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Ong CSB, Fok RW, Tan RCA, Fung SM, Sun S, Ngeow JYY. General practitioners' (GPs) experience, attitudes and needs on clinical genetic services: a systematic review. Fam Med Community Health 2022; 10:fmch-2021-001515. [PMID: 36450397 PMCID: PMC9717000 DOI: 10.1136/fmch-2021-001515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The proliferation and growing demands of genetic testing are anticipated to revolutionise medical practice. As gatekeepers of healthcare systems, general practitioners (GPs) are expected to play a critical role in the provision of clinical genetic services. This paper aims to review existing literature on GPs' experience, attitudes and needs towards clinical genetic services. DESIGN A systematic mixed studies review of papers published between 2010 and 2022. ELIGIBILITY CRITERIA The inclusion criterion was peer-reviewed articles in English and related to GPs' experience, views and needs on any genetic testing. INFORMATION SOURCES The PubMed, PsycINFO, Cochrane, EMBASE databases were searched using Mesh terms, Boolean and wildcards combinations to identify peer-reviewed articles published from 2010 to 2022. Study quality was assessed using Mixed Methods Appraisal Tool. Only articles that fulfilled the inclusion criteria were selected. A thematic meta-synthesis was conducted on the final sample of selected articles to identify key themes. RESULTS A total of 62 articles were included in the review. Uncertainty over GPs' role in providing genetic services were attributed by the lack of confidence and time constraints and rarity of cases may further exacerbate their reluctance to shoulder an expanded role in clinical genetics. Although educational interventions were found to increasing GPs' knowledge and confidence to carry out genetic tasks, varied interest on genetic testing and preference for a shared care model with other genetic health professionals have resulted in minimal translation to clinical adoption. CONCLUSION This review highlights the need for deeper exploration of GPs' varied experience and attitudes towards clinical genetic services to better facilitate targeted intervention in the adoption of clinical genetics.
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Affiliation(s)
- Cheryl Siow Bin Ong
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Rose Wai‑Yee Fok
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ryo Chee Ann Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Shirley Sun
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Joanne Yuen Yie Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Hernandez-Nieto C, Alkon-Meadows T, Lee J, Cacchione T, Iyune-Cojab E, Garza-Galvan M, Luna-Rojas M, Copperman AB, Sandler B. Expanded carrier screening for preconception reproductive risk assessment: Prevalence of carrier status in a Mexican population. Prenat Diagn 2020; 40:635-643. [PMID: 32003480 DOI: 10.1002/pd.5656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/30/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Genetic carrier screening has the potential to identify couples at risk of having a child affected with an autosomal recessive or X-linked disorder. However, the current prevalence of carrier status for these conditions in developing countries is not well defined. This study assesses the prevalence of carrier status of selected genetic conditions utilizing an expanded, pan-ethnic genetic carrier screening panel (ECS) in a large population of Mexican patients. METHODS Retrospective chart review of all patients tested with a single ECS panel at an international infertility center from 2012 to 2018 were included, and the prevalence of positive carrier status in a Mexican population was evaluated. RESULTS Eight hundred five individuals were analyzed with ECS testing for 283 genetic conditions. Three hundred fifty-two carriers (43.7%) were identified with 503 pathogenic variants in 145 different genes. Seventeen of the 391 participating couples (4.34%) were identified as being at-risk couples. The most prevalent alleles found were associated with alpha thalassemia, cystic fibrosis, GJB2 nonsyndromic hearing loss, biotinidase deficiency, and familial Mediterranean fever. CONCLUSION Based on the prevalence and severity of Mendelian disorders, we recommend that couples who wish to conceive regardless of their ethnicity background explore carrier screening and genetic counseling prior to reproductive medical treatment.
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Affiliation(s)
- Carlos Hernandez-Nieto
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Tamar Alkon-Meadows
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Joseph Lee
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA
| | - Teresa Cacchione
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA
| | - Esther Iyune-Cojab
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Maria Garza-Galvan
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Martha Luna-Rojas
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Alan B Copperman
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford CT, USA
| | - Benjamin Sandler
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
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Capalbo A, Chokoshvili D, Dugoff L, Franasiak J, Gleicher N, Pennings G, Simon C. Should the reproductive risk of a couple aiming to conceive be tested in the contemporary clinical context? Fertil Steril 2019; 111:229-238. [PMID: 30642571 DOI: 10.1016/j.fertnstert.2018.11.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Davit Chokoshvili
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Lorraine Dugoff
- Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Jason Franasiak
- IVI-RMA America, Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Norbert Gleicher
- Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York; Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, New York; Department of Obstetrics and Gynecology, Vienna University of Medicine, Vienna, Austria
| | - Guido Pennings
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - Carlos Simon
- Department of Obstetrics and Gynecology, Valencia University, and INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology, Stanford University, Stanford, California; Igenomix, Valencia, Spain.
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Goossens J, De Roose M, Van Hecke A, Goemaes R, Verhaeghe S, Beeckman D. Barriers and facilitators to the provision of preconception care by healthcare providers: A systematic review. Int J Nurs Stud 2018; 87:113-130. [PMID: 30096578 DOI: 10.1016/j.ijnurstu.2018.06.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Healthcare providers play an important role in providing preconception care to women and men of childbearing age. Yet, the provision of preconception care by healthcare providers remains low. OBJECTIVES To provide an overview of barriers and facilitators at multiple levels that influence the provision of preconception care by healthcare providers. DESIGN A mixed-methods systematic review. DATA SOURCES PubMed, Web of Science, CINAHL, The Cochrane Library, and EMBASE were systematically searched up to April 27, 2017. The search strategy contained MeSH terms and key words related to preconception care and healthcare providers. Reference lists of included studies and systematic reviews on preconception care were screened. REVIEW METHODS Publications were eligible if they reported on barriers and facilitators influencing the provision of preconception care by healthcare providers. Data were extracted by two independent reviewers using a data extraction form. Barriers and facilitators were organized based on the social ecological model. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme Qualitative checklist for qualitative studies, the Quality Assessment Tool for quantitative studies, and the Mixed Methods Appraisal Tool for mixed methods studies. RESULTS Thirty-one articles were included. Barriers were more reported than facilitators. These were situated at provider level (unfavourable attitude and lack of knowledge of preconception care, not working in the field of obstetrics and gynaecology, lack of clarity on the responsibility for providing preconception care) and client level (not contacting a healthcare provider in the preconception stage, negative attitude, and lack of knowledge of preconception care). Limited resources (lack of time, tools, guidelines, and reimbursement) were frequently reported at the organizational and societal level. CONCLUSIONS Healthcare providers reported more barriers than facilitators to provide preconception care, which might explain why the provision of preconception care is low. To overcome the different client, provider, organizational, and societal barriers, it is necessary to develop and implement multilevel interventions.
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Affiliation(s)
- Joline Goossens
- University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ 5K3, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Marjon De Roose
- University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ 5K3, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Ann Van Hecke
- University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ 5K3, De Pintelaan 185, B-9000 Ghent, Belgium; Nursing Science, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Régine Goemaes
- University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ 5K3, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ 5K3, De Pintelaan 185, B-9000 Ghent, Belgium; VIVES University College, Department Health Care, Wilgenstraat 32, B-8800 Roeselare, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ 5K3, De Pintelaan 185, B-9000 Ghent, Belgium; School of Health Sciences, Faculty of Health & Medical Sciences, Duke of Kent Building, University of Surrey Guildford Surrey, GU2 7XH, United Kingdom.
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Franasiak JM, Olcha M, Bergh PA, Hong KH, Werner MD, Forman EJ, Zimmerman RS, Scott RT Jr. Expanded carrier screening in an infertile population: how often is clinical decision making affected? Genet Med 2016; 18:1097-101. [PMID: 26938781 DOI: 10.1038/gim.2016.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/06/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Options for preconception genetic screening have grown dramatically. Expanded carrier screening (ECS) now allows for determining carrier status for hundreds of genetic mutations by using a single sample, and some recommend ECS prior to in vitro fertilization. This study seeks to evaluate how often ECS alters clinical management when patients present for infertility care. METHODS All patients tested with ECS at a single infertility care center from 2011 to 2014 were evaluated. The overall rate of positive ECS results and the number of couples who were carriers of the same genetic disorder were evaluated. RESULTS A total of 6,643 individuals were tested, representing 3,738 couples; 1,666 (25.1%) of the individuals had a positive test result for at least one disorder. In 8 of the 3,738 couples, both members of the couple were positive for the same genetic disorder or had a test result that placed them at risk of having an affected child. Three of eight cases were cystic fibrosis. In this cohort, ECS affected clinical care eight times after 6,643 tests (0.12%, confidence interval: 0.05-0.24%) in 3,738 couples (0.21%, confidence interval: 0.09-0.42%). CONCLUSIONS ECS is becoming more widespread. In a large case series, ECS affected clinical decision making for patients presenting for infertility care in 0.21% of cases. This information must be weighed when utilizing these tests and may be a helpful part of patient counseling.Genet Med 18 11, 1097-1101.
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Shao Y, Liu S, Grinzaid K. Evaluation of two-year Jewish genetic disease screening program in Atlanta: insight into community genetic screening approaches. J Community Genet 2015; 6:137-45. [PMID: 25564014 DOI: 10.1007/s12687-014-0208-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022] Open
Abstract
Improvements in genetic testing technologies have led to the development of expanded carrier screening panels for the Ashkenazi Jewish population; however, there are major inconsistencies in current screening practices. A 2-year pilot program was launched in Atlanta in 2010 to promote and facilitate screening for 19 Jewish genetic diseases. We analyzed data from this program, including participant demographics and outreach efforts. This retrospective analysis is based on a de-identified dataset of 724 screenees. Data were obtained through medical chart review and questionnaires and included demographic information, screening results, response to outreach efforts, and follow-up behavior and preferences. We applied descriptive analysis, chi-square tests, and logistic regression to analyze the data and compare findings with published literature. The majority of participants indicated that they were not pregnant or did not have a partner who was pregnant were affiliated with Jewish organizations and reported 100 % AJ ancestry. Overall, carrier frequency was 1 in 3.9. Friends, rabbis, and family members were the most common influencers of the decision to receive screening. People who were older, had a history of pregnancy, and had been previously screened were more likely to educate others (all p < 0.05). Analysis of this 2-year program indicated that people who are ready to have children or expand their families are more likely to get screened and encourage others to be screened. The most effective outreach efforts targeted influencers who then encouraged screening in the target population. Educating influencers and increasing overall awareness were the most effective outreach strategies.
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Affiliation(s)
- Yunru Shao
- Department of Human Genetics, Emory University, 615 Michael Street, Suite 301, Whitehead Bldg., Atlanta, GA, 30322, USA
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Abstract
BACKGROUND Preconception interventions in infertile couples can increase the chance of pregnancy and lower its complications. The success in infertility treatment and achieving a successful pregnancy is of great importance among infertile couples compared to others. This study has tried to investigate necessary preconception interventions before beginning of infertility treatment cycle among infertile couples. MATERIALS AND METHODS This is a cross-sectional study of 268 individuals presenting to fertility clinics (Moshtagh and Shahid beheshty) across the city of Isfahan, Iran. Simple sampling method was used. Questionnaire and patients' medical records were used to collect data. Descriptive and analytic statistical methods and SPSS software were used for analysis. RESULTS The results showed that the interventions related to diseases treatment and prescription of folic acid before the beginning of infertility treatment were complete for most of the subject (47.06% and 79.9% respectively), but referral for genetics counseling had not been conducted in most of the cases (98.9%). Specific interventions in relation with the infertility treatment before beginning the treatment cycle had been conducted in 50% of the subjects. CONCLUSION The results of this study showed a weakness concerning necessary preconception interventions before beginning of infertility treatment cycle in most of the studied subjects. With regard to the effect of preconception interventions on outcome of infertility treatment, and with consideration of high importance of pregnancy success in infertile couples, paying more attention to conduct this manner is necessary.
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Affiliation(s)
- Nafisehsadat Nekuei
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan, Iran
| | - Ashraf Kazemi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan, Iran
| | - Akbar Hasanzadeh
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Alzu'bi A, Zhou L, Watzlaf V. Personal genomic information management and personalized medicine: challenges, current solutions, and roles of HIM professionals. Perspect Health Inf Manag 2014; 11:1c. [PMID: 24808804 PMCID: PMC3995490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In recent years, the term personalized medicine has received more and more attention in the field of healthcare. The increasing use of this term is closely related to the astonishing advancement in DNA sequencing technologies and other high-throughput biotechnologies. A large amount of personal genomic data can be generated by these technologies in a short time. Consequently, the needs for managing, analyzing, and interpreting these personal genomic data to facilitate personalized care are escalated. In this article, we discuss the challenges for implementing genomics-based personalized medicine in healthcare, current solutions to these challenges, and the roles of health information management (HIM) professionals in genomics-based personalized medicine.
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Affiliation(s)
- Amal Alzu'bi
- The Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA
| | - Leming Zhou
- The Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA
| | - Valerie Watzlaf
- The Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA
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Ready K, Haque IS, Srinivasan BS, Marshall JR. Knowledge and attitudes regarding expanded genetic carrier screening among women's healthcare providers. Fertil Steril 2011; 97:407-13. [PMID: 22137493 DOI: 10.1016/j.fertnstert.2011.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/28/2011] [Accepted: 11/14/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine women's healthcare providers' knowledge and attitudes regarding genetic disorders and expanded genetic screening. DESIGN Survey of American Society for Reproductive Medicine 2010 and American College of Obstetricians and Gynecologists 2011 Annual Meeting attendees. The survey included 60 items (12 demographic, 10 knowledge, and 38 attitude). Attitudes were assessed with a 5-point Likert scale. Chi-square or t tests determined significance. SETTING American Society for Reproductive Medicine 2010 and American College of Obstetricians and Gynecologists 2011 Annual Meeting. PATIENT(S) A total of 203 participants completed the survey. Of these, 48% were male, 61% were physicians, 73% were Caucasian, and 42% were aged 35-50 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) None. RESULT(S) Physicians had better knowledge scores than other participants (87% vs. 79%). Knowledge was not influenced by prior personal/family experience with genetic screening. Fewer correct answers were observed for the probability of a positive test (65.2%), the risk of transmitting a gene mutation (62.2%), and the risk of having an affected child (56.2%). Very few participants (18.3%) disagreed with the notion of carrier screening as socially responsible behavior. Some had concerns about test result confidentiality (40.1%) and resulting insurance rate increases (37.0%). Assuming equal costs, most participants preferred to be tested for a larger number of diseases (77.7%) and believed posttest counseling to be helpful (83.7%). CONCLUSION(S) Women's healthcare providers generally had good knowledge and positive attitudes about genetic disorders and expanded genetic screening. Specific misperceptions, both medical and legal, require education.
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