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Blumling AA, McGowan ML, Prows CA, Childers-Buschle K, Martin LJ, Lynch JA, Dufendach KR, Lipstein EA, Kovacic MB, Brinkman WB, Myers MF. Engaging adolescents and young adults in decisions about return of genomic research results: study protocol for a mixed-methods longitudinal clinical trial protocol. BMC Med Inform Decis Mak 2024; 24:391. [PMID: 39696322 PMCID: PMC11657641 DOI: 10.1186/s12911-024-02784-w] [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: 06/26/2023] [Accepted: 11/25/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND To protect minors' future autonomy, professional organizations have historically discouraged returning predictive adult-onset genetic test results and carrier status to children. Recent clinical guidance diverges from this norm, suggesting that when minors have genomic sequencing performed for clinical purposes, parents and children should have the opportunity to learn secondary findings, including for some adult-onset conditions. While parents can currently opt in or out of receiving their child's secondary findings, the American Society of Human Genetics Workgroup on Pediatric Genetic and Genomic Testing suggests including adolescents in the decision-making process. However, it is not clear what factors young people consider when given the opportunity to learn genetic findings for themselves. In this manuscript, we report on the methods for a clinical trial that examines adolescents', young adults', and their parents' decisions about learning genomic information for the adolescent or young adult. METHODS We are enrolling assenting (ages 13-17) adolescents and consenting (ages 18-21) young adults in a prospective genomic screening study to assess the choices they make about receiving individual genomic results. Participants use an online tool to indicate whether they want to learn their personal genetic risk for specific preventable, treatable, and adult-onset conditions, as well as carrier status for autosomal recessive conditions. We are examining (1) how choices differ between adolescent and young adult cohorts (as well as between adolescents/young adults and parents) and (2) decisional conflict and stability across study timepoints. Results are returned based on participants' choices. Qualitative interviews with a subset of participants explore decisional stability, adolescent/young adult engagement with parents in decision-making, and the impact of learning pathogenic/likely pathogenic and autosomal recessive carrier results. DISCUSSION This study explores decision making and decision stability between adolescents and parents (where applicable), as well as the ethical implications and impact of return of clinical-grade genetic research results to adolescents and young adults. The results of this study will contribute empirical evidence to support best practices and guidance on engaging young people in genomic research studies and clinical care that offer return of results. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04481061. Registered 22 July 2020.
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Affiliation(s)
- Amy A Blumling
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michelle L McGowan
- University of Cincinnati, Cincinnati, OH, USA
- Mayo Clinic, Rochester, MN, USA
| | - Cynthia A Prows
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lisa J Martin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - John A Lynch
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | | | - Ellen A Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Melinda Butsch Kovacic
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - William B Brinkman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Melanie F Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- University of Cincinnati, Cincinnati, OH, USA.
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2
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Blumling A, McGowan M, Prows C, Childers-Buschle K, Martin L, Lynch J, Dufendach K, Lipstein E, Kovacic MB, Brinkman B, Myers M. Engaging Adolescents and Young Adults in Decisions About Return of Genomic Research Results: a mixed-methods longitudinal clinical trial protocol. RESEARCH SQUARE 2023:rs.3.rs-2819191. [PMID: 37162875 PMCID: PMC10168476 DOI: 10.21203/rs.3.rs-2819191/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background To protect minors' future autonomy, professional organizations have historically discouraged returning predictive adult-onset genetic test results and carrier status to children. Recent clinical guidance diverges from this norm, suggesting that when minors have genomic sequencing performed for clinical purposes, parents and children should have the opportunity to learn secondary findings, including for some adult-onset conditions. While parents can currently opt in or out of receiving their child's secondary findings, the American Society of Human Genetics Workgroup on Pediatric Genetic and Genomic Testing suggests including adolescents in the decision-making process. However, it is not clear what factors young people consider when given the opportunity to learn genetic findings for themselves. We are examining adolescents', young adults', and parents' (if applicable) decisions about learning genomic information for the adolescent. Methods We are enrolling assenting (ages 13-17) adolescents and consenting (ages 18-21) young adults in a prospective genomic screening study to assess the choices they make about receiving individual genomic results. Participants use an online tool to indicate whether they want to learn their personal genetic risk for specific preventable, treatable, and adult-onset conditions, as well as carrier status for autosomal recessive conditions. We are examining 1) how choices differ between adolescent and young adult cohorts (as well as between adolescents/young adults and parents) and 2) decisional conflict and stability across study timepoints. Results are returned based on participants' choices. Qualitative interviews with a subset of participants explore decisional stability, adolescent/young adult engagement with parents in decision-making, and the impact of learning pathogenic/likely pathogenic and carrier results. Discussion This study explores decision making and decision stability between adolescents and parents (where applicable), as well as the ethical implications and impact of return of clinical-grade genetic research results to adolescents and young adults. The results of this study will contribute empirical evidence to support best practices and guidance on engaging young people in genetic research studies and clinical care that offer return of results.
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Affiliation(s)
| | | | | | | | - Lisa Martin
- Cincinnati Children's Hospital Medical Center
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Smith HS, Bonkowski ES, Hickingbotham MR, Deloge RB, Pereira S. Framing the Family: A Qualitative Exploration of Factors That Shape Family-Level Experience of Pediatric Genomic Sequencing. CHILDREN (BASEL, SWITZERLAND) 2023; 10:774. [PMID: 37238322 PMCID: PMC10217651 DOI: 10.3390/children10050774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child's care and their family's well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS (n = 20) or who had recently completed GS (n = 21). We analyzed qualitative data using multiple rounds of thematic analysis. We organized our thematic findings into three domains of factors that influence the family-level experience of GS: (1) family structure and dynamics; (2) parental identity, relationships, and philosophies; and (3) social and cultural differences. Participants conceptualized their child's family in various ways, ranging from nuclear biological family to support networks made up of friends and communities. Our findings can inform the design and interpretation of preference research to advance family-level value assessment of GS as well as genetic counseling for families.
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Affiliation(s)
- Hadley Stevens Smith
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Emily S. Bonkowski
- Institute for Public Health Genetics, University of Washington School of Public Health, Seattle, WA 98195, USA
- Center for Pediatric Neurological Disease Research, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Madison R. Hickingbotham
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Raymond Belanger Deloge
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
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Bos W, Bunnik EM. Informed consent practices for exome sequencing: An interview study with clinical geneticists in the Netherlands. Mol Genet Genomic Med 2022; 10:e1882. [PMID: 35150093 PMCID: PMC8922961 DOI: 10.1002/mgg3.1882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 01/14/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Genomic sequencing is being used more frequently in the clinic, not only by clinical geneticists, but also by other specialists ("mainstreaming"). The use of genomic sequencing gives rise to challenges regarding informed consent, as it can yield more, and more complex results. METHODS This study maps the informed consent process for exome sequencing in the Netherlands by means of semistructured interviews with 14 clinical geneticists. Interviewees were asked about their strategies for informing patients about exome sequencing and supporting patients in their decision making, about what they think of as essential information elements, about the challenges they experience, and about their preferences for future policy and practice. RESULTS Clinical geneticists typically discuss the following topics: the nature and aim of the test, the possible results (including unsolicited or incidental findings and Variants of Uncertain Significance) of the test and the consequences of those results for the patient and their family members. Some clinical geneticists use a layered approach to informed consent, meaning that they give short and concise information at first, and provide more detailed information depending on the situation or the needs of the patient. CONCLUSION During pre-test counseling for genomic sequencing, clinical geneticists use various strategies to enhance patient understanding and personalization of the informed consent process. Going forward, layering information may be part of a solution to ethical challenges of informed consent, also in mainstream settings.
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Affiliation(s)
- Wendy Bos
- Department of Medical Ethics, Philosophy and History of MedicineErasmus MC, University Medical Centre RotterdamRotterdamthe Netherlands
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of MedicineErasmus MC, University Medical Centre RotterdamRotterdamthe Netherlands
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Sachdev R, Field M, Baynam GS, Beilby J, Berarducci M, Berman Y, Boughtwood T, Cusack MB, Fitzgerald V, Fletcher J, Freckmann M, Grainger N, Kirk E, Lundie B, Lunke S, McGregor L, Mowat D, Parasivam G, Tyrell V, Wallis M, White SM, S L Ma A. Paediatric genomic testing: Navigating medicare rebatable genomic testing. J Paediatr Child Health 2021; 57:477-483. [PMID: 33566436 PMCID: PMC8049061 DOI: 10.1111/jpc.15382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
Genomic testing for a genetic diagnosis is becoming standard of care for many children, especially those with a syndromal intellectual disability. While previously this type of specialised testing was performed mainly by clinical genetics teams, it is increasingly being 'mainstreamed' into standard paediatric care. With the introduction of a new Medicare rebate for genomic testing in May 2020, this type of testing is now available for paediatricians to order, in consultation with clinical genetics. Children must be aged less than 10 years with facial dysmorphism and multiple congenital abnormalities or have global developmental delay or moderate to severe intellectual disability. This rebate should increase the likelihood of a genetic diagnosis, with accompanying benefits for patient management, reproductive planning and diagnostic certainty. Similar to the introduction of chromosomal microarray into mainstream paediatrics, this genomic testing will increase the number of genetic diagnoses, however, will also yield more variants of uncertain significance, incidental findings, and negative results. This paper aims to guide paediatricians through the process of genomic testing, and represents the combined expertise of educators, clinical geneticists, paediatricians and genomic pathologists around Australia. Its purpose is to help paediatricians navigate choosing the right genomic test, consenting patients and understanding the possible outcomes of testing.
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Affiliation(s)
- Rani Sachdev
- Centre for Clinical Genetics, Sydney Children's Hospital‐RandwickSydney Children's Hospitals NetworkSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mike Field
- Cancer GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia,GOLD ServiceHunter‐New England Health ServiceNewcastleNew South WalesAustralia
| | - Gareth S Baynam
- Department of HealthGenetic Services of Western AustraliaPerthWestern AustraliaAustralia
| | - John Beilby
- Department of Diagnostic GenomicsPathWest Laboratory MedicinePerthWestern AustraliaAustralia
| | - Maria Berarducci
- Health Education and Training Institute (HETI)NSW Health ServiceSydneyNew South WalesAustralia
| | - Yemima Berman
- Department of Clinical GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Tiffany Boughtwood
- Australian GenomicsParkvilleVictoriaAustralia,Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Marie B Cusack
- NSW Health Centre for Genetics EducationRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Vanessa Fitzgerald
- Speciality Services and Technology Evaluation Unit, Strategic Reform and Planning BranchNSW Ministry of HealthSydneyNew South WalesAustralia
| | - Jeffery Fletcher
- Department of PaediatricsThe Tweed HospitalTweed HeadsNew South WalesAustralia
| | - Mary‐Louise Freckmann
- Department of Clinical GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Natalie Grainger
- NSW Health Centre for Genetics EducationRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Edwin Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital‐RandwickSydney Children's Hospitals NetworkSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia,Randwick Genomics LaboratoryNSW Health PathologySydneyNew South WalesAustralia
| | - Ben Lundie
- Pathology QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Sebastian Lunke
- Victorian Clinical Genetics ServicesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PathologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Lesley McGregor
- South Australian Clinical Genetics ServiceWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital‐RandwickSydney Children's Hospitals NetworkSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Gayathri Parasivam
- NSW Health Centre for Genetics EducationRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Vanessa Tyrell
- Children's Cancer Institute. RandwickSydneyNew South WalesAustralia
| | - Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health ServiceRoyal Hobart HospitalHobartTasmaniaAustralia,School of MedicineThe University of TasmaniaHobartTasmaniaAustralia
| | - Susan M White
- Victorian Clinical Genetics ServicesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Alan S L Ma
- Specialty of Genomic MedicineUniversity of SydneySydneyNew South WalesAustralia,Department of Clinical Genetics, Children's Hospital WestmeadSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
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Becher N, Andreasen L, Sandager P, Lou S, Petersen OB, Christensen R, Vogel I. Implementation of exome sequencing in fetal diagnostics-Data and experiences from a tertiary center in Denmark. Acta Obstet Gynecol Scand 2020; 99:783-790. [PMID: 32304219 DOI: 10.1111/aogs.13871] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Applying whole-exome sequencing (WES) for the diagnosis of diseases in children has shown significant diagnostic strength compared with chromosomal microarray. WES may also have the potential of adding clinically relevant prenatal information in cases where a fetus is found to have structural anomalies. We present results from the first fetal exomes performed in a tertiary center in Denmark. MATERIAL AND METHODS Couples/expectant parents were included in Central Denmark Region from July 2016 to March 2019. Inclusion was not systematic, but where one or more fetal malformations or severe fetal hydrops were detected, and a specific diagnosis had not been obtained by chromosomal microarray. WES was performed in ongoing pregnancies (N = 11), after intrauterine demise (N = 5), or after termination of pregnancy based on ultrasound findings (N = 19). In most cases, a trio format was applied comprising fetal and parental DNA. RESULTS WES was performed in 35 highly selected fetal cases. Pathogenic variants, or variants likely to explain the phenotype, were detected in 9/35 (26%). Variants of uncertain significance were detected in 7/35 (20%) and there was one secondary finding (3%). Out of the 11 ongoing pregnancies, four reached a genetic diagnosis (36%). Detection rate was highest in cases of multisystem anomalies (7/13, 54%). WES was completed in all three trimesters and both autosomal dominant, autosomal recessive and X-linked inheritance were revealed. CONCLUSIONS We present data from 35 cases of exome sequencing applied in a setting of fetal malformations. Importantly, though, we wish to share our personal experiences with implementing WES into a prenatal setting. As a medical society, we must continue to share what we do not understand, what went wrong, what is difficult, and what we do not agree upon. A common understanding and language are warranted. We also advocate that more research is needed concerning the clinical value, as well as costs and patient perspectives, of using WES in pregnancy. We believe that WES will lead to improved prenatal and perinatal care.
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Affiliation(s)
- Naja Becher
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | - Lotte Andreasen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Puk Sandager
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Christensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lou S, Petersen OB, Lomborg K, Vogel I. How do geneticists and prospective parents interpret and negotiate an uncertain prenatal genetic result? An analysis of clinical interactions. J Genet Couns 2020; 29:1221-1233. [PMID: 32453502 DOI: 10.1002/jgc4.1290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/06/2022]
Abstract
Variants of unknown significance (VUS) and susceptibility loci (SL) are a challenge in prenatal genetic counseling. The aim of this study was to explore how such uncertain genetic results are communicated, negotiated, and made meaningful by genetics healthcare providers and couples in the actual clinical setting where results are delivered. The study was based on an anthropological approach and the material consisted of observations and audio-recordings from 16 purposively sampled genetic counseling sessions where prenatal testing had identified an inherited or de novo VUS or SL result. Field notes and transcripts from audio-recordings were analyzed using thematic analysis. The analysis identified a number of specific interpretations and strategies that clinical geneticists and couples collectively used for dealing with the ambiguity of the result. Thus, the analysis resulted in a total of three themes, each with 3-4 subthemes. The theme 'Setting the scene' describes the three-stage structure of the consultation. The theme 'Dealing with uncertainty' includes 'normalizing strategies' that emphasized the inherent uncertainty in human life in general and 'contextualizing strategies' that placed the result in relation to the surrounding society, where technological developments lead to new and unforeseen challenges. The theme 'Regaining control' includes interpretations that made the knowledge useful by focusing on the value of being prepared for potential, future challenges. Other strategies were to book an extra scan-to reconfirm fetal structural health and to reconnect to the pregnancy. Finally, inquiring about the sex was clearly a way for the couple to signal their investment in the pregnancy. Based on the analysis, we propose that these interpretations served to transform and reduce ambiguity through a process of reconfiguring the biomedical information into knowledge that resonated with the couples' lifeworlds. In this process, both geneticist and couples drew on wider social and moral concerns about uncertainty and responsibility.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Fetal Medicine Unit, Department of Obstetrics & Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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8
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Sanderson SC, Hill M, Patch C, Searle B, Lewis C, Chitty LS. Delivering genome sequencing in clinical practice: an interview study with healthcare professionals involved in the 100 000 Genomes Project. BMJ Open 2019; 9:e029699. [PMID: 31685495 PMCID: PMC6858183 DOI: 10.1136/bmjopen-2019-029699] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Genome sequencing is poised to be incorporated into clinical care for diagnoses of rare diseases and some cancers in many parts of the world. Healthcare professionals are key stakeholders in the clinical delivery of genome sequencing-based services. Our aim was to explore views of healthcare professionals with experience of offering genome sequencing via the 100 000 Genomes Project. DESIGN Interview study using thematic analysis. SETTING Four National Health Service hospitals in London. PARTICIPANTS Twenty-three healthcare professionals (five genetic clinicians and eight non-genetic clinicians (all consultants), and 10 'consenters' from a range of backgrounds) involved in identifying or consenting patients for the 100 000 Genomes Project. RESULTS Most participants expressed positive attitudes towards genome sequencing in terms of improved ability to diagnose rare diseases, but many also expressed concerns, with some believing its superiority over exome sequencing had not yet been demonstrated, or worrying that non-genetic clinicians are inadequately prepared to discuss genome sequencing results with patients. Several emphasised additional evidence about utility of genome sequencing in terms of both main and secondary findings is needed. Most felt non-genetic clinicians could support patients during consent, as long as they have appropriate training and support from genetic teams. Many stated genetics experts will play a vital role in training and supporting non-genetic clinicians in variant interpretation and results delivery, particularly for more complex cases. CONCLUSIONS Healthcare professionals responsible for delivering clinical genome sequencing have largely positive views about the potential for genome sequencing to improve diagnostic yield, but also significant concerns about practical aspects of offering these tests. Non-genetic clinicians delivering genome sequencing require guidance and support. Additional empirical evidence is needed to inform policy and practice, including how genome compares to exome sequencing; utility of secondary findings; training, in particular of non-genetic health professionals; and mechanisms whereby genetics teams can offer appropriate support to their non-genetics colleagues.
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Affiliation(s)
- Saskia C Sanderson
- North East Thames Regional Genetics Service, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Christine Patch
- Society and Ethics Research, Wellcome Genome Campus, Hinxton, United Kingdom
- Genomics England, Queen Mary University of London, London, United Kingdom
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Beverly Searle
- Unique - Understanding Rare Chromosome and Genetic Disorders, Oxted, UK
| | - Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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9
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Gore RH, Bridges JFP, Cohen JS, Biesecker BB. Challenges to informed consent for exome sequencing: A best-worst scaling experiment. J Genet Couns 2019; 28:1189-1197. [PMID: 31553105 DOI: 10.1002/jgc4.1171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 12/27/2022]
Abstract
As exome sequencing expands as a diagnostic tool, patients and providers have voiced concerns about communicating the breadth and scope of potential results when obtaining informed consent. This study aimed to understand how genetic counselors prioritize essential components of the informed consent process and whether counselor factors influence these decisions. Development of a best-worst scaling experiment was informed by a systematic literature review and two focus groups. In all, 11 choice sets were created using a balanced incomplete block design, where participants selected the most and least important object in each set. Mean best-worst (BW) scores were calculated to summarize the relative importance of each object, and mediation analyses assessed whether responses were associated with genetic counselor factors and attitudes. In all, 342 members of the National Society of Genetic Counselors completed the online survey. Ranking of BW scores suggests that participants prioritize collaborative decision-making, assessing understanding and managing expectations, with the least emphasis placed on discussing technological complexities. Stratified analyses found that counselors more experienced with obtaining informed consent for exome sequencing and those reporting higher perceptions of patients' ability to manage information rated discussing variants of uncertain significance as significantly more important (p < .05). Our results suggest that genetic counselors report intentions to prioritize individual patient needs when obtaining informed consent for exome sequencing. Professional characteristics and attitudes may influence preemptive discussion of uncertain results.
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Affiliation(s)
- Rachel H Gore
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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10
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Abstract
New genetic testing technologies such as microarrays and whole exome sequencing mean the diagnostic potential for a child with a development disorder is greatly increased over traditional testing techniques. With this increased potential comes increased expectations from families and professionals about the answers a diagnosis will provide. However, limitations remain and a proportion of individuals will continue to remain undiagnosed. In addition, some individuals will receive novel or very rare diagnoses about which very little is known in terms of prognosis and effective treatments. In this paper, I present an argument for why these families would benefit from additional Genetic Counsellor support and how Clinical Genetics services in the UK could provide this support. I acknowledge that resources are limited, but as demands on services increase and interactions with families become shorter, I argue that this kind of service should be prioritised, for the benefit of these families.
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11
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McGowan ML, Prows CA, DeJonckheere M, Brinkman WB, Vaughn L, Myers MF. Adolescent and Parental Attitudes About Return of Genomic Research Results: Focus Group Findings Regarding Decisional Preferences. J Empir Res Hum Res Ethics 2018; 13:371-382. [PMID: 29806518 DOI: 10.1177/1556264618776613] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Opportunities to participate in genomic sequencing studies, as well as recommendations to screen for variants in 59 medically actionable genes anytime clinical genomic sequencing is performed, indicate adolescents will increasingly be involved in decisions about learning secondary findings from genome sequencing. However, how adolescents want to be involved in such decisions is unknown. We conducted five focus groups with adolescents (2) and parents (3) to learn their decisional preferences about return of genomic research results to adolescents. Discussions about decisional preferences centered around three themes: feelings about receiving genomic risk information, adolescent involvement and capacity to participate in decision-making, and recommendations for parental versus collaborative decision-making. We address the contested space between parental duties to act in their children's best interests when choosing which results to return and adolescents' desires to make autonomous decisions. A collaborative decision-making approach is recommended for obtaining consent from adolescents and their parents for genome sequencing research.
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Affiliation(s)
- Michelle L McGowan
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| | | | | | - William B Brinkman
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| | - Lisa Vaughn
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
| | - Melanie F Myers
- 1 Cincinnati Children's Hospital Medical Center, USA.,2 University of Cincinnati, USA
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12
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Werner-Lin A, Zaspel L, Carlson M, Mueller R, Walser SA, Desai R, Bernhardt BA. Gratitude, protective buffering, and cognitive dissonance: How families respond to pediatric whole exome sequencing in the absence of actionable results. Am J Med Genet A 2018; 176:578-588. [DOI: 10.1002/ajmg.a.38613] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Allison Werner-Lin
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Lori Zaspel
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Mae Carlson
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Rebecca Mueller
- Department of History and Sociology of Science; University of Pennsylvania; Philadelphia Pennsylvania
| | - Sarah A. Walser
- Department of Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Ria Desai
- College of Arts and Science; University of Pennsylvania; Philadelphia Pennsylvania
| | - Barbara A. Bernhardt
- Department of Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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