Primary care physicians' concerns about offering a genetic test to tailor smoking cessation treatment

Levy, Douglas E.; Youatt, Emily J.; Shields, Alexandra E.

doi:10.1097/gim.0b013e31815bf953

Cited by 21 publications

(14 citation statements)

References 65 publications

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“…These findings contrast with European and U.K. health professional concerns about patient harms, pressure, and access (Rogausch et al, 2006;Fargher et al, 2007a;Hoop et al, 2010). However, similar concerns about uncertain clinical utility have been noted with respect to disease-based testing (Escher and Sappino, 2000;Mountcastle-Shah and Holtzman, 2000;Freedman et al, 2003;Levy et al, 2007;Park et al, 2007). Despite these concerns, other studies have found a high likelihood of use of new genetic tests such as PGx testing among PCPs (Park et al, 2007;Shields et al, 2008) and early adopters (Fargher et al, 2007b;Hoop et al, 2010).…”

Section: Discussionmentioning

confidence: 96%

Professional Perspectives About Pharmacogenetic Testing and Managing Ancillary Findings

Haga

Tindall

O’Daniel

2012

Genetic Testing and Molecular Biomarkers

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Aims: Pharmacogenetic (PGx) tests, intended to inform therapeutic decision making through prediction of patient likelihood to respond to or experience an adverse effect from a specific treatment, may also generate ancillary, or incidental, disease information unrelated to the purpose for which the test was ordered. To assess attitudes toward PGx testing, ancillary disease risk information, and related clinical issues, we conducted a series of focus groups among health professionals. Results: Twenty-one primary care and genetics professionals from Durham, NC, were recruited to participate in three focus groups (two of primary care professionals [PCPs] and one of geneticists). Overall, interest in PGx testing was positive, though enthusiasm was reserved among PCPs due to concerns about clinical utility, insurance coverage, delay of treatment, and ability to communicate and interpret ancillary disease risk information. Although many PCPs felt an obligation to disclose information about ancillary disease risk, geneticists did not believe that it was always necessary, noting the complexities of genetic risk results such as incomplete penetrance. Conclusion: This pilot study found that health professionals' interest in the use of PGx testing was limited by concerns about the lack of evidence of clinical utility and their ability to interpret and communicate ancillary disease risk information to patients. Additional educational resources, access to genetic specialists, and clear clinical guidelines about the use of PGx testing would greatly facilitate appropriate use of testing.

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Section: Discussionmentioning

confidence: 96%

Professional Perspectives About Pharmacogenetic Testing and Managing Ancillary Findings

Haga

Tindall

O’Daniel

2012

Genetic Testing and Molecular Biomarkers

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“…Low perceived clinical utility, as well as concerns about potential discrimination, have repeatedly been reported as primary barriers to uptake of both traditional genetic testing and newer applications [35][36][37][38][39] . Similarly, we found that uncertain clinical utility was among the top concerns of respondents for themselves and their patients.…”

Section: Discussionmentioning

confidence: 99%

Genomic Risk Profiling: Attitudes and Use in Personal and Clinical Care of Primary Care Physicians Who Offer Risk Profiling

et al. 2011

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BACKGROUND: Genomic risk profiling involves the analysis of genetic variations linked through statistical associations to a range of disease states. There is considerable controversy as to how, and even whether, to incorporate these tests into routine medical care. OBJECTIVE: To assess physician attitudes and uptake of genomic risk profiling among an 'early adopter' practice group. DESIGN: We surveyed members of MDVIP, a national group of primary care physicians (PCPs), currently offering genomic risk profiling as part of their practice. POPULATION: All physicians in the MDVIP network (N =356) RESULTS: We obtained a 44% response rate. One third of respondents had ordered a test for themselves and 42% for a patient. The odds of having ordered personal testing were 10.51-fold higher for those who felt well-informed about genomic risk testing (p < 0.0001). Of those who had not ordered a test for themselves, 60% expressed concerns for patients regarding discrimination by life and longterm/disability insurers, 61% about test cost, and 62% about clinical utility. The odds of ordering testing for their patients was 8.29-fold higher among respondents who had ordered testing for themselves (p < 0.0001). Of those who had ordered testing for patients, concerns about insurance coverage (p = 0.014) and uncertain clinical utility (p = 0.034) were associated with a lower relative frequency of intention to order testing again in the future. CONCLUSIONS: Our findings demonstrate that respondent familiarity was a key predictor of physician ordering behavior and clinical utility was a primary concern for genomic risk profiling. Educational and interpretive support may enhance uptake of genomic risk profiling.

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“…Due to the large number of CYP2A6 alleles, genotyping to characterize inherited differences in nicotine metabolism can be much more costly than testing for the NMR, which can be determined from blood or saliva for approximately US$50 per sample (Lerman et al 2015). Lastly, primary care physicians may be less inclined to offer a genetic test compared to a phenotypic biomarker; these concerns may relate in part to lack of knowledge about genetics and concerns about the sensitivity of genetic information (Levy et al 2007; Shields et al 2008). …”

Section: The Nicotine Metabolite Ratio As a Biomarker Of Nicotinementioning

confidence: 99%

Precision Medicine for Tobacco Dependence: Development and Validation of the Nicotine Metabolite Ratio

Allenby

Boylan

Lerman

et al. 2016

J Neuroimmune Pharmacol

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Quitting smoking significantly reduces the risk of tobacco-related morbidity and mortality, yet there is a high rate of relapse amongst smokers who try to quit. Phenotypic biomarkers have the potential to improve smoking cessation outcomes by identifying the best available treatment for an individual smoker. In this review, we introduce the nicotine metabolite ratio (NMR) as a reliable and stable phenotypic measure of nicotine metabolism that can guide smoking cessation treatment among smokers who wish to quit. We address how the NMR accounts for sources of variation in nicotine metabolism including genotype and other biological and environmental factors such as estrogen levels, alcohol use, body mass index, or menthol exposure. Then, we highlight clinical trials that validate the NMR as a biomarker to predict therapeutic response to different pharmacotherapies for smoking cessation. Current evidence supports the use of nicotine replacement therapy for slow metabolizers, and non-nicotine treatments such as varenicline for normal metabolizers. Finally, we discuss future research directions to elucidate mechanisms underlying NMR associations with treatment response, and facilitate the implementation of the NMR as biomarker in clinical practice to guide smoking cessation.

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Primary care physicians' concerns about offering a genetic test to tailor smoking cessation treatment

Cited by 21 publications

References 65 publications

Professional Perspectives About Pharmacogenetic Testing and Managing Ancillary Findings

Professional Perspectives About Pharmacogenetic Testing and Managing Ancillary Findings

Genomic Risk Profiling: Attitudes and Use in Personal and Clinical Care of Primary Care Physicians Who Offer Risk Profiling

Precision Medicine for Tobacco Dependence: Development and Validation of the Nicotine Metabolite Ratio

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