Stakeholder Views on Pharmacogenomic Testing

Abstract

Pharmacogenomics has an important role in the evolution of personalized medicine, and its widespread uptake may ultimately depend on the interests and perspectives of key players in health care. Our aim was to summarize studies on stakeholder perspectives and attitudes toward pharmacogenomic testing. Thus, we conducted a review of original research studies that reported stakeholder views on pharmacogenomic testing using a structured approach in PubMed, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and EMBASE. A standardized data abstraction form was developed that included stakeholder group of interest-patients, general public, providers, and payers. Stakeholder views regarding barriers to pharmacogenetic implementation were organized into the following themes: ancillary information-related, clinical, economic, educational, ethical or legal, medical mistrust, and practicality. Of 34 studies that met our inclusion criteria, 37 perspectives were reported (15 on providers, 9 on the general public, 9 on patients, and 4 on payers). The most common topics that arose in studies of providers related to clinical usefulness of genetic data (n=11) and educational needs (n=11). Among the general public, the most common concerns were medical mistrust (n=5), insufficient education (n=5), and practicality (n=5). The most prevalent issues from the patient perspective were ethical or legal (n=6) and economic (n=5) issues. Among payers, leading issues were practicality (n=4) and clinical usefulness (n=3). There was overlap in the topics and concerns across stakeholder perspectives, including lack of knowledge about pharmacogenomic testing. Views on issues related to privacy, cost, and test result dissemination varied by stakeholder perspective. Limited research had been conducted in underrepresented groups. Efforts to address the issues raised by stakeholders may facilitate the implementation of pharmacogenomic testing into clinical practice.

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

“…According to another study, physicians found utility in providing PGx testing to improve patient outcomes by individualizing treatment to guide medication decisions and to decrease time and cost for maximizing the benefits of needed medications [35]. Utilizing PGx testing in order to avoid side effects from medication and improve medication effectiveness have been proposed as benefits in other studies as well [5,17,20,[35][36][37].…”

Integrating Pharmacogenomics into Clinical Practice: Promise vs Reality

“…Several studies have demonstrated that clinicians feel unprepared to deal with pharmacogenomics information for their patients, and are unsure about the impact that such information will have on their clinical practices. (7–11) Thus, one of the largest barriers has been the education of providers about pharmacogenomics, both generally, and at the time of drug prescribing using clinical decision support (CDS) tools.…”

Patient Experiences with Pharmacogenetic Testing in a Primary Care Setting

“…Many studies suggest high patient interest in PGx testing [8][9][10][11][12], particularly to improve drug outcomes and predict the risk of serious adverse events, with lower interest in testing for mild adverse events [9]. In addition to the perceived benefits of PGx testing, several concerns have been raised including cost of the test and insurance coverage, the predictive value of the test, testing turnaround time, privacy, affordability of recommended drug based on the test result and patient sovereignty [7,[13][14][15][16][17]. The limitations of PGx testing to definitively determine which side-effects patients may experience has also been perceived as a weakness of testing [9,10].…”