From precision medicine to precision care: Choosing and using precision medicine in the context of multimorbidity

Abstract

Rapid advances in precision medicine promise dramatic reductions in morbidity and mortality for a growing array of conditions. To realize the benefits of precision medicine and minimize harms, it is necessary to address real-world challenges encountered in translating this research into practice. Foremost among these is how to choose and use precision medicine modalities in real-world practice by addressing issues related to caring for the sizable proportion of people living with multimorbidity.Precision medicine needs to be delivered in the broader context of precision care to account for factors that influence outcomes for specific therapeutics. Precision care integrates a person-centered approach with precision medicine to inform decision making and care planning by taking multimorbidity, functional status, values, goals, preferences, social and societal context into account.Designing dissemination and implementation of precision medicine around precision care would improve person-centered quality and outcomes of care, target interventions to those most likely to benefit thereby improving access to new therapeutics, minimize the risk of withdrawal from the market from unanticipated harms of therapy, and advance health equity by tailoring interventions and care to meet the needs of diverse individuals and populations.Precision medicine delivered in the context of precision care would foster respectful care aligned with preferences, values, and goals, engendering trust, and providing needed information to make informed decisions. Accelerating adoption requires attention to the full continuum of translational research: developing new approaches, demonstrating their usefulness, disseminating and implementing findings, while engaging patients throughout the process. This

Promoting Equity In Clinical Decision Making: Dismantling Race-Based Medicine

“…However, because precision medicine often is narrowly focused on individuals’ genetic characteristicsand does not address other critical factors thatinfluence health outcomes, it may help perpetuateracial and ethnic health inequities. 23 In contrast to precision medicine, precision care is an approach that considers patients’ multiple morbidities functional status, values, goals, and preferences, as well as their social and societal contexts, in the process of developing treatment recommendations. 23 By accounting for social and environmental factors such as income and educational attainment, precision care can help reduce disparities and advance equity.We recommend broadening the focus of precision medicine to align with the precision care approach.…”