Limoges Jacqueline, Chiu Patrick, Dordunoo Dzifa, Puddester Rebecca, Pike April, Wonsiak Tessa, Zakher Bernadette, Carlsson Lindsay, Mussell Jessica K
Athabasca University, Edmonton, AB, Canada.
Ontario Cancer Research Ethics Board, Toronto, ON, Canada.
JBI Evid Synth. 2024 Nov 1;22(11):2267-2312. doi: 10.11124/JBIES-24-00009.
The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda.
The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required.
Published (qualitative, quantitative, mixed methods studies; systematic and literature reviews; and text and opinion papers) and unpublished (gray) literature that focused on genomics-informed nursing strategies to address health disparities over the past 10 years were included. No limitations were placed on language.
The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis, and the summarized results are presented using descriptive statistics and evidence tables.
In total, we screened 818 records and 31 were included in the review. The most common years of publication were 2019 (n=5, 16%), 2020 (n=5, 16%), and 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%), and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 39%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services among ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%), and individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%).
Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science that measures health outcomes is needed to identify best practices.
A French-language version of the abstract of this review is available: http://links.lww.com/SRX/A65 .
本综述的目的是梳理全球范围内现有的证据，以了解护士可用于促进基于基因组学的医疗保健、解决健康差距问题的策略，从而为研究和行动议程的制定提供信息。
将基因组学整合到医疗保健中，正通过更好的预防、诊断和治疗改善患者预后；然而，学者们已注意到健康差距不断扩大的问题。护士在整个卫生系统中工作，能够从临床、研究、教育、政策和领导等角度解决健康差距问题。为此，需要全面了解现有的基于基因组学的策略。
纳入过去10年发表的（定性、定量、混合方法研究；系统评价和文献综述；以及文本和观点论文）和未发表的（灰色）文献，这些文献聚焦于基于基因组学的护理策略以解决健康差距问题。语言不限。
本综述按照JBI循证综述方法进行。于2023年5月25日在5个数据库进行检索：MEDLINE（Ovid）、Embase、Cochrane图书馆（Ovid）、APA PsycINFO（EBSCOhost）和CINAHL（EBSCOhost）。通过网站检索灰色文献，包括国际护士遗传学协会和全球基因组学护理联盟的网站。摘要、标题和全文由2名或更多独立评审员进行筛选。使用数据提取工具提取数据。编码后的数据由2名或更多独立评审员采用常规内容分析法进行分析，总结结果采用描述性统计和证据表呈现。
我们总共筛选了818条记录，31条被纳入本综述。最常见的发表年份是2019年（n = 5，16%）、2020年（n = 5，16%）和2021年（n = 5，16%）。大多数论文来自美国（n = 25，81%），其次是荷兰（n = 3，10%）、英国（n = 1，3%）、坦桑尼亚（n = 1，3%），以及从全球视角撰写的论文（n = 1，3%）。近一半的论文讨论了癌症相关病症（n = 14，45%），其他大多数论文未明确提及某种疾病或病症（n = 12，39%）。在人群方面，护士临床医生被提及的频率最高（n = 16，52%），其次是护士研究人员、学者或科学家（n = 8，26%）。患者群体各不相同，非裔美国患者或社区（n = 7，23%）以及种族或族裔少数群体（n = 6，19%）被讨论得最为频繁。大多数公平问题集中在不同种族和族裔群体之间获得遗传和基因组健康服务的不平等（n = 14，45%）、教育程度或健康素养较低的个体（n = 6，19%）、社会经济地位较低的个体（n = 3，10%）、移民（n = 3，10%）、缺乏保险覆盖的个体（n = 2，6%）、生活在农村或偏远地区的个体（n = 1，3%）以及老年个体（n = 1，3%）。导致健康差距问题的根本原因在患者、提供者和系统层面各不相同。策略分为两类：一类是培养护理人员的策略，另一类是护士可在实践中实施的策略。我们进一步按实践领域对策略进行分类，包括临床实践、教育、研究、政策倡导和领导。提及培养护理人员策略的论文大多与教育领域相关（n = 16，52%），而提及护士可实施策略的论文大多与临床实践相关（n = 19，61%）。
各个实践领域的护士均可借鉴已确定的策略来解决医疗保健中与基因组学相关的健康差距问题。我们发现显著缺乏探索对健康和公平结果影响的干预和评估研究。需要开展更多基于实施科学且测量健康结果的研究，以确定最佳实践。
本综述摘要的法语版本可获取：http://links.lww.com/SRX/A65 。
