评估患者对基因检测的认知，以为药物基因组学的实施提供信息。
Assessment of patient perceptions of genomic testing to inform pharmacogenomic implementation.
作者信息
Lee Yee Ming, McKillip Ryan P, Borden Brittany A, Klammer Catherine E, Ratain Mark J, O'Donnell Peter H
机构信息
aCenter for Personalized Therapeutics bPritzker School of Medicine cCommittee on Clinical Pharmacology and Pharmacogenomics dDepartment of Medicine, The University of Chicago, Chicago, Illinois, USA.
出版信息
Pharmacogenet Genomics. 2017 May;27(5):179-189. doi: 10.1097/FPC.0000000000000275.
OBJECTIVE
Pharmacogenomics seeks to improve prescribing by reducing drug inefficacy/toxicity. However, views of patients during pharmacogenomic-guided care are largely unknown. We sought to understand the attitudes and perceptions of patients in an institutional implementation project and hypothesized that views would differ on the basis of experience with pharmacogenomic-guided care.
METHODS
Two focus groups were conducted - one group included patients who had previously been subjected to broad pharmacogenomic genotyping with results available to physicians (pharmacogenomic group), whereas the other had not been offered genotyping (traditional care). Five domains were explored: (i) experiences with medications/side effects, (ii) understanding of pharmacogenomics, (iii) impact of pharmacogenomics on relationships with healthcare professionals, (iv) scenarios involving pharmacogenomic-guided prescribing, and (v) responses to pharmacogenomic education materials.
RESULTS
Nine pharmacogenomic and 13 traditional care participants were included. Participants in both groups agreed that pharmacogenomics could inform prescribing and help identify problem prescriptions, but expressed concerns over insurance coverage and employment discrimination. Both groups diverged on who should be permitted to access pharmacogenomic results, with some preferring access only for providers with a longstanding relationship, whereas others argued for open access. Notably, traditional care participants showed greater skepticism about how results might be used. Case scenarios and tested educational materials elicited strong desires on the part of patients for physicians to engage participants when considering pharmacogenomic-based prescribing and to utilize shared decision-making.
CONCLUSION
Participants experiencing pharmacogenomic-guided care were more receptive toward pharmacogenomic information being used than traditional care participants. As key stakeholders in implementation, addressing patients' concerns will be important to successfully facilitate clinical dissemination.
目的
药物基因组学旨在通过降低药物无效性/毒性来改善处方用药。然而，在药物基因组学指导的护理过程中患者的观点在很大程度上尚不明确。我们试图了解机构实施项目中患者的态度和看法，并假设这些观点会因药物基因组学指导护理的经验不同而有所差异。
方法
进行了两个焦点小组讨论——一组包括之前接受过广泛药物基因组学基因分型且结果可供医生使用的患者（药物基因组学组），而另一组未接受基因分型（传统护理组）。探讨了五个领域：（i）用药/副作用经历，（ii）对药物基因组学的理解，（iii）药物基因组学对与医疗保健专业人员关系的影响，（iv）涉及药物基因组学指导处方的情景，以及（v）对药物基因组学教育材料的反应。
结果
纳入了9名药物基因组学组参与者和13名传统护理组参与者。两组参与者都认为药物基因组学可以为处方提供信息并有助于识别问题处方，但对保险覆盖范围和就业歧视表示担忧。两组在谁应被允许获取药物基因组学结果上存在分歧，一些人倾向仅允许与患者有长期关系的医疗服务提供者获取，而另一些人则主张公开获取。值得注意的是，传统护理组参与者对结果的使用方式表现出更大的怀疑态度。案例情景和经过测试的教育材料引发了患者强烈的愿望，希望医生在考虑基于药物基因组学的处方时让参与者参与进来并采用共同决策。
结论
与传统护理组参与者相比，经历过药物基因组学指导护理的参与者对使用药物基因组学信息的接受度更高。作为实施过程中的关键利益相关者，解决患者的担忧对于成功促进临床传播至关重要。
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