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Shen FX, Baum ML, Martinez-Martin N, Miner AS, Abraham M, Brownstein CA, Cortez N, Evans BJ, Germine LT, Glahn DC, Grady C, Holm IA, Hurley EA, Kimble S, Lázaro-Muñoz G, Leary K, Marks M, Monette PJ, Jukka-Pekka O, O’Rourke PP, Rauch SL, Shachar C, Sen S, Vahia I, Vassy JL, Baker JT, Bierer BE, Silverman BC. Returning Individual Research Results from Digital Phenotyping in Psychiatry. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:69-90. [PMID: 37155651 PMCID: PMC10630534 DOI: 10.1080/15265161.2023.2180109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants' locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant's real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas.
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Affiliation(s)
- Francis X. Shen
- Harvard Medical School
- Massachusetts General Hospital
- Harvard Law School
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mason Marks
- Harvard Law School
- Florida State University College of Law
- Yale Law School
| | | | | | | | - Scott L. Rauch
- Harvard Medical School
- McLean Hospital
- Mass General Brigham
| | | | | | | | - Jason L. Vassy
- Harvard Medical School
- Brigham and Women’s Hospital
- VA Boston Healthcare System
| | | | - Barbara E. Bierer
- Harvard Medical School
- Brigham and Women’s Hospital
- Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
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2
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Soeprijadi RS, Andarini S, Hariyanti T, Wayan Arsana Wiyasa I. Lactogenesis factors in the Asian population. Clin Chim Acta 2024; 554:117784. [PMID: 38272252 DOI: 10.1016/j.cca.2024.117784] [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: 12/04/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
The increasing incidence of disrupted lactogenesis in Asian populations underscores the importance of timely identification and efficient intervention. This study acknowledges the influence of ethnicity on genetic variations and aims to investigate the genetic mechanisms that contribute to lactogenesis in individuals of Asian descent. This study examines the possibilities of genetic screening as a means of applying preventive measures, with a particular focus on epigenetic techniques. Additionally, the analysis looks into the underlying mechanisms involved in milk production. This review discusses the intricate mechanisms underlying breast milk production and the potential influence of genetic variables on lactogenesis. Specifically, it explores the association between lactogenesis issues and genetic conditions such as depression, obesity, gestational hypertension, and gestational diabetes. These genetic factors could potentially be found by genetic screening as contributors to disruption in lactogenesis. This study aims to promote future investigation in the subject of genetic testing and its potential association with lactogenesis issues, despite the current scarcity of direct research on this topic. The statement posits that the progress made in genetic testing has the potential to provide novel insights into the timely identification and treatment of disrupted lactogenesis.
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Affiliation(s)
- Raden Slamet Soeprijadi
- Doctoral Study Program in Medical Science, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
| | - Sri Andarini
- Department of Public Health, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
| | - Tita Hariyanti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
| | - I Wayan Arsana Wiyasa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
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3
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Assessing Vietnamese American patient perspectives on population genetic testing in primary care: A community-engaged approach. HGG ADVANCES 2022; 3:100134. [PMID: 36039118 PMCID: PMC9418978 DOI: 10.1016/j.xhgg.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/03/2022] [Indexed: 12/04/2022] Open
Abstract
Achieving health equity in precision medicine remains a critical challenge because of the continued underrepresentation of non-white populations in research and barriers to genetic services. The goal of this study was to explore Vietnamese American (VA) participant views toward incorporating genetics in routine healthcare to better serve the local VA community within an integrated health system offering primary care-based population genetic testing to adults for conditions that could be prevented or mitigated when detected early. We conducted semi-structured interviews from August–September 2021, with 22 individuals receiving primary care who self-identified as Vietnamese or VA, and employed rapid qualitative analysis (RQA) to identify key concepts. Community research team members participated in study design, data collection, RQA, and reporting. Findings from the interviews revealed that several participant perceived challenges to genetic testing, which included lack of information, fear of results impact, cost, and privacy concerns. Participants suggested various ways to overcome some of these barriers, such as decreasing the cost of testing, receiving information from a trusted physician, using preferred education strategies in the community, and having convenient access to testing. Study participants also shared a variety of trusted sources they would seek out for advice on genetic testing. This study with VAs identified barriers, facilitators, and messengers to offering genetic testing in a local healthcare context and demonstrated how community-engaged research coupled with RQA is a promising approach for healthcare institutions as they identify needs and tailor strategies for implementing population genetic screening programs in local ethnic communities.
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4
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Chen Z, Ma GX, Zhang X, McLemore MR. Editorial: Community Engagement Is Key to Promoting Asian American, Native Hawaiian, and Pacific Islander Health. Health Equity 2022; 6:681-683. [PMID: 36225667 PMCID: PMC9536337 DOI: 10.1089/heq.2022.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Grace X. Ma
- Center for Asian Health, Department of Urban Health and Population Science at Lewis Katz School of Medicine and Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania, USA
| | - Xinzhi Zhang
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Monica R. McLemore
- Family Health Care Nursing Department, University of California San Francisco, San Francisco, California, USA
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5
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Pham T, Patel A, Muquith M, Zimmern V, Goodspeed K. Abnormal Genetic Testing in Males With Concomitant Neurodevelopmental Disabilities and Genital Malformation. Pediatr Neurol 2022; 134:72-77. [PMID: 35841714 DOI: 10.1016/j.pediatrneurol.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurodevelopmental disorders (NDDs) affect 1:6 children in the United States and are often linked to genetic disorders. Because many genes are enriched in brain and testicular tissue, genital malformations identified early may be a predictor of genetic disorders in children with NDDs. However, few studies have evaluated the specific effects of genital malformations. This study assesses the association between genital malformations and abnormal genetic testing among male patients with NDD. METHODS A retrospective chart review was performed of 447 male patients seen at Children's Health Dallas (2009 to 2019) with concomitant genital malformations and NDDs. We assessed the strength of factors associated with obtaining a genetic test and having abnormal results. RESULTS We identified 447 patients with concomitant genital malformations and NDD. Fifty-six percent (251 of 447) received genetic testing, of which 68.5% (172 of 251) had abnormal results. Patients with mixed genitourinary malformations, global developmental delay (GDD), intellectual delay, or autism spectrum disorder were more likely to have a genetic test. Patients with bilateral testicular involvement, GDD, severe language delay, wheelchair dependence, or abnormal magnetic resonance imaging findings were more likely to have abnormal results. CONCLUSION The diagnostic yield of 68.5% in our cohort of male patients with genital malformations was higher than previous reports of 5% to 35% in NDD populations. More severe phenotypic features may be associated with increased yield. Identification of genital malformations during infancy may guide clinical surveillance, and copresentations with NDDs may support genetic testing.
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Affiliation(s)
- Tri Pham
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Akshat Patel
- University of Texas Southwestern Medical School, Dallas, Texas
| | | | - Vincent Zimmern
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kimberly Goodspeed
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
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Vanderwall RA, Schwartz A, Kipnis L, Skefos CM, Stokes SM, Bhulani N, Weitz M, Gelman R, Garber JE, Rana HQ. Impact of Genetic Counseling on Patient-Reported Electronic Cancer Family History Collection. J Natl Compr Canc Netw 2022; 20:898-905.e2. [PMID: 35948032 DOI: 10.6004/jnccn.2022.7022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/29/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer family history is a vital part of cancer genetic counseling (GC) and genetic testing (GT), but increasing indications for germline cancer GT necessitate less labor-intensive models of collection. We evaluated the impact of GC on patient pedigrees generated by an electronic cancer family history questionnaire (eCFHQ). METHODS An Institutional Review Board-approved review of pedigrees collected through an eCFHQ was conducted. Paired pre-GC and post-GC pedigrees (n=1,113 each group) were analyzed independently by cancer genetic counselors for changes in patient-reported clinical history and to determine whether the pedigrees met NCCN GT criteria. Discrepancy in meeting NCCN GT criteria between pre-GC and post-GC pedigrees was the outcome variable of logistic regressions, with patient and family history characteristics as covariates. RESULTS Overall, 780 (70%) patients had cancer (affected), 869 (78%) were female, and the median age was 57 years (interquartile range, 45-66 years; range, 21-91 years). Of the 1,113 pairs of pre-GC and post-GC pedigrees analyzed, 85 (8%) were blank, 933 (84%) were not discrepant, and 95 (9%) were discrepant in meeting any NCCN GT criteria. Of the discrepant pedigrees, n=79 (83%) became eligible for testing by at least one of the NCCN GT criteria after GC. Patients with discrepant pedigrees were more likely to report no or unknown history of GT (odds ratio [OR], 4.54; 95% CI, 1.66-18.70; P=.01, and OR, 18.47; 95% CI, 5.04-88.73; P<.0001, respectively) and belonged to racially and/or ethnically underrepresented groups (OR, 1.91; 95% CI, 1.08-3.25; P=.02). CONCLUSIONS For most patients (84%), a standalone eCFHQ was sufficient to determine whether NCCN GT criteria were met. More research is needed on the performance of the eCFHQ in diverse patient populations.
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Affiliation(s)
- Rebecca A Vanderwall
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Alison Schwartz
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Lindsay Kipnis
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Catherine M Skefos
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Samantha M Stokes
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Nizar Bhulani
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School; and
| | - Michelle Weitz
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rebecca Gelman
- Harvard Medical School; and.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Judy E Garber
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School; and
| | - Huma Q Rana
- Divisions of Population Sciences and Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School; and
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Lizarondo L, Stern C, Apostolo J, Carrier J, de Borges K, Godfrey C, Kirkpatrick P, Pollock D, Rieger K, Salmond S, Vandyk A, Loveday H. Five common pitfalls in mixed methods systematic reviews - lessons learned. J Clin Epidemiol 2022; 148:178-183. [PMID: 35341946 DOI: 10.1016/j.jclinepi.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Mixed methods systematic reviews (MMSR) combine quantitative and qualitative evidence within a single review. Since the revision of the JBI Methodology for MMSRs in 2020, there has been an increasing number of reviews published that claim to follow this approach. A preliminary examination of these indicated that authors frequently deviated from the methodology. This paper outlines five common 'pitfalls' associated with undertaking MMSR and provides direction for future reviewers attempting MMSR. METHODS Forward citation tracking identified 17 reviews published since the revision of the JBI mixed methods methodological guidance. Methods used in these reviews were then examined against the JBI methodology to identify deviations. RESULTS The issues identified related to the rationale for choosing the methodological approach; incorrect synthesis and integration approach chosen to answer the review question/s posed; the exclusion of primary mixed methods studies in the review; the lack of detail regarding the process of data transformation and a lack of 'mixing' of the quantitative and qualitative components. CONCLUSION This exercise was undertaken to assist systematic reviewers considering conducting a MMSR as well as MMSR users to identify potential areas where authors tend to deviate from the methodological approach. Based on these findings a series of recommendations are provided.
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Affiliation(s)
- Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, 55 Norwich House, King William Road, Adelaide, Australia.
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, 55 Norwich House, King William Road, Adelaide, Australia
| | - Joao Apostolo
- Health Sciences Research Unit: Nursing, Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Portugal
| | - Judith Carrier
- School of Healthcare Sciences, Cardiff University, The Wales Centre For Evidence Based Care: A JBI Centre of Excellence, Cardiff CF10 3AT, United Kingdom
| | - Kelli de Borges
- Universidade Federal de Juiz de For a, Campus Universitário, Rua José Lourenço Kelmer, s/n - São Pedro, Juiz de Fora - MG, 36036-900, Brazil
| | - Christina Godfrey
- School of Nursing, Queen's University, Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence Kingston, 99 University Ave, Kingston, Ontario K7L 3N6, Canada
| | - Pamela Kirkpatrick
- School of Nursing and Midwifery, Robert Gordon University, The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Garthdee House, Garthdee Rd, Garthdee, Aberdeen AB10 7AQ, United Kingdom
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, 55 Norwich House, King William Road, Adelaide, Australia
| | - Kendra Rieger
- School of Nursing, Trinity Western University, 22500 University Dr, Langley, British Columbia, V2Y 1Y1, Canada
| | - Susan Salmond
- School of Nursing, Rutgers, The State University of New Jersey, The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, New Brunswick, New Jersey, USA
| | - Amanda Vandyk
- School of Nursing, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5, Canada
| | - Heather Loveday
- College of Nursing, Midwifery and Healthcare, University of West London, The University of West London Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, St Mary's Rd, London W5 5RF, United Kingdom
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8
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Brown JEH, Young JL, Martinez-Martin N. Psychiatric genomics, mental health equity, and intersectionality: A framework for research and practice. Front Psychiatry 2022; 13:1061705. [PMID: 36620660 PMCID: PMC9812559 DOI: 10.3389/fpsyt.2022.1061705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
The causal mechanisms and manifestations of psychiatric illness cannot be neatly narrowed down or quantified for diagnosis and treatment. Large-scale genome-wide association studies (GWAS) might renew hope for locating genetic predictors and producing precision medicines, however such hopes can also distract from appreciating social factors and structural injustices that demand more socially inclusive and equitable approaches to mental healthcare. A more comprehensive approach begins with recognizing that there is no one type of contributor to mental illness and its duration that should be prioritized over another. We argue that, if the search for biological specificity is to complement the need to alleviate the social distress that produces mental health inequities, psychiatric genomics must incorporate an intersectional dimension to models of mental illness across research priorities, scientific frameworks, and clinical applications. We outline an intersectional framework that will guide all professionals working in the expanding field of psychiatric genomics to better incorporate issues of social context, racial and cultural diversity, and downstream ethical considerations into their work.
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Affiliation(s)
- Julia E H Brown
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer L Young
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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9
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Powell CB, Laurent C, Garcia C, Hoodfar E, Karlea A, Kobelka C, Lee J, Roh J, Kushi LH. Factors influencing genetic counseling and testing for hereditary breast and ovarian cancer syndrome in a large US health care system. Clin Genet 2021; 101:324-334. [PMID: 34927729 DOI: 10.1111/cge.14100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 01/26/2023]
Abstract
Investigate whether disparities and other factors influence referral to genetic counseling and testing for hereditary breast and ovarian cancer syndrome (HBOC) in a large health care system. Examination of clinical, demographic, and socioeconomic factors from electronic health records associated with genetic referral and testing within 12 months after a new cancer diagnosed between August 1, 2013 and December 31, 2018. For patients meeting institutional criteria for HBOC testing, 60.6% were referred for genetic counseling, 88% of whom underwent germline testing; at least one pathogenic variant was found in 15.3%. Referral rates for patients with breast (69%) or ovarian cancer (65.7%) were much higher than for metastatic prostate (11.1%, p < 0.0001) or pancreatic cancer (22.3%, p < 0.0001); referral criteria were implemented more recently for the latter two cancers. Younger age, family history, and chemotherapy were associated with referral. Higher Elixhauser comorbidity score and prior cancer were associated with non-referral. No other factors were associated with genetic referral for all eligible cancers combined, although differences were seen in specific cancers. Race was a significant factor only for breast cancer, with fewer Asians than Whites referred. Health disparities in referral to genetics for HBOC cancers are mitigated in a comprehensive integrated health care system.
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Affiliation(s)
- C Bethan Powell
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA.,Kaiser Permanente Northern California Hereditary Cancer Program San Francisco, Oakland, California, USA
| | - Cecile Laurent
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
| | - Christine Garcia
- Kaiser Permanente Northern California Hereditary Cancer Program San Francisco, Oakland, California, USA
| | - Elizabeth Hoodfar
- Kaiser Permanente Northern California Hereditary Cancer Program San Francisco, Oakland, California, USA.,Kaiser Permanente Northern California Genetics Department, Oakland, California, USA
| | - Audrey Karlea
- Kaiser Permanente Northern California Hereditary Cancer Program San Francisco, Oakland, California, USA.,Kaiser Permanente Northern California Genetics Department, Oakland, California, USA
| | - Christine Kobelka
- Kaiser Permanente Northern California Hereditary Cancer Program San Francisco, Oakland, California, USA.,Kaiser Permanente Northern California Genetics Department, Oakland, California, USA
| | - Jaimie Lee
- Kaiser Permanente Oakland Obstetrics and Gynecology Residency Program, Oakland, California, USA
| | - Janise Roh
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
| | - Lawrence H Kushi
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
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10
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Yu JH. Solidarity in the Absence of Sovereignty: Expanding Group Protections in New Research Contexts. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:22-24. [PMID: 34554076 PMCID: PMC10124740 DOI: 10.1080/15265161.2021.1965259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Joon-Ho Yu
- Division of Genetic Medicine, Division of Bioethics and
Palliative Care, Department of Pediatrics; Institute for Public Health Genetics,
Department of Biostatistics, University of Washington, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle
Children’s Hospital and Research Institute, Seattle, WA, USA
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11
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Truong TK, Kenneson A, Rosen AR, Singh RH. Genetic Referral Patterns and Responses to Clinical Scenarios: A Survey of Primary Care Providers and Clinical Geneticists. J Prim Care Community Health 2021; 12:21501327211046734. [PMID: 34583568 PMCID: PMC8485275 DOI: 10.1177/21501327211046734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary care physicians (PCPs) are considered the gatekeepers of genetic services, but they often underutilize or inappropriately utilize such services, leading to lack of early treatment, incorrect diagnoses, and unnecessary procedures. This study aims to delineate PCP referral patterns, including the frequency of, motivators for, and barriers to genetic referrals and testing in the present landscape of genomics. Methods: A 34-item online survey was distributed to PCPs in the United States (US). PCP demographics, practice characteristics, and referral patterns, motivators, and barriers were analyzed. Six hypothetical clinical scenarios included in the survey also were presented to a cohort of clinical geneticists. We calculated PCPs’ rates of ordering genetic tests and of referral to genetics services in the past year. Rates and responses to clinical scenarios were compared based on respondents’ personal and practice characteristics. Results: A total of 95 PCPs and 25 clinical geneticists participated. Among the PCPs, 79% reported referring and 50% reported ordering genetic testing in the last year. PCPs with genetic counselors (GCs) in their clinic referred at significantly higher rates than those without (P = .008). White PCPs referred at significantly higher rates compared to Black or African American PCPs (P = .009). The most commonly reported motivators for referring patients to genetic services were preference for specialist coordination, lack of knowledge, and family’s desire for risk information. The most commonly reported barriers were patient refusal, provider concerns about costs to patients, and uncertainty of when a genetic referral is appropriate. In response to clinical scenarios, clinical geneticists were in agreement about the need for genetic testing or referral for 2 of the scenarios. For these 2 scenarios, only 48% and 71% of PCPs indicated that they would offer genetic testing or referral, respectively. Conclusions: Responses to clinical scenarios suggest that it is not clear to PCPs when referrals or testing are needed. Collaboration with GCs is one approach to reducing barriers to and improving PCPs’ utilization of genetic services. Clear guidelines from clinical geneticists may help facilitate appropriate use of genetics services by PCPs. Additional research is needed to further describe barriers that PCPs face in genetic testing/referrals.
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Affiliation(s)
- Tina K Truong
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ami R Rosen
- Emory University School of Medicine, Atlanta, GA, USA
| | - Rani H Singh
- Emory University School of Medicine, Atlanta, GA, USA
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