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Baynam G, Hartman AL, Letinturier MCV, Bolz-Johnson M, Carrion P, Grady AC, Dong X, Dooms M, Dreyer L, Graessner H, Granados A, Groza T, Houwink E, Jamuar SS, Vasquez-Loarte T, Tumiene B, Wiafe SA, Bjornson-Pennell H, Groft S. Global health for rare diseases through primary care. Lancet Glob Health 2024; 12:e1192-e1199. [PMID: 38876765 DOI: 10.1016/s2214-109x(24)00134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 06/16/2024]
Abstract
Rare diseases affect over 300 million people worldwide and are gaining recognition as a global health priority. Their inclusion in the UN Sustainable Development Goals, the UN Resolution on Addressing the Challenges of Persons Living with a Rare Disease, and the anticipated WHO Global Network for Rare Diseases and WHO Resolution on Rare Diseases, which is yet to be announced, emphasise their significance. People with rare diseases often face unmet health needs, including access to screening, diagnosis, therapy, and comprehensive health care. These challenges highlight the need for awareness and targeted interventions, including comprehensive education, especially in primary care. The majority of rare disease research, clinical services, and health systems are addressed with specialist care. WHO Member States have committed to focusing on primary health care in both universal health coverage and health-related Sustainable Development Goals. Recognising this opportunity, the International Rare Diseases Research Consortium (IRDiRC) assembled a global, multistakeholder task force to identify key barriers and opportunities for empowering primary health-care providers in addressing rare disease challenges.
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Affiliation(s)
- Gareth Baynam
- Rare Care Centre, Perth Children's Hospital and Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Perth, WA, Australia.
| | - Adam L Hartman
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Matt Bolz-Johnson
- EURORDIS-Rare Diseases Europe, Fondation Universitaire, Brussels, Belgium
| | | | - Alice Chen Grady
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Xinran Dong
- Children's Hospital of Fudan University, Shanghai, China
| | - Marc Dooms
- University Hospitals Leuven, Leuven, Belgium
| | - Lauren Dreyer
- Genetic Services Western Australia, King Edward Memorial Hospital, Perth, WA, Australia
| | - Holm Graessner
- Centre for Rare Diseases, Institute for Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Alicia Granados
- Global Medical Affairs Rare Diseases, Sanofi, Barcelona, Spain
| | - Tudor Groza
- Rare Care Centre, Perth Children's Hospital and Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Perth, WA, Australia; European Bioinformatics Institute, European Molecular Biology Laboratory, Hinxton, UK
| | - Elisa Houwink
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saumya Shekhar Jamuar
- KK Women's and Children's Hospital, SingHealth Duke-NUS Institute of Precision Medicine, Singapore
| | - Tania Vasquez-Loarte
- Rare Disease G2MC, Department of Pediatrics, Wyckoff Heights Medical Center, New York, NY, USA
| | - Biruté Tumiene
- Vilnius University Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Stephen Groft
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
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Barriers to genetic testing in clinical psychiatry and ways to overcome them: from clinicians' attitudes to sociocultural differences between patients across the globe. Transl Psychiatry 2022; 12:442. [PMID: 36220808 PMCID: PMC9553897 DOI: 10.1038/s41398-022-02203-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Genetic testing has evolved rapidly over recent years and new developments have the potential to provide insights that could improve the ability to diagnose, treat, and prevent diseases. Information obtained through genetic testing has proven useful in other specialties, such as cardiology and oncology. Nonetheless, a range of barriers impedes techniques, such as whole-exome or whole-genome sequencing, pharmacogenomics, and polygenic risk scoring, from being implemented in psychiatric practice. These barriers may be procedural (e.g., limitations in extrapolating results to the individual level), economic (e.g., perceived relatively elevated costs precluding insurance coverage), or related to clinicians' knowledge, attitudes, and practices (e.g., perceived unfavorable cost-effectiveness, insufficient understanding of probability statistics, and concerns regarding genetic counseling). Additionally, several ethical concerns may arise (e.g., increased stigma and discrimination through exclusion from health insurance). Here, we provide an overview of potential barriers for the implementation of genetic testing in psychiatry, as well as an in-depth discussion of strategies to address these challenges.
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Hoxhaj I, Tognetto A, Acampora A, Stojanovic J, Boccia S. Core Competencies in Cancer Genomics for Healthcare Professionals: Results From a Systematic Literature Review and a Delphi Process. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1332-1342. [PMID: 33442861 DOI: 10.1007/s13187-021-01956-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
The continuous development and use of genomic sequencing requires healthcare professionals to constantly integrate these advancements into their clinical practice. There is a documented lack of cancer genomics contents in the teaching and learning programs. We aimed to identify the core competencies in cancer genomics for non-genetic healthcare professionals. We performed a literature review in PubMed, SCOPUS, and Web of Science databases to retrieve articles published from 2000 to 2018, in English or Italian language. We included articles that reported the competencies for non-genetic healthcare professionals in cancer genomics. A web-based modified Delphi survey was conducted, aiming to define, through consensus, a set of core competencies that should be covered in the curricula. The international expert panel included specialists in genetics, genomics, oncology, and medical specialists. In the literature review, we retrieved nine articles, from which we identified core competencies for general physicians and nurses. The competencies were organized in three main domains: knowledge, attitudes, and practical abilities. In the second round of Delphi survey, consensus of 83.3% was reached for the definition of the core competencies. Thirty-seven items were defined as the competencies required for physicians and forty-two items for nurses. Through a consensus-based approach, a set of core competencies in cancer genomics for non-genetic healthcare professionals has been identified. Our findings could benchmark standards for curriculum development and future educational strategies.
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Affiliation(s)
- Ilda Hoxhaj
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Istituto di Sanita Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 -, 00168, Rome, Italy.
| | - Alessia Tognetto
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Istituto di Sanita Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 -, 00168, Rome, Italy
| | - Anna Acampora
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Istituto di Sanita Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 -, 00168, Rome, Italy
| | - Jovana Stojanovic
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Istituto di Sanita Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 -, 00168, Rome, Italy
- Department of Health, Kinesiology, and Applied Physiology (HKAP), Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, 5400, Boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Stefania Boccia
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Istituto di Sanita Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 -, 00168, Rome, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Rigter T, Jansen ME, de Groot JM, Janssen SWJ, Rodenburg W, Cornel MC. Implementation of Pharmacogenetics in Primary Care: A Multi-Stakeholder Perspective. Front Genet 2020; 11:10. [PMID: 32076434 PMCID: PMC7006602 DOI: 10.3389/fgene.2020.00010] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/06/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Aberrant pharmacogenetic variants occur in a high proportion of people and might be relevant for the prescription of over 26 drugs in primary care. Early identification of patients who metabolize these drugs more rapidly or slowly than average could predict therapeutic effectivity and safety. Yet implementation of pharmacogenetics is progressing slowly. A high public health impact can potentially be achieved by increasing the proportion of people tested, when and where eligible according to clinical validity and utility. Methods In this study we defined actions, roles, and responsibilities for implementation of pharmacogenetics in primary care in consultation with stakeholder groups, by using a three-step mixed-methods approach. First, to define barriers and facilitators, public pharmacists (n = 24), primary care physicians (n = 8), and patients (n = 21) participated in focus groups and face-to-face interviews. Second, a multidisciplinary expert meeting (n = 16) was organized to define desired actions, roles, and responsibilities. Third, an online Delphi Study (n = 18) was conducted to prioritize the designated actions. Results For the integration of pharmacogenetics in primary care guidelines and practice, lack of evidence for clinical utility was mentioned as a main barrier. Furthermore, reimbursement, and facilitation of data registration and sharing were considered as key elements for future routine application of pharmacogenetic testing. Moreover, the division of roles and responsibilities, especially between general practitioners and pharmacists, is currently perceived as unclear. Sixteen actions in these four areas (clinical utility, reimbursement, data registration and sharing, and roles and responsibilities) were formulated and assigned to specific actors during the expert meeting. After ranking these 16 actions in the Delphi Study, nine actions remained pertinent, covering the four areas with at least one action. However, participants showed low agreement on the prioritization of the different actions, illustrating their different perspectives and the need to attune between them. Discussion Stakeholders together were able to formulate required actions to achieve true integration of pharmacogenetics in primary care, but no consensus could be achieved on the prioritization of the actions. Coordination of the current independent initiatives by the different stakeholders could facilitate effective and efficient implementation of useful pharmacogenetics in primary care.
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Affiliation(s)
- Tessel Rigter
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Marleen E Jansen
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jordy M de Groot
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Susan W J Janssen
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Wendy Rodenburg
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
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Tognetto A, Michelazzo MB, Ricciardi W, Federici A, Boccia S. Core competencies in genetics for healthcare professionals: results from a literature review and a Delphi method. BMC MEDICAL EDUCATION 2019; 19:19. [PMID: 30635068 PMCID: PMC6329113 DOI: 10.1186/s12909-019-1456-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/04/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Advances in genetics and genomics require that healthcare professionals manage and incorporate new technologies into the appropriate clinical practice. The aim of this study was to identify core competencies in genetics for non-geneticists, both physicians and non-physicians. METHODS We performed a literature review by searching MEDLINE, SCOPUS, and ISI Web of Science databases to identify studies reporting competencies in genetics in terms of knowledge, attitudes and abilities for non-genetic healthcare professionals. Furthermore, we conducted a survey according to a modified Delphi method, involving genetics experts to evaluate the competencies to be included as items of the curricula. RESULTS Three eligible documents were identified and 3 Delphi rounds were carried out to reach a consensus on the competencies to be incorporated in the curricula. With reference to the curriculum for physicians, 19 items were included in the knowledge domain, 3 in the attitudes and 10 in the abilities domain. We developed two different curricula for non-physicians: one specific for those working in genetic services (20 items in the knowledge domain, 3 in the attitudes and 12 in the abilities) and one for those not working in genetic services (10 items in the knowledge domain, 3 in the attitudes and 2 in the abilities). CONCLUSIONS We developed 3 curricula in genetics addressed to non-genetic healthcare professionals. They differ in the "knowledge" and "abilities", while the "attitudes" are the same for all the healthcare professionals. Although some concerns about the generalizability of the findings could arise due to the Italian perspective, we envisage the curricula can be used for genetics educational programs in several contexts.
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Affiliation(s)
- Alessia Tognetto
- Università Cattolica del Sacro Cuore, Sezione di Igiene, Istituto di Sanità Pubblica, Roma, Italy
| | | | - Walter Ricciardi
- Università Cattolica del Sacro Cuore, Sezione di Igiene, Istituto di Sanità Pubblica, Roma, Italy
- Istituto Superiore di Sanità, Roma, Italy
| | - Antonio Federici
- Direzione Generale Prevenzione Sanitaria, Ministero della Salute, Roma, Italy
| | - Stefania Boccia
- Università Cattolica del Sacro Cuore, Sezione di Igiene, Istituto di Sanità Pubblica, Roma, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Igiene Ospedaliera, Roma, Italy
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Paneque M, Turchetti D, Jackson L, Lunt P, Houwink E, Skirton H. A systematic review of interventions to provide genetics education for primary care. BMC FAMILY PRACTICE 2016; 17:89. [PMID: 27445117 PMCID: PMC4957387 DOI: 10.1186/s12875-016-0483-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND At least 10 % of patients seen in primary care are said to have a condition in which genetics has an influence. However, patients at risk of genetic disease may not be recognised, while those who seek advice may not be referred or managed appropriately. Primary care practitioners lack knowledge of genetics and genetic testing relevant for daily practice and feel inadequate to deliver genetic services. The aim of this systematic review was to evaluate genetics educational interventions in the context of primary care. METHODS Following the process for systematic reviews developed by the Centre for Reviews and Dissemination, we conducted a search of five relevant electronic databases. Primary research papers were eligible for inclusion if they included data on outcomes of interventions regarding genetics education for primary care practitioners. The results from each paper were coded and grouped under themes. RESULTS Eleven studies were included in the review. The five major themes identified inductively (post hoc) were: prior experience, changes in confidence, changes in knowledge, changes in practice, satisfaction and feedback. In five of the studies, knowledge of practitioners was improved following the educational programmes, but this tended to be in specific topic areas, while practitioner confidence improved in six studies. However, there was little apparent change to practice. CONCLUSIONS There are insufficient studies of relevant quality to inform educational interventions in genetics for primary care practitioners. Educational initiatives should be assessed using changes in practice, as well as in confidence and knowledge, to determine if they are effective in causing significant changes in practice in genetic risk assessment and appropriate management of patients.
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Affiliation(s)
- Milena Paneque
- />i3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- />IBMC – Institute for Molecular and Cell Biology, UnIGENe and Centre for Predictive and Preventive Genetics (CGPP), Universidade do Porto, Porto, Portugal
| | - Daniela Turchetti
- />Department of Medical and Surgical Sciences, Unit of Medical Genetics, University of Bologna, Bologna, Italy
| | - Leigh Jackson
- />Faculty of Health and Human Sciences, Plymouth University, Plymouth, PL4 8AA UK
| | - Peter Lunt
- />Faculty of Health and Human Sciences, Plymouth University, Plymouth, PL4 8AA UK
| | - Elisa Houwink
- />Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- />Department of Family Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Heather Skirton
- />Faculty of Health and Human Sciences, Plymouth University, Plymouth, PL4 8AA UK
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David SP, Johnson SG, Berger AC, Feero WG, Terry SF, Green LA, Phillips RL, Ginsburg GS. Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable. Ann Fam Med 2015; 13:373-80. [PMID: 26195686 PMCID: PMC4508182 DOI: 10.1370/afm.1772] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 01/08/2023] Open
Abstract
Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system.
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Affiliation(s)
- Sean P David
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California Roundtable on Translating Genomic-Based Research for Health, Institute of Medicine (IOM) of the National Academies
| | - Samuel G Johnson
- Roundtable on Translating Genomic-Based Research for Health, Institute of Medicine (IOM) of the National Academies Applied Pharmacogenomics, Kaiser-Permanente Colorado, Aurora, Colorado Department of Clinical Pharmacy, University of Colorado, Denver, Colorado
| | - Adam C Berger
- Applied Pharmacogenomics, Kaiser-Permanente Colorado, Aurora, Colorado
| | - W Gregory Feero
- Applied Pharmacogenomics, Kaiser-Permanente Colorado, Aurora, Colorado Maine-Dartmouth Family Medicine Residency Program, Augusta, Maine
| | - Sharon F Terry
- Roundtable on Translating Genomic-Based Research for Health, Institute of Medicine (IOM) of the National Academies Genetic Alliance, Washington, DC
| | - Larry A Green
- Department of Family Medicine, University of Colorado, Denver, Colorado
| | | | - Geoffrey S Ginsburg
- Roundtable on Translating Genomic-Based Research for Health, Institute of Medicine (IOM) of the National Academies Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, North Carolina
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Kulatunga GGAK, Marasinghe RB, Karunathilake IM, Dissanayake VHW. Development and implementation of a web-based continuing professional development (CPD) programme on medical genetics. J Telemed Telecare 2014; 19:388-92. [PMID: 24218351 DOI: 10.1177/1357633x13506525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We developed, implemented and evaluated a web-based continuing professional development (CPD) programme on medical genetics. Development of the CPD programme followed the ADDIE model, i.e. Analysis, Design, Develop, Implement and Evaluation. An invitation to participate in a needs analysis survey was sent to all doctors on the email list of the Sri Lanka Medical Association. A total of 129 completed surveys was received (57% of the 228 who accessed the online survey). The average age of respondents was 42 years (range 27-81). The male: female ratio was approximately 2 : 1. Almost all respondents (96%) selected web-based CPD programmes, or web-based and conventional lectures, as their preferred method of learning. The programme was piloted on a group of 10 doctors. The average pre-knowledge score was 40.3 and the post-knowledge score was 62.1 marks out of 100 (P = 0.002). We conclude that a web-based CPD programme on medical genetics is feasible in Sri Lanka.
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Houwink EJF, van Teeffelen SR, Muijtjens AMM, Henneman L, Jacobi F, van Luijk SJ, Jan Dinant G, van der Vleuten C, Cornel MC. Sustained effects of online genetics education: a randomized controlled trial on oncogenetics. Eur J Hum Genet 2014; 22:310-6. [PMID: 23942200 PMCID: PMC3925286 DOI: 10.1038/ejhg.2013.163] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/07/2013] [Accepted: 06/15/2013] [Indexed: 01/21/2023] Open
Abstract
Medical professionals are increasingly expected to deliver genetic services in daily patient care. However, genetics education is considered to be suboptimal and in urgent need of revision and innovation. We designed a Genetics e-learning Continuing Professional Development (CPD) module aimed at improving general practitioners' (GPs') knowledge about oncogenetics, and we conducted a randomized controlled trial to evaluate the outcomes at the first two levels of the Kirkpatrick framework (satisfaction, learning and behavior). Between September 2011 and March 2012, a parallel-group, pre- and post-retention (6-month follow-up) controlled group intervention trial was conducted, with repeated measurements using validated questionnaires. Eighty Dutch GP volunteers were randomly assigned to the intervention or the control group. Satisfaction with the module was high, with the three item's scores in the range 4.1-4.3 (5-point scale) and a global score of 7.9 (10-point scale). Knowledge gains post test and at retention test were 0.055 (P<0.05) and 0.079 (P<0.01), respectively, with moderate effect sizes (0.27 and 0.31, respectively). The participants appreciated applicability in daily practice of knowledge aspects (item scores 3.3-3.8, five-point scale), but scores on self-reported identification of disease, referral to a specialist and knowledge about the possibilities/limitations of genetic testing were near neutral (2.7-2.8, five-point scale). The Genetics e-learning CPD module proved to be a feasible, satisfactory and clinically applicable method to improve oncogenetics knowledge. The educational effects can inform further development of online genetics modules aimed at improving physicians' genetics knowledge and could potentially be relevant internationally and across a wider range of potential audiences.
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Affiliation(s)
- Elisa JF Houwink
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Sarah R van Teeffelen
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Arno MM Muijtjens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Florijn Jacobi
- The Dutch College of General Practitioners (NHG), Utrecht, The Netherlands
| | - Scheltus J van Luijk
- Department of Education and Resident Training, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Geert Jan Dinant
- Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Barreiro CZ, Bidondo MP, Garrido JA, Deurloo J, Acevedo E, Luna A, Gutiérrez E, Dellamea CA, Picón C, Torres K, De Castro MF, Torrado MV, Teiber ML, Kassab S, Elmeaudy P, Rodriguez J. CHACO outreach project: the development of a primary health care-based medical genetic service in an Argentinean province. J Community Genet 2013; 4:321-34. [PMID: 23904211 DOI: 10.1007/s12687-013-0157-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022] Open
Abstract
Dissemination of knowledge in genetics to be applied in medicine has created a growing need for capacity building in health care workers. The CAPABILITY ARGENTINA outreach project protocol was designed as a model to introduce genetics in areas without genetic services. Our aim was for genetic health care to become part of primary care in an Argentine province lacking genetic services. The program was innovative as professionals from the referral center (Garrahan Hospital S.A.M.I.C.) traveled to remote areas to train professionals through problem-based education. A logical framework was designed for a local needs assessment. Teaching materials (Powerpoint presentations, printed syllabus, and CD) and a web page were developed. A demonstration project was carried out in the Province of Chaco, Argentina. A total of 485 health workers were trained. The number of consultations increased significantly in participating areas comparing before and after the training period. To support this increase, a complementary project was set up from a public hospital sponsored from within Argentina to build a cytogenetic laboratory in the capital of the Province of Chaco. The model was improved for reproduction in other areas in Argentina. CAPABILITY ARGENTINA is a capacity building model for training of primary care professionals in genetics that may be applied to other medical specialties. The outcomes of the programme have a direct impact on clinical practice.
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Affiliation(s)
- C Z Barreiro
- Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C.P. 1245, Buenos Aires, Argentina,
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Hawkins AK, Ho A. Genetic counseling and the ethical issues around direct to consumer genetic testing. J Genet Couns 2012; 21:367-73. [PMID: 22290190 DOI: 10.1007/s10897-012-9488-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 01/20/2012] [Indexed: 01/13/2023]
Abstract
Over the last several years, direct to consumer(DTC) genetic testing has received increasing attention in the public, healthcare and academic realms. DTC genetic testing companies face considerable criticism and scepticism,particularly from the medical and genetic counseling community. This raises the question of what specific aspects of DTC genetic testing provoke concerns, and conversely,promises, for genetic counselors. This paper addresses this question by exploring DTC genetic testing through an ethic allens. By considering the fundamental ethical approaches influencing genetic counseling (the ethic of care and principle-based ethics) we highlight the specific ethical concerns raised by DTC genetic testing companies. Ultimately,when considering the ethics of DTC testing in a genetic counseling context, we should think of it as a balancing act. We need careful and detailed consideration of the risks and troubling aspects of such testing, as well as the potentially beneficial direct and indirect impacts of the increased availability of DTC genetic testing. As a result it is essential that genetic counselors stay informed and involved in the ongoing debate about DTC genetic testing and DTC companies. Doing so will ensure that the ethical theories and principles fundamental to the profession of genetic counseling are promoted not just in traditional counseling sessions,but also on a broader level. Ultimately this will help ensure that the public enjoys the benefits of an increasingly genetic based healthcare system.
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Affiliation(s)
- Alice K Hawkins
- Centre for Applied Ethics, University of British Columbia, 227-6356 Agricultural Road, Vancouver, BC V6T1Z2, Canada.
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Vieira TA, Giugliani C, da Silva LP, Faccini LS, Loguercio Leite JC, Artigalás OAP, Medeiros Lenz ML, Muñoz-Rojas MV, Giugliani R. Inclusion of medical genetics in primary health care: report of a pilot project in Brazil. J Community Genet 2012; 4:137-45. [PMID: 22829114 DOI: 10.1007/s12687-012-0110-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/21/2012] [Indexed: 12/01/2022] Open
Affiliation(s)
- Taiane Alves Vieira
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,
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13
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Ferguson LA, Salgado M. Joubert Syndrome and Related Disorders: Implications for Nurse Practitioners. J Nurse Pract 2012. [DOI: 10.1016/j.nurpra.2012.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The virtual diagnostic laboratory: a new way of teaching undergraduate medical students about genetic testing. Genet Med 2012; 13:973-7. [PMID: 21811165 DOI: 10.1097/gim.0b013e318225ac13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Medical students often perceive genetics as a discipline focused on rare diseases with relevance only to genetics specialists. Because genetic testing has now infiltrated most if not all medical disciplines, we need new teaching approaches to help trainees incorporate emerging genetic testing strategies appropriately into medical practice. With the ever-increasing number of known disease-associated genes, it is also important to shift from a paradigm of memorization to one of critical evaluation and an awareness of available resources. METHODS We designed case-based virtual laboratory sessions for first-year medical students at Emory University. These sessions emphasize both rare and common health issues and allow the students to practice applying their fundamental genetics knowledge in the diagnostic setting. RESULTS These sessions proved a valuable approach to presenting the intricacies of diagnostic genetic testing. Students rate the sessions very highly, with 92% of them agreeing or strongly agreeing that the sessions had educational value. The students commented that ours was an effective approach to teaching the material that illustrates well the impact of genetics on patient care. CONCLUSIONS The virtual diagnostic laboratory approach is an effective, nonlecture-based method of teaching medical students about genetic testing strategies and their application in the clinical setting.
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Abstract
Purpose: General practitioners (GPs) are increasingly expected to deliver genetics services in daily patient care. Education in primary care genetics is considered suboptimal and in urgent need of revision and innovation. The aim of this study was to prioritize topics for genetics education for general practice. Methods: A Delphi consensus procedure consisting of three rounds was conducted. A purposively selected heterogeneous panel (n = 18) of experts, comprising six practicing GPs who were also engaged in research, five GP trainers, four clinical genetics professionals, and three representatives of patient organizations, participated. Educational needs regarding genetics in general practice in terms of knowledge, skills, and attitudes were rated and ranked in a top-10 list. Results: The entire panel completed all three rounds. Kendall's coefficient of concordance indicated significant agreement regarding the top 10 genetic education needs (P < 0.001). “Recognizing signals that are potentially indicative of a hereditary component of a disease” was rated highest, followed by “Evaluating indications for referral to a clinical genetics centre” and “Knowledge of the possibilities and limitations of genetic tests.” Conclusions: The priorities resulting from this study can inform the development of educational modules, including input for case-based education, to improve GP performance in genetic patient care.
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Abstract
Genetic research, techniques, and knowledge have rapidly expanded in the last two decades with the completion of the Human Genome Project and other major advances in discovery research and diagnostic technologies. Although these developments have obvious potential, they also raise significant challenges related to programs for the actual delivery of useful genetic testing and services. This challenge is particularly acute in rural and remote areas, where lack of access to genetic services is pervasive resulting in significant inequities in access and availability of services. Huntington disease, the classic example of an adult-onset hereditary disorder, is used to illustrate this concern and highlight the imperative of exploring novel mechanisms to improve access to effective genetic services. The components of an effective and practical solution strategy are outlined, including the development of innovative delivery systems such as telemedicine, web-based education tools, and cost-reduction mechanisms. A proactive approach is essential to ensure the potential benefits, and availability of clinical genetics is realized by those in need rather than just those in reach.
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Houwink EJ, van Luijk SJ, Henneman L, van der Vleuten C, Jan Dinant G, Cornel MC. Genetic educational needs and the role of genetics in primary care: a focus group study with multiple perspectives. BMC FAMILY PRACTICE 2011; 12:5. [PMID: 21329524 PMCID: PMC3053218 DOI: 10.1186/1471-2296-12-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 02/17/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Available evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals. METHODS Forty-four participants took part in three types of focus groups: mono-disciplinary groups of general practitioners and midwives, respectively and multidisciplinary groups composed of a diverse set of experts. The focus group sessions were audio-taped, transcribed verbatim and analysed using content analysis. Recurrent themes were identified. RESULTS Four themes emerged regarding the educational needs and the role of genetics in primary care: (1) genetics knowledge, (2) family history, (3) ethical dilemmas and psychosocial effects in relation to genetics and (4) insight into the organisation and role of clinical genetics services. These themes reflect a shift in the role of genetics in primary care with implications for education. Although all focus group participants acknowledged the importance of genetics education, general practitioners felt this need more urgently than midwives and more strongly emphasized their perceived knowledge deficiencies. CONCLUSION The responsibilities of primary care providers with regard to genetics require further study. The results of this study will help to develop effective genetics education strategies to improve primary care providers' competencies in this area. More research into the educational priorities in genetics is needed to design courses that are suitable for postgraduate and master programmes for general practitioners and midwives.
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Affiliation(s)
- Elisa Jf Houwink
- Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Nippert I, Harris HJ, Julian-Reynier C, Kristoffersson U, Ten Kate LP, Anionwu E, Benjamin C, Challen K, Schmidtke J, Nippert RP, Harris R. Confidence of primary care physicians in their ability to carry out basic medical genetic tasks-a European survey in five countries-Part 1. J Community Genet 2010; 2:1-11. [PMID: 22109718 DOI: 10.1007/s12687-010-0030-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022] Open
Abstract
Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians' background in medical genetics.
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Affiliation(s)
- Irmgard Nippert
- Frauengesundheitsforschung/Institut für Humangenetik, Universitätsklinikum Münster, Niels- Stensen-Str. 14, 48149, Münster, Germany,
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Bennett CL, Burke SE, Burton H, Farndon PA. A toolkit for incorporating genetics into mainstream medical services: Learning from service development pilots in England. BMC Health Serv Res 2010; 10:125. [PMID: 20470377 PMCID: PMC2887834 DOI: 10.1186/1472-6963-10-125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 05/14/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. METHODS Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. RESULTS Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. CONCLUSIONS Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions.
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Affiliation(s)
- Catherine L Bennett
- NHS National Genetics Education and Development Centre, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
| | - Sarah E Burke
- School of Education, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Hilary Burton
- PHG Foundation, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Peter A Farndon
- NHS National Genetics Education and Development Centre, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
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Thompson M, Levi AC, Borghi F, Bellora P, Bogliatto F, Garbossa D, Bronda M, Lanfranco G, Moffa F, Dörfl J. Considering the implication of variations within Delphi research. Fam Pract 2009; 26:420-4. [PMID: 19684122 DOI: 10.1093/fampra/cmp051] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Delphi research is an increasingly popular method within medical, social and psychological research. It tends to be employed where established theory or knowledge are lacking but where 'experts' are thought to hold relevant information. It consists of developing and administering sequential questionnaires that seek to move towards a position of relative consensus. Although the original authors of the technique established a specific method, the literature reveals modifications in the way this is applied. Variations include (i) restricting the ability of experts to respond to the original question, (ii) changing or varying the expert groups used and (iii) the point at which the research ends. This paper provides an overview of the technique and explains these variations and their implications before highlighting possible ways forward.
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Affiliation(s)
- Miles Thompson
- Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, UK.
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Caulfield T. Direct-to-consumer genetics and health policy: a worst-case scenario? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:48-50. [PMID: 19998115 DOI: 10.1080/15265160902918770] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Timothy Caulfield
- Faculty of Law and School of Public Health, Health Law Institute, Law Centre, University of Alberta, Edmonton AB.
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