Attitudes of clinicians following large-scale pharmacogenomics implementation

Abstract

Clinician attitudes towards multiplexed genomic testing may be vital to the success of translational programs. We surveyed clinicians at an academic medical center about their views on a large pharmacogenomics implementation, the PREDICT (Pharmacogenomic Resource for Enhanced Decisions in Care & Treatment) program. Participants were asked about test ordering, major factors influencing use of results, expectations of efficacy, and responsibility for applying results to patient care. Virtually all respondents (99%) agreed that pharmacogenomics variants influence patients’ response to drug therapy. The majority (92%) favored immediate, active notification when a clinically significant drug-genome interaction was present. However, clinicians were divided on which providers were responsible for acting on a result when a prescription change was indicated and whether patients should be directly notified of a significant result. We concluded genotype results were valued for tailoring prescriptions, but clinicians do not agree on how to appropriately assign clinical responsibility for actionable results from a multiplexed panel.

Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC)

“…While surveys of general populations of physicians have indicated limited knowledge and experience with pharmacogenetics 33,34 and genome-guided prescribing through CDS, 35 a more recent study conducted in a setting with a pre-emptive pharmacogenetics testing program revealed that their physicians were supportive of this type of program and that pharmacogenetic-guided therapy, particularly for cardiovascular medications, has clinical utility. 36 Although our consensus terms were generated by experts, nearly 50% of our participants identified as clinicians, and the use of terms by non-expert clinicians and patients was considered throughout the process and most of our experts practice in clinical settings with non-experts.…”

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

“…According to another study, physicians found utility in providing PGx testing to improve patient outcomes by individualizing treatment to guide medication decisions and to decrease time and cost for maximizing the benefits of needed medications [35]. Utilizing PGx testing in order to avoid side effects from medication and improve medication effectiveness have been proposed as benefits in other studies as well [5,17,20,[35][36][37].…”

“…In order for PGx testing methods to be most effective, stakeholders, such as physicians, will need to better understand the process themselves in order to provide recommendations of such testing to their patients [20,35]. Other studies conducted with medical, graduate and pharmacy students who underwent personal genomic testing, which included PGx-related data, also revealed that this testing provided insight into the patient experience and increased understanding of genetic concepts [37][38][39][40].…”

“…Physicians described the need for more understandable result reports for both themselves and their patients and less delay in receiving results. Previous studies have reported physicians' views on their lack of preparedness in interpreting and providing recommendations based on PGx results to their patients [9,20]. Modifications have been made in response to these concerns; result reports were revised to be more clear, concise and patient-centered.…”

“…Clinical decision support methods have been employed in some primary care practices; however, physicians may not always know how to utilize and incorporate pharmacogenomics decision alerts in their medical decision-making [19]. In one study, only 30% of physicians receiving the alert were inclined to make a change in prescription based on the specific alert, and in another study physicians reported disagreement about who should be responsible for receiving results and providing patient follow-up [10,20].…”