School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Semin Oncol. 2019 Jun;46(3):291-303. doi: 10.1053/j.seminoncol.2019.05.001. Epub 2019 Jun 10.
Use of precision medicine in oncology is burgeoning and can provide patients with new treatment options. However, it is not clear how precision medicine is impacting healthcare professionals (HCPs), particularly with regards to their concerns about this new approach. We therefore synthesized the existing literature on HCPs' attitudes toward cancer precision medicine. We searched four databases for relevant articles. Two reviewers screened eligible articles and extracted data. We assessed the quality of each article using the QualSyst tool. We found 22 articles, representing 4,321 HCPs (63.7% cancer specialists). HCPs held largely positive attitudes toward cancer precision medicine, including their capacity to facilitate treatment decisions and provide prognostic information. However, they also had concerns regarding costs, insurance coverage, limited HCP knowledge about precision medicine, potential misuse, difficulties accessing the tests, and delays in receiving test results. Most HCPs felt that test-related decisions should be shared between families and HCPs. HCPs intended to disclose actionable results but were less inclined to disclose negative/secondary findings. HCPs had a strong preference for genetic counselor involvement when disclosing germline findings. Most HCPs intended to use somatic and germline tests in their future practice but the extent to which pharmacogenomic tests will be used is uncertain. HCPs indicated that additional evidence supporting test utility and increased availability of treatment guidelines could facilitate the use of testing. HCPs held generally positive attitudes toward cancer precision medicine, however there were some key concerns. Addressing concerns early, devising educational support for HCPs and developing guidelines may facilitate the successful implementation of precision medicine trials in the future.
精准医学在肿瘤学中的应用正在兴起，可以为患者提供新的治疗选择。然而，目前尚不清楚精准医学对医疗保健专业人员（HCP）的影响如何，特别是在他们对这种新方法的担忧方面。因此，我们综合了现有的关于 HCP 对癌症精准医学态度的文献。我们在四个数据库中搜索了相关文章。两名审查员筛选了合格的文章并提取了数据。我们使用 QualSyst 工具评估了每篇文章的质量。我们发现了 22 篇文章，代表了 4321 名 HCP（63.7%是癌症专家）。HCP 对癌症精准医学持基本积极的态度，包括其促进治疗决策和提供预后信息的能力。然而，他们也对成本、保险覆盖范围、HCP 对精准医学的知识有限、潜在滥用、难以获得测试、以及测试结果延迟等方面表示担忧。大多数 HCP 认为与测试相关的决策应由家庭和 HCP 共同做出。HCP 打算披露可采取行动的结果，但不太愿意披露阴性/次要发现。HCP 强烈希望在披露种系发现时涉及遗传咨询师。大多数 HCP 打算在未来的实践中使用体细胞和种系测试，但尚不确定是否会使用遗传药理学测试。HCP 表示，额外的证据支持测试的实用性和增加治疗指南的可获得性将有助于测试的使用。HCP 对癌症精准医学的态度总体上是积极的，但也存在一些关键问题。尽早解决这些问题，为 HCP 提供教育支持并制定指南，可能有助于未来精准医学试验的成功实施。
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