Personalized Medicine, Availability, and Group Disparity: An Inquiry into How Physicians Perceive and Rate the Elements and Barriers of Personalized Medicine

Petersen, Katelin E; Prows, Cynthia A.; Martin, Lisa J.; Maglo, Koffi N.

doi:10.1159/000362359

Cited by 23 publications

(21 citation statements)

References 67 publications

(115 reference statements)

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“…What is the current level of competence of PH professionals in genomics? Several surveys have been performed to evaluate the knowledge, attitudes and professional behavior of physicians towards the integration of human genomic discoveries into clinical practice [16][17][18][19][20][21], but only one study targeted PH practitioners [22] and it focused solely on predictive genetic tests for chronic diseases. We conducted a survey on a sample of European PH professionals belonging to the network of the European Public Health Association (EUPHA), which represents European PH professionals, to assess their attitudes towards their role in the implementation of PHG, and their knowledge and attitudes regarding genetic testing and genetic services.…”

Section: Introductionmentioning

confidence: 99%

Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey

et al. 2020

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Background The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services.

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Section: Introductionmentioning

confidence: 99%

Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey

et al. 2020

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“…Therapies specific for genetic mutations that are more common in patients of low socioeconomic status due to certain environmental exposures may therefore never be developed, which would propagate these patients' exclusion from precision medicine. Therefore, patients from lower socioeconomic backgrounds require increased protection to ensure their access to and representation within these trials [24,25].…”

Section: Justicementioning

confidence: 99%

Ethical Considerations of Neuro-oncology Trial Design in the Era of Precision Medicine

Gupta¹,

Smith²,

Broekman³

2019

Ethics of Innovation in Neurosurgery

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priority as part of a major US public health initiative. This new paradigm builds on the idea that cancers that harbor certain oncogenic mutations may be particularly susceptible to therapies that specifically target the aberrant proteins created by these mutations. As next-generation sequencing techniques have begun to uncover some of the mutations that drive the formation and growth of various cancers, applying this new therapeutic framework has the potential to revolutionize cancer management.The last decade has seen many innovations in the usage of targeted therapies. Vemurafenib, a targeted kinase inhibitor of the B-Raf protein variant produced by a V600E point mutation in BRAF, has been shown to reduce tumor burden and to improve overall survival in melanoma patients [1]. Similarly, gefitinib and erlotinib prolong survival for patients with non-small cell lung cancer by inhibiting overactive epidermal growth factor receptor caused by activating mutations in EGFR [2,3]. Precision medicine potentially has tremendous applicability in neuro-oncology and will allow patients to receive individualized therapies that target the genetic mutations underlying their diseases [4]. Indeed, early phase n-of-1 and small cohort investigational trials studies have already begun to demonstrate the potential of precision medicine in neuro-oncology [5][6][7].The successes and potential of precision medicine have also introduced new challenges not only related to clinical care, but also to ethics of clinical research. While there remains little doubt of the potential improvements in efficacy with precision medicine, characterizing and understanding these challenges can uphold the standards of patient autonomy, respect, and protection. In this discussion, we review pertinent ethical challenges to early phase clinical trials in precision medicine. AbstractThe field of oncology is currently undergoing a paradigm shift. Advances in the understanding of tumor biology and in tumor sequencing technology have contributed to the shift towards precision medicine, the therapeutic framework of targeting the individual oncogenic changes each tumor harbors. The success of precision medicine therapies, such as targeted kinase inhibitors and immunotherapies, in other cancers have motivated studies in brain cancers. The high specificity and cost of these therapies also encourage a shift in clinical trial design away from randomized control trials towards smaller, more exclusive early phase clinical trials. While these new trials advance the clinical application of increasingly precise and individualized therapies, their design brings ethical challenges. We review the pertinent ethical considerations for clinical trials of precision medicine in neuro-oncology and discuss methods to protect patients in this new era of trial design.

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“…They may use genomics tools to evaluate the health impact of PH interventions on different subsets of the population ( 1 ). Despite the fact that several surveys have been performed to evaluate knowledge, attitudes, and professional behaviors of physicians toward the integration of human genomic discoveries in clinical practice ( 11 – 16 ), only one study has been conducted for PH professionals. The study focused on knowledge, attitudes, and training needs of the members of the Italian Society of Hygiene, Preventive Medicine, and Public Health (S.It.I.)…”

Section: Materials and Equipmentmentioning

confidence: 99%

Identification of Delivery Models for the Provision of Predictive Genetic Testing in Europe: Protocol for a Multicentre Qualitative Study and a Systematic Review of the Literature

Unim

Lagerberg

Pitini

et al. 2017

Front. Public Health

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IntroductionThe appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community’s readiness to incorporate public health genomics into their practice.Materials and equipmentThe project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members’ knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000–2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries’ government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops.Expected impact of the study on public healthThe transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services.

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Personalized Medicine, Availability, and Group Disparity: An Inquiry into How Physicians Perceive and Rate the Elements and Barriers of Personalized Medicine

Cited by 23 publications

References 67 publications

Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey

Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey

Ethical Considerations of Neuro-oncology Trial Design in the Era of Precision Medicine

Identification of Delivery Models for the Provision of Predictive Genetic Testing in Europe: Protocol for a Multicentre Qualitative Study and a Systematic Review of the Literature

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