders in research on best practices for clinical genomic sequencing. Per Med 2020; 17:435-444. [PMID: 33026293 PMCID: PMC7938705 DOI: 10.2217/pme-2020-0074] [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] [Indexed: 12/15/2022]
Abstract
Aim: Maximizing the utility and equity of genomic sequencing integration in clinical care requires engaging patients, their families, and communities. The NCGENES 2 study explores the impact of engagement between clinicians and caregivers of children with undiagnosed conditions in the context of a diagnostic genomic sequencing study. Methods: A Community Consult Team (CCT) of diverse parents and advocates for children with genetic and/or neurodevelopmental conditions was formed. Results: Early and consistent engagement with the CCT resulted in adaptations to study protocol and materials relevant to this unique study population. Discussion: This study demonstrates valuable contributions of community stakeholders to inform the implementation of translational genomics research for diverse participants.
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Affiliation(s)
- Ida Griesemer
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill NC, USA
| | - Brooke S Staley
- Department of Epidemiology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Derrick Byrd
- Parent/Advocate, Family Resource Center South Atlantic, Raleigh, NC, USA
| | - Carol Conway
- Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA
| | - Tracey L Grant
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Leach
- Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Laura Milko
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Lonna Mollison
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Sharron Reid
- Parent/Advocate, Wake County Sickle Cell Support Group, Raleigh, NC, USA
| | | | - Margaret Waltz
- Department of Social Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine & Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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17
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Luna Puerta L, Kendall W, Davies B, Day S, Ward H. The reported impact of public involvement in biobanks: A scoping review. Health Expect 2020; 23:759-788. [PMID: 32378306 PMCID: PMC7495079 DOI: 10.1111/hex.13067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Biobanks increasingly employ public involvement and engagement strategies, though few studies have explored their impact. This review aims to (a) investigate how the impact of public involvement in biobanks is reported and conceptualized by study authors; in order to (b) suggest how the research community might re-conceptualize the impact of public involvement in biobanks. METHODS A systematic literature search of three electronic databases and the INVOLVE Evidence Library in January 2019. Studies commenting on the impact of public involvement in a biobank were included, and a narrative review was conducted. RESULTS AND DISCUSSION Forty-one studies covering thirty-one biobanks were included, with varying degrees of public involvement. Impact was categorized according to where it was seen: 'the biobank', 'people involved' and 'the wider research community'. Most studies reported involvement in a 'functional' way, in relation to improved rates of participation in the biobank. Broader forms of impact were reported but were vaguely defined and measured. This review highlights a lack of clarity of purpose and varied researcher conceptualizations of involvement. We pose three areas for further research and consideration by biobank researchers and public involvement practitioners. CONCLUSIONS Functional approaches to public involvement in biobanking limit impact. This conceptualization of involvement emerges from an entrenched technical understanding that ignores its political nature, complicated by long-standing disagreement about the values of public involvement. This study urges a re-imagination of impact, re-conceptualized as a two-way learning process. More support will help researchers and members of the public to undergo such reflective exercises.
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Affiliation(s)
- Lidia Luna Puerta
- NIHR Imperial BRC Patient Experience Research CentreImperial College LondonLondonUK
- Family Medicine and Primary CareLee Kong Chian School of MedicineNanyang Technological University SingaporeSingaporeSingapore
| | - Will Kendall
- NIHR Imperial BRC Patient Experience Research CentreImperial College LondonLondonUK
- Department of SociologyLondon School of EconomicsLondonUK
| | - Bethan Davies
- NIHR Imperial BRC Patient Experience Research CentreImperial College LondonLondonUK
| | - Sophie Day
- NIHR Imperial BRC Patient Experience Research CentreImperial College LondonLondonUK
| | - Helen Ward
- NIHR Imperial BRC Patient Experience Research CentreImperial College LondonLondonUK
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18
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An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia. J Pers Med 2020; 10:jpm10030067. [PMID: 32717811 PMCID: PMC7565418 DOI: 10.3390/jpm10030067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Electronic health record (EHR)-based clinical decision support (CDS) can address the low awareness and undertreatment of familial hypercholesterolemia (FH), a disorder associated with a markedly increased risk of coronary heart disease. We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact.
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Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review. Diagnostics (Basel) 2020; 10:diagnostics10050327. [PMID: 32443856 PMCID: PMC7277945 DOI: 10.3390/diagnostics10050327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS's with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders' roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.
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20
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Wöhlke S, Schaper M, Oliveri S, Cutica I, Spinella F, Pravettoni G, Steinberger D, Schicktanz S. German and Italian Users of Web-Accessed Genetic Data: Attitudes on Personal Utility and Personal Sharing Preferences. Results of a Comparative Survey (n=192). Front Genet 2020; 11:102. [PMID: 32265977 PMCID: PMC7099127 DOI: 10.3389/fgene.2020.00102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Abstract
Genetic information is increasingly provided outside of the traditional clinical setting, allowing users to access it directly via specialized online platforms. This development is possibly resulting in changing ethical and social challenges for users of predictive genetic tests. Little is known about the attitudes and experiences of users of web-accessed genetic information. This survey analyzes data from two European countries with regard to the utility of genetic information, the users’ ways of making use of and dealing with information, and their sharing behavior. Particular focus is given to ethical and social questions regarding the motivation to share personal genetic results with others. Social factors tested for are national background, gender, and marital, parental, and educational status. This study will contribute to public discourse and offer ethical recommendations. The study will also serve to validate the developed questionnaire for use in population representative surveys.
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Affiliation(s)
- Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Serena Oliveri
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Ilaria Cutica
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Gabriella Pravettoni
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Brunette CA, Miller SJ, Majahalme N, Hau C, MacMullen L, Advani S, Ludin SA, Zimolzak AJ, Vassy JL. Pragmatic Trials in Genomic Medicine: The Integrating Pharmacogenetics In Clinical Care (I-PICC) Study. Clin Transl Sci 2020; 13:381-390. [PMID: 31808996 PMCID: PMC7070795 DOI: 10.1111/cts.12723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 12/19/2022] Open
Abstract
Pragmatic clinical trials (PCTs) have an established presence in clinical research and yet have only recently garnered attention within the landscape of genomic medicine. Using the PRagmatic-Explanatory Continuum Indicator Summary 2 (PRECIS-2) as a framework, this paper illustrates the application of PCT principles to The Integrating Pharmacogenetics In Clinical Care (I-PICC) Study, a trial of pharmacogenetic testing prior to statin initiation for cardiovascular disease prevention in primary care. The trial achieved high engagement with providers (85% enrolled of those approached) and enrolled a representative sample of participants for which statin therapy would be recommended. The I-PICC Study has a high level of pragmatism, which should enhance the generalizability of its findings. The PRECIS-2 may be useful in the design and evaluation of PCTs of genomic medicine interventions, contributing to the generation of evidence that can bridge the gap between genomics innovation and clinical adoption.
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Affiliation(s)
| | | | | | - Cynthia Hau
- VA Boston Healthcare SystemBostonMassachusettsUSA
| | | | | | - Sophie A. Ludin
- VA Boston Healthcare SystemBostonMassachusettsUSA
- Cornell UniversityIthacaNew YorkUSA
| | - Andrew J. Zimolzak
- VA Boston Healthcare SystemBostonMassachusettsUSA
- Baylor College of MedicineHoustonTexasUSA
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
| | - Jason L. Vassy
- VA Boston Healthcare SystemBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Division of General Internal Medicine and Primary CareBrigham and Women's HospitalBostonMassachusettsUSA
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22
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Yusif S, Hafeez-Baig A, Soar J. An Exploratory Study of the Readiness of Public Healthcare Facilities in Developing Countries to Adopt Health Information Technology (HIT)/e-Health: the Case of Ghana. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2020; 4:189-214. [DOI: 10.1007/s41666-020-00070-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
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Platt J, Raj M, Büyüktür AG, Trinidad MG, Olopade O, Ackerman MS, Kardia S. Willingness to Participate in Health Information Networks with Diverse Data Use: Evaluating Public Perspectives. EGEMS (WASHINGTON, DC) 2019; 7:33. [PMID: 31367650 PMCID: PMC6659576 DOI: 10.5334/egems.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 05/16/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Health information generated by health care encounters, research enterprises, and public health is increasingly interoperable and shareable across uses and users. This paper examines the US public's willingness to be a part of multi-user health information networks and identifies factors associated with that willingness. METHODS Using a probability-based sample (n = 890), we examined the univariable and multivariable relationships between willingness to participate in health information networks and demographic factors, trust, altruism, beliefs about the public's ethical obligation to participate in research, privacy, medical deception, and policy and governance using linear regression modeling. RESULTS Willingness to be a part of a multi-user network that includes health care providers, mental health, social services, research, or quality improvement is low (26 percent-7.4 percent, depending on the user). Using stepwise regression, we identified a model that explained 42.6 percent of the variability in willingness to participate and included nine statistically significant factors associated with the outcome: Trust in the health system, confidence in policy, the belief that people have an obligation to participate in research, the belief that health researchers are accountable for conducting ethical research, the desire to give permission, education, concerns about insurance, privacy, and preference for notification. DISCUSSION Our results suggest willingness to be a part of multi-user data networks is low, but that attention to governance may increase willingness. Building trust to enable acceptance of multi-use data networks will require a commitment to aligning data access practices with the expectations of the people whose data is being used.
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Affiliation(s)
- Jodyn Platt
- University of Michigan Medical School, Department of Learning Health Sciences, US
| | - Minakshi Raj
- University of Michigan School of Public Health, Department of Health Management and Policy, US
| | - Ayşe G. Büyüktür
- University of Michigan School of Information and Michigan Institute for Clinical and Health Research, US
| | - M. Grace Trinidad
- University of Michigan Medical School, Department of Learning Health Sciences, US
| | | | - Mark S. Ackerman
- University of Michigan School of Information, College of Engineering, EECS, and Medical School, Department of Learning Health Systems, US
| | - Sharon Kardia
- University of Michigan School of Public Health, Department of Epidemiology, US
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Alrahbi D, Khan M, Hussain M. Exploring the motivators of technology adoption in healthcare. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1607451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Dana Alrahbi
- College of Business Administration, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Mehmood Khan
- College of Business Administration, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Matloub Hussain
- College of Business Administration, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Hauser D, Obeng AO, Fei K, Ramos MA, Horowitz CR. Views Of Primary Care Providers On Testing Patients For Genetic Risks For Common Chronic Diseases. Health Aff (Millwood) 2019; 37:793-800. [PMID: 29733703 DOI: 10.1377/hlthaff.2017.1548] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We surveyed 488 primary care providers in community and academic practices in New York City in the period 2014-16 about their views on genetic testing for chronic diseases. The majority of the providers, most of whom were current or recent physicians in training, had had formal genetics education and had positive views of the utility of genetic testing. However, they felt unprepared to work with patients at high risk for genetic conditions and were not confident about interpreting test results. Many were concerned that genetic testing might lead to insurance discrimination and lacked trust in companies that offer genetic tests. These findings point to some of the attitudes and knowledge gaps among the providers that should be considered in the clinical implementation of genomic medicine for chronic conditions. Enhanced training, guidelines, clinical tools, and awareness of patient protections might support the effective adoption of genomic medicine by primary care providers.
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Affiliation(s)
- Diane Hauser
- Diane Hauser ( ) is a senior associate in the Institute for Family Health and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, both in New York City
| | - Aniwaa Owusu Obeng
- Aniwaa Owusu Obeng is an assistant professor in the Charles Bronfman Institute for Personalized Medicine and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, and the clinical pharmacogenomics coordinator in the Pharmacy Department at Mount Sinai Hospital
| | - Kezhen Fei
- Kezhen Fei is a biostatistician in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
| | - Michelle A Ramos
- Michelle A. Ramos is a program manager in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
| | - Carol R Horowitz
- Carol R. Horowitz is a professor in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
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Applying participatory design to a pharmacy system intervention. Res Social Adm Pharm 2018; 15:1358-1367. [PMID: 30509852 DOI: 10.1016/j.sapharm.2018.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory design (PD), a method that utilizes the involvement of patients and other stakeholders, is well-suited for the design of multifaceted interventions in complex work systems, such as community pharmacies, that have diverse and dynamic end-users. OBJECTIVE The objective is to describe a blueprint for how to use PD when designing a community pharmacy intervention. This paper outlines the steps of PD and highlights the advantages and disadvantages of this method. METHODS PD is explained step-wise to underscore the considerations required of researchers unfamiliar with PD. This includes the development of a tailored PD approach, PD session preparatory work, data collection, and intervention development and evaluation. The stakeholders recruited for the community pharmacy intervention were pharmacy staff and older adult patients who received prescriptions at the pharmacy corporation in which the intervention was being implemented. The PD process was a series of six adaptive sessions: (1) problem identification, (2) solution generation, (3) convergence, (4) prototyping, (5) initial evaluation, and (6) formative evaluation. RESULTS A description of the PD process to design a community pharmacy intervention is provided. The process led to the development of a patient-centered prototype. The advantages of using PD included the opportunity to clarify problems faced by stakeholders, generation of novel solutions to incorporate into the intervention, and the ability to vet and fine-tune stakeholder design ideas in an iterative fashion. The insight gained was unprecedented and invaluable to the researchers. The biggest challenge of employing PD was the time-sensitive and time-intensive nature of developing each session, collecting data, and reflecting on the results in order to design subsequent sessions. CONCLUSIONS The PD process led to the development of a patient-centered prototype. PD enabled stakeholders to generate creative solutions and provide unique insight on addressing issues faced in healthcare redesign research and specifically in community pharmacies.
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Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT, Biesecker BB, Biesecker LG, Cooper GM, East K, Filipski K, Fullerton SM, Gelb BD, Goddard KA, Hailu B, Hart R, Hassmiller-Lich K, Joseph G, Kenny EE, Koenig BA, Knight S, Kwok PY, Lewis KL, McGuire AL, Norton ME, Ou J, Parsons DW, Powell BC, Risch N, Robinson M, Rini C, Scollon S, Slavotinek AM, Veenstra DL, Wasserstein MP, Wilfond BS, Hindorff LA, Plon SE, Jarvik GP, Jarvik GP. The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations. Am J Hum Genet 2018; 103:319-327. [PMID: 30193136 DOI: 10.1016/j.ajhg.2018.08.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/26/2023] Open
Abstract
The Clinical Sequencing Evidence-Generating Research (CSER) consortium, now in its second funding cycle, is investigating the effectiveness of integrating genomic (exome or genome) sequencing into the clinical care of diverse and medically underserved individuals in a variety of healthcare settings and disease states. The consortium comprises a coordinating center, six funded extramural clinical projects, and an ongoing National Human Genome Research Institute (NHGRI) intramural project. Collectively, these projects aim to enroll and sequence over 6,100 participants in four years. At least 60% of participants will be of non-European ancestry or from underserved settings, with the goal of diversifying the populations that are providing an evidence base for genomic medicine. Five of the six clinical projects are enrolling pediatric patients with various phenotypes. One of these five projects is also enrolling couples whose fetus has a structural anomaly, and the sixth project is enrolling adults at risk for hereditary cancer. The ongoing NHGRI intramural project has enrolled primarily healthy adults. Goals of the consortium include assessing the clinical utility of genomic sequencing, exploring medical follow up and cascade testing of relatives, and evaluating patient-provider-laboratory level interactions that influence the use of this technology. The findings from the CSER consortium will offer patients, healthcare systems, and policymakers a clearer understanding of the opportunities and challenges of providing genomic medicine in diverse populations and settings, and contribute evidence toward developing best practices for the delivery of clinically useful and cost-effective genomic sequencing in diverse healthcare settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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Physician-Reported Benefits and Barriers to Clinical Implementation of Genomic Medicine: A Multi-Site IGNITE-Network Survey. J Pers Med 2018; 8:jpm8030024. [PMID: 30042363 PMCID: PMC6163471 DOI: 10.3390/jpm8030024] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 12/23/2022] Open
Abstract
Genetic medicine is one of the key components of personalized medicine, but adoption in clinical practice is still limited. To understand potential barriers and provider attitudes, we surveyed 285 physicians from five Implementing GeNomics In pracTicE (IGNITE) sites about their perceptions as to the clinical utility of genetic data as well as their preparedness to integrate it into practice. These responses were also analyzed in comparison to the type of study occurring at the physicians' institution (pharmacogenetics versus disease genetics). The majority believed that genetic testing is clinically useful; however, only a third believed that they had obtained adequate training to care for genetically "high-risk" patients. Physicians involved in pharmacogenetics initiatives were more favorable towards genetic testing applications; they found it to be clinically useful and felt more prepared and confident in their abilities to adopt it into their practice in comparison to those participating in disease genetics initiatives. These results suggest that investigators should explore which attributes of clinical pharmacogenetics (such as the use of simplified genetics-guided recommendations) can be implemented to improve attitudes and preparedness to implement disease genetics in care. Most physicians felt unprepared to use genetic information in their practice; accordingly, major steps should be taken to develop effective clinical tools and training strategies for physicians.
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Jeon J, Du M, Schoen RE, Hoffmeister M, Newcomb PA, Berndt SI, Caan B, Campbell PT, Chan AT, Chang-Claude J, Giles GG, Gong J, Harrison TA, Huyghe JR, Jacobs EJ, Li L, Lin Y, Le Marchand L, Potter JD, Qu C, Bien SA, Zubair N, Macinnis RJ, Buchanan DD, Hopper JL, Cao Y, Nishihara R, Rennert G, Slattery ML, Thomas DC, Woods MO, Prentice RL, Gruber SB, Zheng Y, Brenner H, Hayes RB, White E, Peters U, Hsu L. Determining Risk of Colorectal Cancer and Starting Age of Screening Based on Lifestyle, Environmental, and Genetic Factors. Gastroenterology 2018; 154:2152-2164.e19. [PMID: 29458155 PMCID: PMC5985207 DOI: 10.1053/j.gastro.2018.02.021] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/22/2018] [Accepted: 02/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Guidelines for initiating colorectal cancer (CRC) screening are based on family history but do not consider lifestyle, environmental, or genetic risk factors. We developed models to determine risk of CRC, based on lifestyle and environmental factors and genetic variants, and to identify an optimal age to begin screening. METHODS We collected data from 9748 CRC cases and 10,590 controls in the Genetics and Epidemiology of Colorectal Cancer Consortium and the Colorectal Transdisciplinary study, from 1992 through 2005. Half of the participants were used to develop the risk determination model and the other half were used to evaluate the discriminatory accuracy (validation set). Models of CRC risk were created based on family history, 19 lifestyle and environmental factors (E-score), and 63 CRC-associated single-nucleotide polymorphisms identified in genome-wide association studies (G-score). We evaluated the discriminatory accuracy of the models by calculating area under the receiver operating characteristic curve values, adjusting for study, age, and endoscopy history for the validation set. We used the models to project the 10-year absolute risk of CRC for a given risk profile and recommend ages to begin screening in comparison to CRC risk for an average individual at 50 years of age, using external population incidence rates for non-Hispanic whites from the Surveillance, Epidemiology, and End Results program registry. RESULTS In our models, E-score and G-score each determined risk of CRC with greater accuracy than family history. A model that combined both scores and family history estimated CRC risk with an area under the receiver operating characteristic curve value of 0.63 (95% confidence interval, 0.62-0.64) for men and 0.62 (95% confidence interval, 0.61-0.63) for women; area under the receiver operating characteristic curve values based on only family history ranged from 0.53 to 0.54 and those based only E-score or G-score ranged from 0.59 to 0.60. Although screening is recommended to begin at age 50 years for individuals with no family history of CRC, starting ages calculated based on combined E-score and G-score differed by 12 years for men and 14 for women, for individuals with the highest vs the lowest 10% of risk. CONCLUSIONS We used data from 2 large international consortia to develop CRC risk calculation models that included genetic and environmental factors along with family history. These determine risk of CRC and starting ages for screening with greater accuracy than the family history only model, which is based on the current screening guideline. These scoring systems might serve as a first step toward developing individualized CRC prevention strategies.
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Affiliation(s)
- Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
| | - Mengmeng Du
- Memorial Sloan Kettering, New York, New York
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Bette Caan
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California
| | - Peter T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jenny Chang-Claude
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, and Centre for Epidemiology and Biostatistics, School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - Jian Gong
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tabitha A Harrison
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jeroen R Huyghe
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Eric J Jacobs
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Li Li
- Case Western Reserve University, Cleveland, Ohio
| | - Yi Lin
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Conghui Qu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie A Bien
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Niha Zubair
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert J Macinnis
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, and Centre for Epidemiology and Biostatistics, School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - Daniel D Buchanan
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Genetic Medicine and Family Cancer Clinic, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Epidemiology, School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Yin Cao
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Reiko Nishihara
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Martha L Slattery
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Duncan C Thomas
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael O Woods
- Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Ross L Prentice
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephen B Gruber
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Richard B Hayes
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Emily White
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Li Hsu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Informing evaluation of a smartphone application for people with acquired brain injury: a stakeholder engagement study. BMC Med Inform Decis Mak 2018; 18:33. [PMID: 29848312 PMCID: PMC5975503 DOI: 10.1186/s12911-018-0611-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. METHODS We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses. RESULTS We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone. CONCLUSIONS The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions.
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Jones LK, Kulchak Rahm A, Gionfriddo MR, Williams JL, Fan AL, Pulk RA, Wright EA, Williams MS. Developing Pharmacogenomic Reports: Insights from Patients and Clinicians. Clin Transl Sci 2018; 11:289-295. [PMID: 29316365 PMCID: PMC5944570 DOI: 10.1111/cts.12534] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/06/2017] [Indexed: 01/17/2023] Open
Abstract
Increasingly, for a variety of indications, patients have their genomes sequenced and actionable results returned. A subset of returned results is pharmacogenomic (PGx) variants involved in the metabolism or action of medications. Although the impact of these variants on health is well-documented, little research exists on how to communicate these findings to patients and clinicians. We conducted semistructured interviews with end users to understand how best to communicate PGx results. Overall, patients and clinicians had similar opinions regarding report content, delivery, and application. Unique concerns specific to each stakeholder group were also expressed. Patients wanted an easy-to-understand individualized report that clinicians utilized to guide their care. Clinicians wanted reports that were easy-to-use, actionable, and integrated into their workflow. Implementation of these reports in a clinical setting will allow for broader user feedback and iterative improvement.
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Affiliation(s)
| | | | | | | | - Audrey L. Fan
- GeisingerDanvillePennsylvaniaUSA
- Genome MedicalSan FranciscoCaliforniaUSA
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Abe J, Lobo JM, Trifiletti DM, Showalter TN. Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy. BMC Med Inform Decis Mak 2017; 17:128. [PMID: 28836985 PMCID: PMC5571582 DOI: 10.1186/s12911-017-0526-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/18/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. METHODS We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. RESULTS The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. CONCLUSIONS A range of stakeholders provided valuable insights regarding the design of a personalized decision aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.
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Affiliation(s)
- James Abe
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908 USA
| | - Jennifer M. Lobo
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Daniel M. Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908 USA
| | - Timothy N. Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908 USA
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Sanderson SC, Brothers KB, Mercaldo ND, Clayton EW, Antommaria AHM, Aufox SA, Brilliant MH, Campos D, Carrell DS, Connolly J, Conway P, Fullerton SM, Garrison NA, Horowitz CR, Jarvik GP, Kaufman D, Kitchner TE, Li R, Ludman EJ, McCarty CA, McCormick JB, McManus VD, Myers MF, Scrol A, Williams JL, Shrubsole MJ, Schildcrout JS, Smith ME, Holm IA. Public Attitudes toward Consent and Data Sharing in Biobank Research: A Large Multi-site Experimental Survey in the US. Am J Hum Genet 2017; 100:414-427. [PMID: 28190457 DOI: 10.1016/j.ajhg.2017.01.021] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/11/2017] [Indexed: 12/16/2022] Open
Abstract
Individuals participating in biobanks and other large research projects are increasingly asked to provide broad consent for open-ended research use and widespread sharing of their biosamples and data. We assessed willingness to participate in a biobank using different consent and data sharing models, hypothesizing that willingness would be higher under more restrictive scenarios. Perceived benefits, concerns, and information needs were also assessed. In this experimental survey, individuals from 11 US healthcare systems in the Electronic Medical Records and Genomics (eMERGE) Network were randomly allocated to one of three hypothetical scenarios: tiered consent and controlled data sharing; broad consent and controlled data sharing; or broad consent and open data sharing. Of 82,328 eligible individuals, exactly 13,000 (15.8%) completed the survey. Overall, 66% (95% CI: 63%-69%) of population-weighted respondents stated they would be willing to participate in a biobank; willingness and attitudes did not differ between respondents in the three scenarios. Willingness to participate was associated with self-identified white race, higher educational attainment, lower religiosity, perceiving more research benefits, fewer concerns, and fewer information needs. Most (86%, CI: 84%-87%) participants would want to know what would happen if a researcher misused their health information; fewer (51%, CI: 47%-55%) would worry about their privacy. The concern that the use of broad consent and open data sharing could adversely affect participant recruitment is not supported by these findings. Addressing potential participants' concerns and information needs and building trust and relationships with communities may increase acceptance of broad consent and wide data sharing in biobank research.
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Affiliation(s)
- Saskia C Sanderson
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Great Ormond Street Hospital, London WC1N 3JH, UK; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA.
| | | | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN 37203, USA
| | | | - Sharon A Aufox
- Center for Genetic Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Murray H Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Diego Campos
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - John Connolly
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Pat Conway
- Essentia Institute of Rural Health, Duluth, MN 55805, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Nanibaa' A Garrison
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics, University of Washington, Seattle, WA 98101, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gail P Jarvik
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - David Kaufman
- Division of Genomics and Society, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Terrie E Kitchner
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | | | | | | | - Valerie D McManus
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Melanie F Myers
- Genetic Counseling Graduate Program, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH 45229, USA
| | - Aaron Scrol
- Group Health Research Institute, Seattle, WA 98101, USA
| | - Janet L Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, PA 17822, USA
| | - Martha J Shrubsole
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA 02115, USA
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Heath M, Appan R, Gudigantala N. Exploring Health Information Exchange (HIE) Through Collaboration Framework: Normative Guidelines for IT Leadership of Healthcare Organizations. INFORMATION SYSTEMS MANAGEMENT 2017. [DOI: 10.1080/10580530.2017.1288524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michele Heath
- Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio, USA
| | - Radha Appan
- Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio, USA
| | - Naveen Gudigantala
- Robert B. Pamplin Jr. School of Business Administration, University of Portland, Portland, Oregon, USA
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Carman KL, Workman TA. Engaging patients and consumers in research evidence: Applying the conceptual model of patient and family engagement. PATIENT EDUCATION AND COUNSELING 2017; 100:25-29. [PMID: 27473639 DOI: 10.1016/j.pec.2016.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This essay discusses applying the Conceptual Framework for Patient and Family Engagement to partnerships with patients and consumers to increase their use of research evidence in healthcare decisions. The framework's foundational principles hold that engagement occurs on a continuum across all levels of healthcare-from direct care to policymaking-with patients and healthcare professionals working in full partnership and sharing responsibility for achieving a safe, high-quality, efficient, and patient-centered healthcare system. DISCUSSION Research evidence can serve as a critical decision-making tool in partnerships between patients and health professionals. However, as the framework suggests, without patient and consumer engagement in the design, planning, interpretation, and dissemination of research findings, it is unlikely that the broader consumer population will find research evidence useful, much less use it, to guide their healthcare decisions. Understanding what factors influence patient and consumer engagement can lead to effective strategies that enable meaningful partnerships between patients and researchers. CONCLUSION Understanding patient and consumer perspectives of research evidence is critical to engaging them in meaningful partnerships that produce actionable research findings that they can in turn use in partnership with health professionals to improve their own health and the healthcare system as a whole.
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Affiliation(s)
- Kristin L Carman
- American Institutes for Research, 1000 Thomas Jefferson Street NW, 20007, Washington DC, United States
| | - Thomas A Workman
- American Institutes for Research, 1000 Thomas Jefferson Street NW, 20007, Washington DC, United States.
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Stewart R, Davis K. 'Big data' in mental health research: current status and emerging possibilities. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1055-72. [PMID: 27465245 PMCID: PMC4977335 DOI: 10.1007/s00127-016-1266-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/08/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE 'Big data' are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future. METHODS A narrative review. RESULTS Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention. DISCUSSION We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users.
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Affiliation(s)
- Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK.
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK
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Sweet K, Sturm AC, Schmidlen T, Hovick S, Peng J, Manickam K, Salikhova A, McElroy J, Scheinfeldt L, Toland AE, Roberts JS, Christman M. EMR documentation of physician-patient communication following genomic counseling for actionable complex disease and pharmacogenomic results. Clin Genet 2016; 91:545-556. [PMID: 27322592 DOI: 10.1111/cge.12820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 01/06/2023]
Abstract
Genomic risk information for potentially actionable complex diseases and pharmacogenomics communicated through genomic counseling (GC) may motivate physicians and patients to take preventive actions. The Ohio State University-Coriell Personalized Medicine Collaborative is a randomized trial to measure the effects of in-person GC on chronic disease patients provided with multiplex results. Nine personalized genomic risk reports were provided to patients through a web portal, and to physicians via electronic medical record (EMR). Active arm participants (98, 39% female) received GC within 1 month of report viewing; control arm subjects (101, 54% female) could access counseling 3-months post-report viewing. We examined whether GC affected documentation of physician-patient communication by reviewing the first clinical note following the patient's GC visit or report upload to the EMR. Multivariable logistic regression modeling estimated the independent effect of GC on physician-patient communication, as intention to treat (ITT) and per protocol (PP), adjusted for physician educational intervention. Counselees in the active arm had more physician-patient communications than control subjects [ITT, odds ratio (OR): 3.76 (95% confidence interval (CI): 1.38-10.22, p < 0.0094); PP, OR: 5.53 (95% CI: 2.20-13.90, p = 0.0017). In conclusion, GC appreciably affected physician-patient communication following receipt of potentially actionable genomic risk information.
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Affiliation(s)
- K Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A C Sturm
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - T Schmidlen
- Coriell Personalized Medicine Collaborative, Coriell Institute for Medical Research, Camden, NJ, USA
| | - S Hovick
- School of Communication, Ohio State University, Columbus, OH, USA
| | - J Peng
- Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, USA
| | - K Manickam
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA.,Geisinger Health System, Genomic Medicine Institute, Precision Health Center, Forty Fort, PA, USA
| | - A Salikhova
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J McElroy
- Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, USA
| | - L Scheinfeldt
- Coriell Personalized Medicine Collaborative, Coriell Institute for Medical Research, Camden, NJ, USA.,Department of Biology, Temple University, Philadelphia, PA, USA
| | - A E Toland
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J S Roberts
- Department of Health Behaviour & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - M Christman
- Coriell Personalized Medicine Collaborative, Coriell Institute for Medical Research, Camden, NJ, USA
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Kruglyak KM, Lin E, Ong FS. Next-Generation Sequencing and Applications to the Diagnosis and Treatment of Lung Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 890:123-36. [PMID: 26703802 DOI: 10.1007/978-3-319-24932-2_7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer is a genetic disease characterized by uncontrolled growth of abnormal cells. Over time, somatic mutations accumulate in the cells of an individual due to replication errors, chromosome segregation errors, or DNA damage. When not caught by traditional mechanisms, these somatic mutations can lead to cellular proliferation, the hallmark of cancer. Lung cancer is the leading cause of cancer-related mortality in the United States, accounting for approximately 160,000 deaths annually. Five year survival rates for lung cancer remain low (<50 %) for all stages, with even worse prognosis (<15 %) in late stage cases. Technological advances, including advances in next-generation sequencing (NGS), offer the vision of personalized medicine or precision oncology, wherein an individual's treatment can be based on his or her individual molecular profile, rather than on historical population-based medicine. Towards this end, NGS has already been used to identify new biomarker candidates for the early diagnosis of lung cancer and is increasingly used to guide personalized treatment decisions. In this review we will provide a high-level overview of NGS technology and summarize its application to the diagnosis and treatment of lung cancer. We will also describe how NGS can drive advances that bring us closer to precision oncology and discuss some of the technical challenges that will need to be overcome in order to realize this ultimate goal.
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Affiliation(s)
| | - Erick Lin
- Medical Affairs, Ambry Genetics, Inc., Aliso Viejo, CA, USA
| | - Frank S Ong
- Medical Affairs and Clinical Development, NantHealth, LLC, Culver City, CA, USA.
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Sanderson SC, Suckiel SA, Zweig M, Bottinger EP, Jabs EW, Richardson LD. Development and preliminary evaluation of an online educational video about whole-genome sequencing for research participants, patients, and the general public. Genet Med 2016; 18:501-12. [PMID: 26334178 PMCID: PMC4857185 DOI: 10.1038/gim.2015.118] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/08/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND As whole-genome sequencing (WGS) increases in availability, WGS educational aids are needed for research participants, patients, and the general public. Our aim was therefore to develop an accessible and scalable WGS educational aid. METHODS We engaged multiple stakeholders in an iterative process over a 1-year period culminating in the production of a novel 10-minute WGS educational animated video, "Whole Genome Sequencing and You" (https://goo.gl/HV8ezJ). We then presented the animated video to 281 online-survey respondents (the video-information group). There were also two comparison groups: a written-information group (n = 281) and a no-information group (n = 300). RESULTS In the video-information group, 79% reported the video was easy to understand, satisfaction scores were high (mean 4.00 on 1-5 scale, where 5 = high satisfaction), and knowledge increased significantly. There were significant differences in knowledge compared with the no-information group but few differences compared with the written-information group. Intention to receive personal results from WGS and decisional conflict in response to a hypothetical scenario did not differ between the three groups. CONCLUSIONS The educational animated video, "Whole Genome Sequencing and You," was well received by this sample of online-survey respondents. Further work is needed to evaluate its utility as an aid to informed decision making about WGS in other populations.Genet Med 18 5, 501-512.
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Affiliation(s)
- Saskia C. Sanderson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sabrina A. Suckiel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Micol Zweig
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erwin P. Bottinger
- Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ethylin Wang Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Evans JP, Wilhelmsen KC, Berg J, Schmitt CP, Krishnamurthy A, Fecho K, Ahalt SC. A New Framework and Prototype Solution for Clinical Decision Support and Research in Genomics and Other Data-intensive Fields of Medicine. EGEMS 2016; 4:1198. [PMID: 27195307 PMCID: PMC4862762 DOI: 10.13063/2327-9214.1198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction: In genomics and other fields, it is now possible to capture and store large amounts of data in electronic medical records (EMRs). However, it is not clear if the routine accumulation of massive amounts of (largely uninterpretable) data will yield any health benefits to patients. Nevertheless, the use of large-scale medical data is likely to grow. To meet emerging challenges and facilitate optimal use of genomic data, our institution initiated a comprehensive planning process that addresses the needs of all stakeholders (e.g., patients, families, healthcare providers, researchers, technical staff, administrators). Our experience with this process and a key genomics research project contributed to the proposed framework. Framework: We propose a two-pronged Genomic Clinical Decision Support System (CDSS) that encompasses the concept of the “Clinical Mendeliome” as a patient-centric list of genomic variants that are clinically actionable and introduces the concept of the “Archival Value Criterion” as a decision-making formalism that approximates the cost-effectiveness of capturing, storing, and curating genome-scale sequencing data. We describe a prototype Genomic CDSS that we developed as a first step toward implementation of the framework. Conclusion: The proposed framework and prototype solution are designed to address the perspectives of stakeholders, stimulate effective clinical use of genomic data, drive genomic research, and meet current and future needs. The framework also can be broadly applied to additional fields, including other ‘-omics’ fields. We advocate for the creation of a Task Force on the Clinical Mendeliome, charged with defining Clinical Mendeliomes and drafting clinical guidelines for their use.
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Affiliation(s)
- James P Evans
- Department of Genetics, University of North Carolina at Chapel Hill; Department of Medicine, University of North Carolina at Chapel Hill
| | - Kirk C Wilhelmsen
- Department of Genetics, University of North Carolina at Chapel Hill; Department of Neurology, University of North Carolina at Chapel Hill
| | - Jonathan Berg
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Charles P Schmitt
- Renaissance Computing Institute, University of North Carolina at Chapel Hill
| | - Ashok Krishnamurthy
- Renaissance Computing Institute, University of North Carolina at Chapel Hill
| | - Karamarie Fecho
- Renaissance Computing Institute, University of North Carolina at Chapel Hill
| | - Stanley C Ahalt
- Department of Computer Science, University of North Carolina at Chapel Hill; Renaissance Computing Institute, University of North Carolina at Chapel Hill
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Hall JL, Ryan JJ, Bray BE, Brown C, Lanfear D, Newby LK, Relling MV, Risch NJ, Roden DM, Shaw SY, Tcheng JE, Tenenbaum J, Wang TN, Weintraub WS. Merging Electronic Health Record Data and Genomics for Cardiovascular Research: A Science Advisory From the American Heart Association. ACTA ACUST UNITED AC 2016; 9:193-202. [PMID: 26976545 DOI: 10.1161/hcg.0000000000000029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The process of scientific discovery is rapidly evolving. The funding climate has influenced a favorable shift in scientific discovery toward the use of existing resources such as the electronic health record. The electronic health record enables long-term outlooks on human health and disease, in conjunction with multidimensional phenotypes that include laboratory data, images, vital signs, and other clinical information. Initial work has confirmed the utility of the electronic health record for understanding mechanisms and patterns of variability in disease susceptibility, disease evolution, and drug responses. The addition of biobanks and genomic data to the information contained in the electronic health record has been demonstrated. The purpose of this statement is to discuss the current challenges in and the potential for merging electronic health record data and genomics for cardiovascular research.
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Huang BE, Mulyasasmita W, Rajagopal G. The path from big data to precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1157686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Roy S, LaFramboise WA, Nikiforov YE, Nikiforova MN, Routbort MJ, Pfeifer J, Nagarajan R, Carter AB, Pantanowitz L. Next-Generation Sequencing Informatics: Challenges and Strategies for Implementation in a Clinical Environment. Arch Pathol Lab Med 2016; 140:958-75. [PMID: 26901284 DOI: 10.5858/arpa.2015-0507-ra] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Next-generation sequencing (NGS) is revolutionizing the discipline of laboratory medicine, with a deep and direct impact on patient care. Although it empowers clinical laboratories with unprecedented genomic sequencing capability, NGS has brought along obvious and obtrusive informatics challenges. Bioinformatics and clinical informatics are separate disciplines with typically a small degree of overlap, but they have been brought together by the enthusiastic adoption of NGS in clinical laboratories. The result has been a collaborative environment for the development of novel informatics solutions. Sustaining NGS-based testing in a regulated clinical environment requires institutional support to build and maintain a practical, robust, scalable, secure, and cost-effective informatics infrastructure. OBJECTIVE -To discuss the novel NGS informatics challenges facing pathology laboratories today and offer solutions and future developments to address these obstacles. DATA SOURCES -The published literature pertaining to NGS informatics was reviewed. The coauthors, experts in the fields of molecular pathology, precision medicine, and pathology informatics, also contributed their experiences. CONCLUSIONS -The boundary between bioinformatics and clinical informatics has significantly blurred with the introduction of NGS into clinical molecular laboratories. Next-generation sequencing technology and the data derived from these tests, if managed well in the clinical laboratory, will redefine the practice of medicine. In order to sustain this progress, adoption of smart computing technology will be essential. Computational pathologists will be expected to play a major role in rendering diagnostic and theranostic services by leveraging "Big Data" and modern computing tools.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Liron Pantanowitz
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Roy, LaFramboise, Nikiforov, Nikiforova, and Pantanowitz); the Department of Pathology, MD Anderson Cancer Center, Houston, Texas (Dr Routbort); the Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (Drs Pfeifer and Nagarajan); PierianDx, St Louis, Missouri (Dr Nagarajan); and the Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia (Dr Carter)
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Physician perspectives of CYP2C19 and clopidogrel drug-gene interaction active clinical decision support alerts. Int J Med Inform 2015; 86:117-25. [PMID: 26642939 DOI: 10.1016/j.ijmedinf.2015.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 09/29/2015] [Accepted: 11/06/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness. MATERIALS AND METHODS 52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction. RESULTS Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts. PRINCIPAL CONCLUSIONS Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways.
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Frye MA, Doederlein A, Koenig B, McElroy SL, Nassan M, Seymour LR, Biernacka JM, Daniels AS. National survey and community advisory board development for a bipolar disorder biobank. Bipolar Disord 2015; 17:598-605. [PMID: 26291791 PMCID: PMC4643402 DOI: 10.1111/bdi.12322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/17/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of the present study was to engage a national advocacy group and local stakeholders for guidance in developing a bipolar disorder biobank through a web-based survey and a community advisory board. METHODS The Depression and Bipolar Support Alliance and the Mayo Clinic Bipolar Biobank conducted a national web-based survey inquiring about interest in participating in a biobank (i.e., giving DNA and clinical information). A community advisory board was convened to guide establishment of the biobank and identify key deliverables from the research project and for the community. RESULTS Among 385 survey respondents, funding source (87%), professional opinion (76%), mental health consumer opinion (79%), and return of research results (91%) were believed to be important for considering study participation. Significantly more patients were willing to participate in a biobank managed by a university or clinic (78.2%) than one managed by government (63.4%) or industry (58.2%; both p < 0.001). The nine-member community advisory board expressed interest in research to help predict the likelihood of bipolar disorder developing in a child of an affected parent and which medications to avoid. The advisory board endorsed the use of a comprehension questionnaire to evaluate participants' understanding of the study (e.g., longevity of DNA specimens, right to remove samples, accessing medical records) as a means to strengthen the informed consent process. CONCLUSIONS These national survey and community advisory data support the merit of establishing a biobank to enable studies of disease risk, provided that health records and research results are adequately protected. The goals of earlier diagnosis and individualized treatment of bipolar disorder were endorsed.
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Affiliation(s)
- Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Barbara Koenig
- Institute for Health and Aging, University of California, San Francisco, CA, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, USA
- Department of Psychiatry, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Malik Nassan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Lisa R Seymour
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Applying evidence from economic evaluations to translate cancer survivorship research into care. J Cancer Surviv 2015; 9:560-6. [DOI: 10.1007/s11764-015-0433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/27/2015] [Indexed: 01/16/2023]
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Public trust in health information sharing: implications for biobanking and electronic health record systems. J Pers Med 2015; 5:3-21. [PMID: 25654300 PMCID: PMC4384055 DOI: 10.3390/jpm5010003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 12/28/2022] Open
Abstract
Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447). We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust) were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making.
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Kimball BC, Nowakowski KE, Maschke KJ, McCormick JB. Genomic data in the electronic medical record: perspectives from a biobank community advisory board. J Empir Res Hum Res Ethics 2014; 9:16-24. [PMID: 25747687 DOI: 10.1177/1556264614553922] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A proof of principle pharmacogenomic translational study was used as a case example to explore Biobank Community Advisory Board (CAB) member views about placing genomic information into the medical record and to establish how CAB input could affect research design. CAB members expressed enthusiasm for the potential benefit of the research discussed, yet voiced concerns regarding the recruitment and consent materials. They discussed the value of genomic research and its clinical utility; the risk of genetic discrimination; and personal ownership of genomic data. Members distinguished between indirect benefits to future generations and individual risk to research participants. Feedback was used to revise the recruitment and consent materials. Results highlight tensions reported between the public's support for genomic research and concerns with genomic information in the medical record and its use in medical decision-making.
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Lin E, Chien J, Ong FS, Fan JB. Challenges and opportunities for next-generation sequencing in companion diagnostics. Expert Rev Mol Diagn 2014; 15:193-209. [DOI: 10.1586/14737159.2015.961916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Nishimura AA, Tarczy-Hornoch P, Shirts BH. Pragmatic and Ethical Challenges of Incorporating the Genome into the Electronic Medical Record. CURRENT GENETIC MEDICINE REPORTS 2014; 2:201-211. [PMID: 26146597 DOI: 10.1007/s40142-014-0051-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent successes in the use of gene sequencing for patient care highlight the potential of genomic medicine. For genomics to become a part of usual care, pertinent elements of a patient's genomic test must be communicated to the most appropriate care providers. Electronic medical records may serve as a useful tool for storing and disseminating genomic data. Yet, the structure of existing EMRs and the nature of genomic data pose a number of pragmatic and ethical challenges in their integration. Through a review of the recent genome-EMR integration literature, we explore concrete examples of these challenges, categorized under four key questions: What data will we store? How will we store it? How will we use it? How will we protect it? We conclude that genome-EMR integration requires a rigorous, multi-faceted and interdisciplinary approach of study. Problems facing the field are numerous, but few are intractable.
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Affiliation(s)
- Adam A Nishimura
- Department of Biomedical Informatics and Medical Education, University of Washington
| | - Peter Tarczy-Hornoch
- Department of Biomedical Informatics and Medical Education, University of Washington ; Department of Pediatrics, University of Washington ; Department of Computer Science and Engineering, University of Washington
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington
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