EMRdocumentation of physician–patient communication following genomic counseling for actionable complex disease and pharmacogenomic results

Abstract

Genomic risk information for potentially actionable complex diseases and pharmacogenomics communicated through genomic counseling may motivate physicians and patients to take preventive actions. The Ohio State University-Coriell Personalized Medicine Collaborative is a randomized trial to measure the effects of in-person genomic counseling on chronic disease patients provided with multiplex results. Nine personalized genomic risk reports were provided to patients through a web portal, and to physicians via electronic medical record (EMR). Active arm participants (98, 39% female) received genomic counseling within one month of report viewing; control arm subjects (101, 54% female) could access counseling 3-months post-report viewing. We examined whether genomic counseling affected documentation of physician-patient communication by reviewing the first clinical note following the patient’s genomic counseling visit or report upload to the EMR. Multivariable logistic regression modeling estimated the independent effect of genomic counseling on physician-patient communication, as Intention to Treat (ITT) and Per Protocol (PP), adjusted for physician educational intervention. Counselees in the active arm had more physician-patient communications than control subjects (ITT, OR: 3.76 (95% CI: 1.38 – 10.22, P<0.0094); PP, OR: 5.53 (95% CI: 2.20 – 13.90, P=0.0017). In conclusion, genomic counseling appreciably affected physician-patient communication following receipt of potentially actionable genomic risk information.

Patient-provider communications about pharmacogenomic results increase patient recall of medication changes

“…As pharmacogenomic results become increasingly available at the pointof-care, it is important to assess patient-provider communications and implications of results delivery, as these considerations will affect widespread adoption [12][13][14] . A limited amount of research has suggested that pharmacogenomic results may positively influence doctorpatient communications 15,16 . Feelings of shared decision-making between patient and provider in the context of pharmacogenomic results may also positively impact prescribing communications 15 .…”

Outcomes of a Randomized Controlled Trial of Genomic Counseling for Patients Receiving Personalized and Actionable Complex Disease Reports

“…The CPMC web portal also offers text and multimedia format educational materials and tools that enable study participants to learn more about basic genetics concepts, complex disease genetics, pharmacogenetics, family history risk, relative risk and health condition specific summaries detailing disease etiology, risk factors, treatment and available preventative or risk reducing actions. Results from primary outcomes of various trials related to the CPMC have been previously reported (Gordon et al, 2012; Schmidlen et al, 2016; Schmidlen et al, 2014; Sweet et al, 2016). …”

Counselees’ Perspectives of Genomic Counseling Following Online Receipt of Multiple Actionable Complex Disease and Pharmacogenomic Results: a Qualitative Research Study

“…Results from primary outcomes of various trials related to the CPMC have been previously reported (Gordon et al, 2012; Schmidlen T, 2016; Schmidlen et al, 2014; Sweet K, 2016). For this qualitative interview study, participants were either from the Ohio State University chronic disease cohort (OSU-CPMC) comprised of individuals diagnosed with either hypertension or congestive heart failure (n=199) or the CPMC cohort.…”