Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
Genet Med. 2020 Jul;22(7):1149-1155. doi: 10.1038/s41436-020-0785-6. Epub 2020 Apr 21.
Genetic and genomic health information increasingly informs routine clinical care and treatment. This systematic review aimed to identify the barriers and facilitators to integrating genetics and genomics into nurses' and physicians' usual practice (mainstreaming).
A search of MEDLINE, EMBASE, CINAHL, and PsycINFO generated 7873 articles, of which 48 were included. Using narrative synthesis, barriers and facilitators were mapped to the Theoretical Domains Framework (TDF).
Barriers were limitations to genetics knowledge and skill, low confidence initiating genetics discussions, lack of resources and guidelines, and concerns about discrimination and psychological harm. Facilitators were positive attitudes toward genetics, willingness to participate in discussions upon patient initiation, and intention to engage in genetics education.
Nurses and physicians are largely underprepared to integrate genetic and genomic health information into routine clinical care. Ethical, legal, and psychological concerns surrounding genetic information can lead to avoidance of genetics discussions. The knowledge-practice gap could limit patients' and families' access to vital genetic information. Building the capacity of the current and next generation of nurses and physicians to integrate genetics and genomics into usual clinical practice is essential if opportunities afforded by precision medicine are to be fully realized.
遗传和基因组健康信息越来越多地为常规临床护理和治疗提供信息。本系统评价旨在确定将遗传学和基因组学纳入护士和医生常规实践（主流化）的障碍和促进因素。
对 MEDLINE、EMBASE、CINAHL 和 PsycINFO 进行搜索，共生成了 7873 篇文章，其中包括 48 篇文章。使用叙述性综合方法，将障碍和促进因素映射到理论领域框架（TDF）。
障碍包括遗传知识和技能的局限性、对发起遗传讨论的信心低、缺乏资源和指南，以及对歧视和心理伤害的担忧。促进因素包括对遗传学的积极态度、愿意在患者发起讨论时参与讨论，以及参与遗传学教育的意愿。
护士和医生在将遗传和基因组健康信息整合到常规临床护理中基本上准备不足。遗传信息带来的伦理、法律和心理问题可能导致回避遗传讨论。知识-实践差距可能限制患者和家属获得重要遗传信息的机会。如果要充分实现精准医学带来的机会，就必须提高当前和下一代护士和医生将遗传学和基因组学整合到常规临床实践中的能力。
