Pharmacogenomic Testing for Major Depression: A Qualitative Study of the Perceptions of People with Lived Experience and Professional Stakeholders

Abstract

Objectives With increasing evidence for the clinical utility of pharmacogenomic (PGx) testing for depression, there is a growing need to consider issues related to the clinical implementation of this testing. The perspectives of key stakeholders (both people with lived experience [PWLE] and providers) are critical, but not frequently explored. The purpose of this study was to understand how PWLE and healthcare providers/policy experts (P/HCPs) perceive PGx testing for depression, to inform the consideration of clinical implementation within the healthcare system in British Columbia (BC), Canada. Methods We recruited two cohorts of participants to complete individual 1-h, semi-structured interviews: (a) PWLE, recruited from patient and research engagement networks and organizations and (b) P/HCPs, recruited via targeted invitation. Interviews were audiotaped, transcribed verbatim, de-identified, and analysed using interpretive description. Results Seventeen interviews were completed with PWLE (7 with experience of PGx testing for depression; 10 without); 15 interviews were completed with P/HCPs (family physicians, psychiatrists, nurses, pharmacists, genetic counsellors, medical geneticists, lab technologists, program directors, and insurers). Visual models of PWLE's and P/HCP's perceptions of and attitudes towards PGx testing were developed separately, but both were heavily influenced by participants’ prior professional and/or personal experiences with depression and/or PGx testing. Both groups expressed a need for evidence and numerous considerations for the implementation of PGx testing in BC, including the requirement for conclusive economic analyses, patient and provider education, technological and clinical support, local testing facilities, and measures to ensure equitable access to testing. Conclusions While hopeful about the potential for therapeutic benefit from PGx testing, PWLE and P/HCPs see the need for robust evidence of utility, and BC-wide infrastructure and policies to ensure equitable and effective access to PGx testing. Further research into the accessibility, effectiveness, and cost-effectiveness of various implementation strategies is needed to inform PGx testing use in BC.

Advancing CYP2D6 Pharmacogenetics through a Pharmacoequity Lens

“…There is evidence that community-based approaches are effective in engaging communities historically under-represented for enhanced participation in pharmacogenetics studies. [34][35][36][37][38] Such efforts have been successfully used to reduce the power imbalance between investigators and participants as well as improve study participation.…”

“…Community leaders would be empowered to play more prominent roles in the investigation (e.g., providing input for study design decisions, contributing as authors). There is evidence that community‐based approaches are effective in engaging communities historically under‐represented for enhanced participation in pharmacogenetics studies 34‐38 . Such efforts have been successfully used to reduce the power imbalance between investigators and participants as well as improve study participation.…”

Co-learning commentary: a patient partner perspective in mental health care research

“…Our participation in this research project on mental health has led to creativity, inclusivity, and a cooperative ethos within our team, with plenty of space for kindness and laughter along the way. We were integrated into components of the project that we chose: thematically coding a rapid review, developing questions and advising on engagement processes for focus groups [ 16 ], shaping an economic model [ 15 ]. We were offered and accepted invitations for contributing to abstracts, manuscripts, presentations, and the funder’s biannual progress reports.…”

“…Our lived experience of depression has been a foundation of the project meetings, treated with respect and Riches et al Research Involvement and Engagement (2023) 9:24 validated by the researchers. We were included in all aspects of the research, clearly seen in our involvement with co-creating the computer simulation model for our project [15], assisting in a literature review, and co-contributing to the creation of interview guides and questionnaires for potential study participants [16]. Since patient partners shaped these study methods, we directly influenced project-wide results.…”

Mental Health Prescribers’ Perceptions on the Use of Pharmacogenetic Testing in the Management of Depression in the Middle East and North Africa Region

“… 24 Additionally, it was found that PGx application in psychiatry is further challenged by the high cost of testing and the lack of cost effectiveness studies as reported by a previous research to assess concerns of HCPs regarding PGx testing in depression. 22 , 25 …”