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Schwartz MLB, McDonald WS, Hallquist MLG, Hu Y, McCormick CZ, Walters NL, Tsun J, Zimmerman K, Decker A, Gray C, Malinowski J, Sturm AC, Buchanan AH. Genetics Visit Uptake Among Individuals Receiving Clinically Actionable Genomic Screening Results. JAMA Netw Open 2024; 7:e242388. [PMID: 38488794 PMCID: PMC10943406 DOI: 10.1001/jamanetworkopen.2024.2388] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/23/2024] [Indexed: 03/18/2024] Open
Abstract
Importance Screening unselected populations for clinically actionable genetic disease risk can improve ascertainment and facilitate risk management. Genetics visits may encourage at-risk individuals to perform recommended management, but little has been reported on genetics visit completion or factors associated with completion in genomic screening programs. Objective To identify factors associated with postdisclosure genetics visits in a genomic screening cohort. Design, Setting, and Participants This was a cohort study of biobank data in a health care system in central Pennsylvania. Participants' exome sequence data were reviewed for pathogenic or likely pathogenic (P/LP) results in all genes on the American College of Medical Genetics and Genomics Secondary Findings list. Clinically confirmed results were disclosed by phone and letter. Participants included adult MyCode biobank participants who received P/LP results between July 2015 and November 2019. Data were analyzed from May 2021 to March 2022. Exposure Clinically confirmed P/LP result disclosed by phone or letter. Main Outcomes and Measures Completion of genetics visit in which the result was discussed and variables associated with completion were assessed by electronic health record (EHR) review. Results Among a total of 1160 participants (703 [60.6%] female; median [IQR] age, 57.0 [42.1-68.5] years), fewer than half of participants (551 of 1160 [47.5%]) completed a genetics visit. Younger age (odds ratio [OR] for age 18-40 years, 2.98; 95% CI, 1.40-6.53; OR for age 41-65 years, 2.36; 95% CI, 1.22-4.74; OR for age 66-80 years, 2.60; 95% CI, 1.41-4.98 vs age ≥81 years); female sex (OR, 1.49; 95% CI, 1.14-1.96); being married (OR, 1.74; 95% CI, 1.23-2.47) or divorced (OR, 1.80; 95% CI, 1.11-2.91); lower Charlson comorbidity index (OR for score of 0-2, 1.76; 95% CI, 1.16-2.68; OR for score of 3-4, 1.73; 95% CI, 1.18-2.54 vs score of ≥5); EHR patient portal use (OR, 1.42; 95% CI, 1.06-1.89); living closer to a genetics clinic (OR, 1.64; 95% CI, 1.14-2.36 for <8.9 miles vs >20.1 miles); successful results disclosure (OR for disclosure by genetic counselor, 16.32; 95% CI, 8.16-37.45; OR for disclosure by research assistant, 20.30; 95% CI, 10.25-46.31 vs unsuccessful phone disclosure); and having a hereditary cancer result (OR, 2.13; 95% CI, 1.28-3.58 vs other disease risk) were significantly associated with higher rates of genetics visit completion. Preference to follow up with primary care was the most common reported reason for declining a genetics visit (68 of 152 patients [44.7%]). Conclusions and Relevance This cohort study of a biobank-based population genomic screening program suggests that targeted patient engagement, improving multidisciplinary coordination, and reducing barriers to follow-up care may be necessary for enhancing genetics visit uptake.
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Affiliation(s)
- Marci L. B. Schwartz
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | | | | | - Jessica Tsun
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | | | - Amie Decker
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- University of Arkansas Medical Sciences, Little Rock
| | - Celia Gray
- Phenomics and Clinical Data Core, Geisinger, Danville, Pennsylvania
| | | | - Amy C. Sturm
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- 23andMe, Sunnyvale, California
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Yu KD, Betts MN, Urban GM, Schwartz MLB, Robinson TO, Moyer RJ, Taddonio SW, Vasudevan A, Johns A, Sturm AC, Kelly MA, Williams MS, Poler SM, Buchanan AH. Evaluation of Malignant Hyperthermia Features in Patients with Pathogenic or Likely Pathogenic RYR1 Variants Disclosed through a Population Genomic Screening Program. Anesthesiology 2024; 140:52-61. [PMID: 37787745 DOI: 10.1097/aln.0000000000004786] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Malignant hyperthermia (MH) susceptibility is a heritable musculoskeletal disorder that can present as a potentially fatal hypermetabolic response to triggering anesthesia agents. Genomic screening for variants in MH-associated genes RYR1 and CACNA1S provides an opportunity to prevent morbidity and mortality. There are limited outcomes data from disclosing variants in RYR1, the most common MH susceptibility gene, in unselected populations. The authors sought to identify the rate of MH features or fulminant episodes after triggering agent exposure in an unselected population undergoing genomic screening including actionable RYR1 variants. METHODS The MyCode Community Health Initiative by Geisinger (USA) is an electronic health record-linked biobank that discloses pathogenic and likely pathogenic variants in clinically actionable genes to patient-participants. Available electronic anesthesia and ambulatory records for participants with actionable RYR1 results returned through December 2020 were evaluated for pertinent findings via double-coded chart reviews and reconciliation. Descriptive statistics for observed phenotypes were calculated. RESULTS One hundred fifty-two participants had an actionable RYR1 variant disclosed during the study period. None had previous documented genetic testing for MH susceptibility; one had previous contracture testing diagnosing MH susceptibility. Sixty-eight participants (44.7%) had anesthesia records documenting triggering agent exposure during at least one procedure. None received dantrolene treatment or had documented muscle rigidity, myoglobinuria, hyperkalemia, elevated creatine kinase, severe myalgia, or tea-colored urine. Of 120 possibly MH-related findings (postoperative intensive care unit admissions, hyperthermia, arterial blood gas evaluation, hypercapnia, or tachycardia), 112 (93.3%) were deemed unlikely to be MH events; 8 (6.7%) had insufficient records to determine etiology. CONCLUSIONS Results demonstrate a low frequency of classic intraanesthetic hypermetabolic phenotypes in an unselected population with actionable RYR1 variants. Further research on the actionability of screening for MH susceptibility in unselected populations, including economic impact, predictors of MH episodes, and expanded clinical phenotypes, is necessary. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Kristen D Yu
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | - Megan N Betts
- Department of Genomic Health, Geisinger, Danville, Pennsylvania; WellSpan Health, York, Pennsylvania
| | | | - Marci L B Schwartz
- Department of Genomic Health, Geisinger, Danville, Pennsylvania; Division of Clinical and Metabolic Genetics, and Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, Canada
| | | | - Robert J Moyer
- Department of Anesthesiology, Geisinger, Danville, Pennsylvania
| | - Scott W Taddonio
- Department of Anesthesiology, Geisinger, Danville, Pennsylvania; Department of Anesthesiology, Jefferson Health, Philadelphia, Pennsylvania
| | - Anasuya Vasudevan
- Department of Anesthesiology, Geisinger, Danville, Pennsylvania; Vigilant Anesthesia PC, New York, New York
| | - Alicia Johns
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - Amy C Sturm
- Department of Genomic Health, Geisinger, Danville, Pennsylvania; 23andMe, Sunnyvale, California
| | - Melissa A Kelly
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | - Marc S Williams
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | - S Mark Poler
- Department of Anesthesiology, Geisinger, Danville, Pennsylvania
| | - Adam H Buchanan
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
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3
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Savatt JM, Johns A, Schwartz MLB, McDonald WS, Salvati ZM, Oritz NM, Masnick M, Hatchell K, Hao J, Buchanan AH, Williams MS. Testing and Management of Iron Overload After Genetic Screening-Identified Hemochromatosis. JAMA Netw Open 2023; 6:e2338995. [PMID: 37870835 PMCID: PMC10594145 DOI: 10.1001/jamanetworkopen.2023.38995] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/08/2023] [Indexed: 10/24/2023] Open
Abstract
Importance HFE gene-associated hereditary hemochromatosis type 1 (HH1) is underdiagnosed, resulting in missed opportunities for preventing morbidity and mortality. Objective To assess whether screening for p.Cys282Tyr homozygosity is associated with recognition and management of asymptomatic iron overload. Design, Setting, and Participants This cross-sectional study obtained data from the Geisinger MyCode Community Health Initiative, a biobank of biological samples and linked electronic health record data from a rural, integrated health care system. Participants included those who received a p.Cys282Tyr homozygous result via genomic screening (MyCode identified), had previously diagnosed HH1 (clinically identified), and those negative for p.Cys282Tyr homozygosity between 2017 and 2018. Data were analyzed from April 2020 to August 2023. Exposure Disclosure of a p.Cys282Tyr homozygous result. Main Outcomes and Measures Postdisclosure management and HFE-associated phenotypes in MyCode-identified participants were analyzed. Rates of HFE-associated phenotypes in MyCode-identified participants were compared with those of clinically identified participants. Relevant laboratory values and rates of laboratory iron overload among participants negative for p.Cys282Tyr homozygosity were compared with those of MyCode-identified participants. Results A total of 86 601 participants had available exome sequences at the time of analysis, of whom 52 994 (61.4%) were assigned female at birth, and the median (IQR) age was 62.0 (47.0-73.0) years. HFE p.Cys282Tyr homozygosity was disclosed to 201 participants, of whom 57 (28.4%) had a prior clinical HH1 diagnosis, leaving 144 participants who learned of their status through screening. There were 86 300 individuals negative for p.Cys282Tyr homozygosity. After result disclosure, among MyCode-identified participants, 99 (68.8%) had a recommended laboratory test and 36 (69.2%) with laboratory or liver biopsy evidence of iron overload began phlebotomy or chelation. Fifty-three (36.8%) had iron overload; rates of laboratory iron overload were higher in MyCode-identified participants than participants negative for p.Cys282Tyr homozygosity (females: 34.1% vs 2.1%, P < .001; males: 39.0% vs 2.9%, P < .001). Iron overload (females: 34.1% vs 79.3%, P < .001; males: 40.7% vs 67.9%, P = .02) and some liver-associated phenotypes were observed at lower frequencies in MyCode-identified participants compared with clinically identified individuals. Conclusions and Relevance Results of this cross-sectional study showed the ability of genomic screening to identify undiagnosed iron overload and encourage relevant management, suggesting the potential benefit of population screening for HFE p.Cys282Tyr homozygosity. Further studies are needed to examine the implications of genomic screening for health outcomes and cost-effectiveness.
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Affiliation(s)
| | - Alicia Johns
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - Marci L. B. Schwartz
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Nicole M. Oritz
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | - Max Masnick
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | | | - Jing Hao
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
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4
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Bhandari V, Kim R, Faghfoury H, Silver J, Chan RH, Ding Q, Schwartz MLB, Bril V. Congenital Myopathy Due to Pathogenic Missense Variant in the MYBPC1 Gene. Can J Neurol Sci 2023:1-3. [PMID: 37577974 DOI: 10.1017/cjn.2023.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Affiliation(s)
- Vinaya Bhandari
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raymond Kim
- Division of Clinical and Metabolic Genetics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hanna Faghfoury
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Josh Silver
- Department of Molecular Genetics, University of Toronto & Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Raymond H Chan
- University health Network, University of Toronto, Toronto, ON, Canada
| | - Qiliang Ding
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marci L B Schwartz
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
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5
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Campbell-Salome G, Jones LK, Walters NL, Morgan KM, Brangan A, Ladd IG, McGowan MP, Wilemon K, Schmidlen TJ, Simmons E, Schwartz MLB, McMinn MN, Tricou E, Rahm AK, Ahmed CD, Sturm AC. Optimizing communication strategies and designing a comprehensive program to facilitate cascade testing for familial hypercholesterolemia. BMC Health Serv Res 2023; 23:340. [PMID: 37020233 PMCID: PMC10074725 DOI: 10.1186/s12913-023-09304-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This project aimed to optimize communication strategies to support family communication about familial hypercholesterolemia (FH) and improve cascade testing uptake among at-risk relatives. Individuals and families with FH provided feedback on multiple strategies including: a family letter, digital tools, and direct contact. METHODS Feedback from participants was collected via dyadic interviews (n = 11) and surveys (n = 98) on communication strategies and their proposed implementation to improve cascade testing uptake. We conducted a thematic analysis to identify how to optimize each strategy. We categorized optimizations and their implementation within the project's healthcare system using a Traffic Light approach. RESULTS Thematic analysis resulted in four distinct suggested optimizations for each communication strategy and seven suggested optimizations that were suitable across all strategies. Four suggestions for developing a comprehensive cascade testing program, which would offer all optimized communication strategies also emerged. All optimized suggestions coded green (n = 21) were incorporated. Suggestions coded yellow (n = 12) were partially incorporated. Only two suggestions were coded red and could not be incorporated. CONCLUSIONS This project demonstrates how to collect and analyze stakeholder feedback for program design. We identified feasible suggested optimizations, resulting in communication strategies that are patient-informed and patient-centered. Optimized strategies were implemented in a comprehensive cascade testing program.
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Affiliation(s)
- Gemme Campbell-Salome
- Department of Genomic Health, Geisinger, , Danville, PA, USA.
- Department of Population Health Sciences, Geisinger, Danville, PA, USA.
| | - Laney K Jones
- Department of Genomic Health, Geisinger, , Danville, PA, USA
- Geisinger Heart and Vascular Institute, Geisinger, Danville, PA, USA
| | | | - Kelly M Morgan
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Andrew Brangan
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Ilene G Ladd
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Mary P McGowan
- The Family Heart Foundation, Pasadena, CA, USA
- Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | - Marci L B Schwartz
- Cardiac Genome Clinic, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, ON, Canada
| | - Megan N McMinn
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Eric Tricou
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | - Alanna K Rahm
- Department of Genomic Health, Geisinger, , Danville, PA, USA
| | | | - Amy C Sturm
- Department of Genomic Health, Geisinger, , Danville, PA, USA
- Geisinger Heart and Vascular Institute, Geisinger, Danville, PA, USA
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6
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Blout Zawatsky CL, Bick D, Bier L, Funke B, Lebo M, Lewis KL, Orlova E, Qian E, Ryan L, Schwartz MLB, Soper ER. Elective genomic testing: Practice resource of the National Society of Genetic Counselors. J Genet Couns 2023; 32:281-299. [PMID: 36597794 DOI: 10.1002/jgc4.1654] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 01/05/2023]
Abstract
Genetic counseling for patients who are pursuing genetic testing in the absence of a medical indication, referred to as elective genomic testing (EGT), is becoming more common. This type of testing has the potential to detect genetic conditions before there is a significant health impact permitting earlier management and/or treatment. Pre- and post-test counseling for EGT is similar to indication-based genetic testing. Both require a complete family and medical history when ordering a test or interpreting a result. However, EGT counseling has some special considerations including greater uncertainties around penetrance and clinical utility and a lack of published guidelines. While certain considerations in the selection of a high-quality genetic testing laboratory are universal, there are some considerations that are unique to the selection of a laboratory performing EGT. This practice resource intends to provide guidance for genetic counselors and other healthcare providers caring for adults seeking pre- or post-test counseling for EGT. Genetic counselors and other genetics trained healthcare providers are the ideal medical professionals to supply accurate information to individuals seeking counseling about EGT enabling them to make informed decisions about testing and follow-up.
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Affiliation(s)
- Carrie L Blout Zawatsky
- Genomes2People, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA.,The MGH Institute of Health Professions, Boston, Massachusetts, USA
| | | | - Louise Bier
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Matthew Lebo
- Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Cambridge, Massachusetts, USA.,Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Boston, Massachusetts, USA
| | - Katie L Lewis
- Center for Precision Health Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Ekaterina Orlova
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emily Qian
- Department of Genetics, Yale University, New Haven, Connecticut, USA
| | | | - Marci L B Schwartz
- Cardiac Genome Clinic, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily R Soper
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Campbell-Salome G, Walters NL, Ladd IG, Sheldon A, Ahmed CD, Brangan A, McMinn MN, Rahm AK, Schwartz MLB, Tricou E, Fisher CL, Sturm AC. Motivating cascade testing for familial hypercholesterolemia: applying the extended parallel process model for clinician communication. Transl Behav Med 2022; 12:800-809. [PMID: 35429393 PMCID: PMC9291357 DOI: 10.1093/tbm/ibac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Motivating at-risk relatives to undergo cascade testing for familial hypercholesterolemia (FH) is critical for diagnosis and lifesaving treatment. As credible sources of information, clinicians can assist in family communication about FH and motivate cascade testing uptake. However, there are no guidelines regarding how clinicians should effectively communicate with probands (the first person diagnosed in the family) and at-risk relatives. Individuals and families with FH can inform our understanding of the most effective communications to promote cascade testing. Guided by the extended parallel process model (EPPM), we analyzed the perspectives of individuals and families with FH for effective messaging clinicians can use to promote cascade testing uptake. We analyzed narrative data from interviews and surveys collected as part of a larger mixed-methods study. The EPPM was used to identify message features recommended by individuals and families with FH that focus on four key constructs (severity, susceptibility, response efficacy, self-efficacy) to promote cascade testing. Participants included 22 individuals from 11 dyadic interviews and 98 survey respondents. Participants described prioritizing multiple messages that address each EPPM construct to alert relatives about their risk. They illustrated strategies clinicians could use within each EPPM construct to communicate to at-risk relatives about the importance of pursuing diagnosis via cascade testing and subsequent treatment for high cholesterol due to FH. Findings provide guidance on effective messaging to motivate cascade testing uptake for FH and demonstrates how the EPPM may guide communication with at-risk relatives about genetic risk and motivate cascade testing broadly.
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Affiliation(s)
- Gemme Campbell-Salome
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | | | - Ilene G Ladd
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | | | - Andrew Brangan
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Megan N McMinn
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | - Eric Tricou
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
- Heart Institute, Geisinger, Danville, PA, USA
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8
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Buchanan AH, Manickam K, Meyer MN, Wagner JK, Hallquist MLG, Williams JL, Rahm AK, Williams MS, Chen ZME, Shah CK, Garg TK, Lazzeri AL, Schwartz MLB, Lindbuchler DAM, Fan AL, Leeming R, Servano PO, Smith AL, Vogel VG, Abul-Husn NS, Dewey FE, Lebo MS, Mason-Suares HM, Ritchie MD, Davis FD, Carey DJ, Feinberg DT, Faucett WA, Ledbetter DH, Murray MF. Correction to: Early cancer diagnoses through BRCA1/2 screening of unselected adult biobank participants. Genet Med 2021; 23:2470. [PMID: 34646007 PMCID: PMC9119243 DOI: 10.1038/s41436-021-01304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Adam H Buchanan
- Geisinger Health System, Danville, PA, USA. .,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA.
| | - Kandamurugu Manickam
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Michelle N Meyer
- Geisinger Health System, Danville, PA, USA.,Center for Translational Bioethics and Health Care Policy, Geisinger Health System, Danville, PA, USA
| | - Jennifer K Wagner
- Geisinger Health System, Danville, PA, USA.,Center for Translational Bioethics and Health Care Policy, Geisinger Health System, Danville, PA, USA
| | - Miranda L G Hallquist
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Janet L Williams
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Alanna Kulchak Rahm
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Marc S Williams
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Zong-Ming E Chen
- Geisinger Health System, Danville, PA, USA.,Laboratory Medicine, Geisinger Health System, Danville, PA, USA
| | - Chaitali K Shah
- Geisinger Health System, Danville, PA, USA.,Radiology, Geisinger Health System, Danville, PA, USA
| | - Tullika K Garg
- Geisinger Health System, Danville, PA, USA.,Department of Urology, Geisinger Health System, Danville, PA, USA
| | - Amanda L Lazzeri
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Marci L B Schwartz
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - D' Andra M Lindbuchler
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Audrey L Fan
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Rosemary Leeming
- Geisinger Health System, Danville, PA, USA.,General Surgery, Geisinger Health System, Danville, PA, USA
| | - Pedro O Servano
- Geisinger Health System, Danville, PA, USA.,Family Medicine, Geisinger Health System, Danville, PA, USA
| | - Ashlee L Smith
- Geisinger Health System, Danville, PA, USA.,Women's Health, Geisinger Health System, Danville, PA, USA
| | - Victor G Vogel
- Geisinger Health System, Danville, PA, USA.,Hematology & Oncology, Geisinger Health System, Danville, PA, USA
| | | | | | - Matthew S Lebo
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Heather M Mason-Suares
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Marylyn D Ritchie
- Geisinger Health System, Danville, PA, USA.,Biomedical and Translational Informatics, Geisinger Health System, Danville, PA, USA
| | - F Daniel Davis
- Geisinger Health System, Danville, PA, USA.,Center for Translational Bioethics and Health Care Policy, Geisinger Health System, Danville, PA, USA
| | - David J Carey
- Geisinger Health System, Danville, PA, USA.,Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, USA
| | - David T Feinberg
- Geisinger Health System, Danville, PA, USA.,Office of the Chief Executive Officer, Geisinger Health System, Danville, PA, USA
| | - W Andrew Faucett
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - David H Ledbetter
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
| | - Michael F Murray
- Geisinger Health System, Danville, PA, USA.,Genomic Medicine Institute, Geisinger Health System, Danville, PA, USA
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Schwartz MLB, Buchanan AH, Hallquist MLG, Haggerty CM, Sturm AC. Genetic counseling for patients with positive genomic screening results: Considerations for when the genetic test comes first. J Genet Couns 2021; 30:634-644. [PMID: 33786929 DOI: 10.1002/jgc4.1386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 01/06/2023]
Abstract
Emerging genetic testing delivery models have enabled individuals to receive testing without a medical indication. This article will highlight key considerations for patient care in the setting of adult patients with positive results for monogenic disease identified through genomic screening. Suggestions for how to adapt genetic counseling to a genomic screening population will encompass topics such as phenotyping, risk assessments, and the use of existing guidelines and resources. Case examples will demonstrate principles of genotype-first patient care.
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Affiliation(s)
| | | | | | - Christopher M Haggerty
- The Heart Institute, Geisinger, Danville, PA, USA.,Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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10
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Carruth ED, Beer D, Alsaid A, Schwartz MLB, McMinn M, Kelly MA, Buchanan AH, Nevius CD, Calkins H, James CA, Murray B, Tichnell C, Matsumura ME, Kirchner HL, Fornwalt BK, Sturm AC, Haggerty CM. Clinical Findings and Diagnostic Yield of Arrhythmogenic Cardiomyopathy Through Genomic Screening of Pathogenic or Likely Pathogenic Desmosome Gene Variants. Circ Genom Precis Med 2021; 14:e003302. [PMID: 33684294 DOI: 10.1161/circgen.120.003302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genomic screening holds great promise for presymptomatic identification of hidden disease, and prevention of dramatic events, including sudden cardiac death associated with arrhythmogenic cardiomyopathy (ACM). Herein, we present findings from clinical follow-up of carriers of ACM-associated pathogenic/likely pathogenic desmosome variants ascertained through genomic screening. METHODS Of 64 548 eligible participants in Geisinger MyCode Genomic Screening and Counseling program (2015-present), 92 individuals (0.14%) identified with pathogenic/likely pathogenic desmosome variants by clinical laboratory testing were referred for evaluation. We reviewed preresult medical history, patient-reported family history, and diagnostic testing results to assess both arrhythmogenic right ventricular cardiomyopathy and left-dominant ACM. RESULTS One carrier had a prior diagnosis of dilated cardiomyopathy with arrhythmia; no other related diagnoses or diagnostic family history criteria were reported. Fifty-nine carriers (64%) had diagnostic testing in follow-up. Excluding the variant, 21/59 carriers satisfied at least one arrhythmogenic right ventricular cardiomyopathy task force criterion, 11 (52%) of whom harbored DSP variants, but only 5 exhibited multiple criteria. Six (10%) carriers demonstrated evidence of left-dominant ACM, including high rates of atypical late gadolinium enhancement by magnetic resonance imaging and nonsustained ventricular tachycardia. Two individuals received new cardiomyopathy diagnoses and received defibrillators for primary prevention. CONCLUSIONS Genomic screening for pathogenic/likely pathogenic variants in desmosome genes can uncover both left- and right-dominant ACM. Findings of overt cardiomyopathy were limited but were most common in DSP-variant carriers and notably absent in PKP2-variant carriers. Consideration of the pathogenic/likely pathogenic variant as a major criterion for diagnosis is inappropriate in the setting of genomic screening.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dominik Beer
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - Amro Alsaid
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - Marci L B Schwartz
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Megan McMinn
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Melissa A Kelly
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Adam H Buchanan
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Martin E Matsumura
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - H Lester Kirchner
- Department of Population Health Sciences (H.L.K.), Geisinger, Danville, PA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Amy C Sturm
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA.,Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
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11
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Schwartz MLB, Klein WMP, Erby LAH, Smith CH, Roter DL. The impact of the number of tests presented and a provider recommendation on decisions about genetic testing for cancer risk. Patient Educ Couns 2021; 104:265-275. [PMID: 32994107 PMCID: PMC7854998 DOI: 10.1016/j.pec.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/06/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine how the method of presenting testing options and a provider recommendation can influence a decision about genetic testing for inherited cancer predispositions. METHODS An online hypothetical vignette study was completed by 454 healthy volunteers. Participants were randomized to receive one of two survey versions which differed by genetic testing choice presentation. One group was shown three options simultaneously (no test, 5-gene or 15-gene), and a second group received the 15-gene option after choosing between the no test and 5-gene options. A preference-based provider recommendation was also incorporated. We examined the effect of these interventions on test selection. RESULTS Participants in the simultaneous group were more likely to choose a genetic test than those in the sequential group (OR: 2.35, p=0.003). This effect was no longer observed when individuals who had selected no-test in the sequential group were told about the 15-gene test (OR: 1.03 p=0.932). Incorporating a provider recommendation into the hypothetical scenario led to more preference-consistent choices (χ2 = 8.53, p < 0.0035,). CONCLUSIONS A larger menu of testing choices led to higher testing uptake. A preference-based clinician recommendation resulted in more preference-consistent choices. PRACTICE IMPLICATIONS The structuring of testing options and preference-sensitive recommendations appear to facilitate informed testing decisions.
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Affiliation(s)
- Marci L B Schwartz
- National Human Genome Research Institute, National Institutes of Health, Bethesda, USA; Genomic Medicine Institute, Geisinger, Danville, USA.
| | - William M P Klein
- National Human Genome Research Institute, National Institutes of Health, Bethesda, USA; Behavioral Research Program, National Cancer Institute, Bethesda, USA
| | - Lori A H Erby
- National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Christy H Smith
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, USA
| | - Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, USA
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12
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Buchanan AH, Lester Kirchner H, Schwartz MLB, Kelly MA, Schmidlen T, Jones LK, Hallquist MLG, Rocha H, Betts M, Schwiter R, Butry L, Lazzeri AL, Frisbie LR, Rahm AK, Hao J, Willard HF, Martin CL, Ledbetter DH, Williams MS, Sturm AC. Clinical outcomes of a genomic screening program for actionable genetic conditions. Genet Med 2020; 22:1874-1882. [PMID: 32601386 PMCID: PMC7605431 DOI: 10.1038/s41436-020-0876-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose Three genetic conditions—hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia—have tier 1 evidence for interventions that reduce morbidity and mortality, prompting proposals to screen unselected populations for these conditions. We examined the impact of genomic screening on risk management and early detection in an unselected population. Methods Observational study of electronic health records (EHR) among individuals in whom a pathogenic/likely pathogenic variant in a tier 1 gene was discovered through Geisinger’s MyCode project. EHR of all eligible participants was evaluated for a prior genetic diagnosis and, among participants without such a diagnosis, relevant personal/family history, postdisclosure clinical diagnoses, and postdisclosure risk management. Results Eighty-seven percent of participants (305/351) did not have a prior genetic diagnosis of their tier 1 result. Of these, 65% had EHR evidence of relevant personal and/or family history of disease. Of 255 individuals eligible to have risk management, 70% (n = 179) had a recommended risk management procedure after results disclosure. Thirteen percent of participants (41/305) received a relevant clinical diagnosis after results disclosure. Conclusion Genomic screening programs can identify previously unrecognized individuals at increased risk of cancer and heart disease and facilitate risk management and early cancer detection.
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Affiliation(s)
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | | | | | - Tara Schmidlen
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Laney K Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Megan Betts
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | - Loren Butry
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | | | | | - Jing Hao
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Huntington F Willard
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Genome Medical, Durham, NC, USA
| | - Christa L Martin
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Autism and Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - David H Ledbetter
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Autism and Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | | | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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13
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Hallquist MLG, Tricou EP, Hallquist MN, Savatt JM, Rocha H, Evans AE, Deckard N, Hu Y, Kirchner HL, Pervola J, Rahm AK, Rashkin M, Schmidlen TJ, Schwartz MLB, Williams JL, Williams MS, Buchanan AH. Positive impact of genetic counseling assistants on genetic counseling efficiency, patient volume, and cost in a cancer genetics clinic. Genet Med 2020; 22:1348-1354. [DOI: 10.1038/s41436-020-0797-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/29/2022] Open
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14
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Williams MS, Buchanan AH, Davis FD, Faucett WA, Hallquist MLG, Leader JB, Martin CL, McCormick CZ, Meyer MN, Murray MF, Rahm AK, Schwartz MLB, Sturm AC, Wagner JK, Williams JL, Willard HF, Ledbetter DH. Patient-Centered Precision Health In A Learning Health Care System: Geisinger's Genomic Medicine Experience. Health Aff (Millwood) 2019; 37:757-764. [PMID: 29733722 DOI: 10.1377/hlthaff.2017.1557] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care delivery is increasingly influenced by the emerging concepts of precision health and the learning health care system. Although not synonymous with precision health, genomics is a key enabler of individualized care. Delivering patient-centered, genomics-informed care based on individual-level data in the current national landscape of health care delivery is a daunting challenge. Problems to overcome include data generation, analysis, storage, and transfer; knowledge management and representation for patients and providers at the point of care; process management; and outcomes definition, collection, and analysis. Development, testing, and implementation of a genomics-informed program requires multidisciplinary collaboration and building the concepts of precision health into a multilevel implementation framework. Using the principles of a learning health care system provides a promising solution. This article describes the implementation of population-based genomic medicine in an integrated learning health care system-a working example of a precision health program.
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Affiliation(s)
- Marc S Williams
- Marc S. Williams ( ) is director of the Genomic Medicine Institute, Geisinger, in Danville, Pennsylvania
| | - Adam H Buchanan
- Adam H. Buchanan is an assistant professor at the Genomic Medicine Institute, Geisinger
| | - F Daniel Davis
- F. Daniel Davis is director of the Center for Bioethics and Healthcare Policy, Geisinger
| | - W Andrew Faucett
- W. Andrew Faucett is a professor at the Genomic Medicine Institute, Geisinger
| | - Miranda L G Hallquist
- Miranda L. G. Hallquist is a genetic counselor at the Genomic Medicine Institute, Geisinger
| | - Joseph B Leader
- Joseph B. Leader is director of the Phenomic Analytics and Clinical Data Core, Geisinger
| | - Christa L Martin
- Christa L. Martin is director of the Autism and Developmental Medicine Institute, Geisinger
| | - Cara Z McCormick
- Cara Z. McCormick is a senior assistant at the Genomic Medicine Institute, Geisinger
| | - Michelle N Meyer
- Michelle N. Meyer is associate director for research ethics at the Center for Translational Bioethics and Health Care Policy, Geisinger
| | - Michael F Murray
- Michael F. Murray was a physician in the Genomic Medicine Institute, Geisinger, at the time this work was completed. He is now at the Yale School of Medicine
| | - Alanna K Rahm
- Alanna K. Rahm is an assistant professor at the Genomic Medicine Institute, Geisinger
| | - Marci L B Schwartz
- Marci L. B. Schwartz is a genetic counselor at the Genomic Medicine Institute, Geisinger
| | - Amy C Sturm
- Amy C. Sturm is a professor at the Genomic Medicine Institute, Geisinger
| | - Jennifer K Wagner
- Jennifer K. Wagner is associate director of bioethics research, Center for Translational Bioethics and Health Care Policy, Geisinger
| | - Janet L Williams
- Janet L. Williams is director of research genetic counselors, Genomic Medicine Institute, Geisinger
| | - Huntington F Willard
- Huntington F. Willard is director of the National Precision Health Institute, Geisinger
| | - David H Ledbetter
- David H. Ledbetter is executive vice president and chief scientific officer, Geisinger
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15
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Manickam K, Buchanan AH, Schwartz MLB, Hallquist MLG, Williams JL, Rahm AK, Rocha H, Savatt JM, Evans AE, Butry LM, Lazzeri AL, Lindbuchler DM, Flansburg CN, Leeming R, Vogel VG, Lebo MS, Mason-Suares HM, Hoskinson DC, Abul-Husn NS, Dewey FE, Overton JD, Reid JG, Baras A, Willard HF, McCormick CZ, Krishnamurthy SB, Hartzel DN, Kost KA, Lavage DR, Sturm AC, Frisbie LR, Person TN, Metpally RP, Giovanni MA, Lowry LE, Leader JB, Ritchie MD, Carey DJ, Justice AE, Kirchner HL, Faucett WA, Williams MS, Ledbetter DH, Murray MF. Exome Sequencing-Based Screening for BRCA1/2 Expected Pathogenic Variants Among Adult Biobank Participants. JAMA Netw Open 2018; 1:e182140. [PMID: 30646163 PMCID: PMC6324494 DOI: 10.1001/jamanetworkopen.2018.2140] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Detection of disease-associated variants in the BRCA1 and BRCA2 (BRCA1/2) genes allows for cancer prevention and early diagnosis in high-risk individuals. OBJECTIVES To identify pathogenic and likely pathogenic (P/LP) BRCA1/2 variants in an unselected research cohort, and to characterize the features associated with P/LP variants. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study of adult volunteers (n = 50 726) who underwent exome sequencing at a single health care system (Geisinger Health System, Danville, Pennsylvania) from January 1, 2014, to March 1, 2016. Participants are part of the DiscovEHR cohort and were identified through the Geisinger MyCode Community Health Initiative. They consented to a research protocol that included sequencing and return of actionable test results. Clinical data from electronic health records and clinical visits were correlated with variants. Comparisons were made between those with (cases) and those without (controls) P/LP variants in BRCA1/2. MAIN OUTCOMES Prevalence of P/LP BRCA1/2 variants in cohort, proportion of variant carriers not previously ascertained through clinical testing, and personal and family history of relevant cancers among BRCA1/2 variant carriers and noncarriers. RESULTS Of the 50 726 health system patients who underwent exome sequencing, 50 459 (99.5%) had no expected pathogenic BRCA1/2 variants and 267 (0.5%) were BRCA1/2 carriers. Of the 267 cases (148 [55.4%] were women and 119 [44.6%] were men with a mean [range] age of 58.9 [23-90] years), 183 (68.5%) received clinically confirmed results in their electronic health record. Among the 267 participants with P/LP BRCA1/2 variants, 219 (82.0%) had no prior clinical testing, 95 (35.6%) had BRCA1 variants, and 172 (64.4%) had BRCA2 variants. Syndromic cancer diagnoses were present in 11 (47.8%) of the 23 deceased BRCA1/2 carriers and in 56 (20.9%) of all 267 BRCA1/2 carriers. Among women, 31 (20.9%) of 148 variant carriers had a personal history of breast cancer, compared with 1554 (5.2%) of 29 880 noncarriers (odds ratio [OR], 5.95; 95% CI, 3.88-9.13; P < .001). Ovarian cancer history was present in 15 (10.1%) of 148 variant carriers and in 195 (0.6%) of 29 880 variant noncarriers (OR, 18.30; 95% CI, 10.48-31.4; P < .001). Among 89 BRCA1/2 carriers without prior testing but with comprehensive personal and family history data, 44 (49.4%) did not meet published guidelines for clinical testing. CONCLUSIONS AND RELEVANCE This study found that compared with previous clinical care, exome sequencing-based screening identified 5 times as many individuals with P/LP BRCA1/2 variants. These findings suggest that genomic screening may identify BRCA1/2-associated cancer risk that might otherwise remain undetected within health care systems and may provide opportunities to reduce morbidity and mortality in patients.
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Affiliation(s)
- Kandamurugu Manickam
- Molecular and Human Genetics Department, Nationwide Children’s Hospital, Columbus, Ohio
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | | | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Alyson E. Evans
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Loren M. Butry
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | - Victor G. Vogel
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Matthew S. Lebo
- Laboratory for Molecular Medicine, Partners HealthCare, Cambridge, Massachusetts
| | | | - Derick C. Hoskinson
- Laboratory for Molecular Medicine, Partners HealthCare, Cambridge, Massachusetts
| | | | | | | | | | - Aris Baras
- Regeneron Genetics Center, Tarrytown, New York
| | | | | | | | | | - Korey A. Kost
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - T. Nate Person
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | - Lacy E. Lowry
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Marylyn D. Ritchie
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
- Center for Translational Bioinformatics, University of Pennsylvania, Philadelphia
| | - David J. Carey
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Anne E. Justice
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | - Michael F. Murray
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
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16
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Schwartz MLB, McCormick CZ, Lazzeri AL, Lindbuchler DM, Hallquist MLG, Manickam K, Buchanan AH, Rahm AK, Giovanni MA, Frisbie L, Flansburg CN, Davis FD, Sturm AC, Nicastro C, Lebo MS, Mason-Suares H, Mahanta LM, Carey DJ, Williams JL, Williams MS, Ledbetter DH, Faucett WA, Murray MF. A Model for Genome-First Care: Returning Secondary Genomic Findings to Participants and Their Healthcare Providers in a Large Research Cohort. Am J Hum Genet 2018; 103:328-337. [PMID: 30100086 PMCID: PMC6128218 DOI: 10.1016/j.ajhg.2018.07.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [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: 03/15/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022] Open
Abstract
There is growing interest in communicating clinically relevant DNA sequence findings to research participants who join projects with a primary research goal other than the clinical return of such results. Since Geisinger's MyCode Community Health Initiative (MyCode) was launched in 2007, more than 200,000 participants have been broadly consented for discovery research. In 2013 the MyCode consent was amended to include a secondary analysis of research genomic sequences that allows for delivery of clinical results. Since May 2015, pathogenic and likely pathogenic variants from a set list of genes associated with monogenic conditions have prompted "genome-first" clinical encounters. The encounters are described as genome-first because they are identified independent of any clinical parameters. This article (1) details our process for generating clinical results from research data, delivering results to participants and providers, facilitating condition-specific clinical evaluations, and promoting cascade testing of relatives, and (2) summarizes early results and participant uptake. We report on 542 participants who had results uploaded to the electronic health record as of February 1, 2018 and 291 unique clinical providers notified with one or more participant results. Of these 542 participants, 515 (95.0%) were reached to disclose their results and 27 (5.0%) were lost to follow-up. We describe an exportable model for delivery of clinical care through secondary use of research data. In addition, subject and provider participation data from the initial phase of these efforts can inform other institutions planning similar programs.
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Affiliation(s)
| | | | | | - D'Andra M Lindbuchler
- Geisinger, Danville, PA 17822, USA; Wilkes-Barre Area Career and Technical Center, Plains Township, PA 18705, USA
| | | | - Kandamurugu Manickam
- Geisinger, Danville, PA 17822, USA; Nationwide Children's Hospital, Columbus, OH 43205, USA
| | | | | | | | | | | | | | | | | | - Matthew S Lebo
- Laboratory for Molecular Medicine, Cambridge, MA 02139, USA
| | | | | | | | | | | | | | | | - Michael F Murray
- Geisinger, Danville, PA 17822, USA; Yale School of Medicine, New Haven, CT 06510, USA.
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17
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Affiliation(s)
- Marci L B Schwartz
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania
| | - Michael F Murray
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania
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