The benefits of using genomic science in population health management may be growing increasingly clear to healthcare providers as the data accumulates, but do patients automatically buy in to the approach, and what if they don’t? Two of the organizations profiled in the genomics feature in Healthcare Executive’s July/August issue offered their thoughts on the patient perspective.
What has been your institution’s response from patients regarding genomic testing?
Loretta Erhunmwunsee, MD, assistant professor, division of thoracic surgery, and assistant professor, division of health equities, department of population health, City of Hope, Duarte, Calif.: “Patients react incredibly positively once they are educated about the benefits of genomic testing. Many are seeking it out and come to their doctor’s visits asking about it because of their own research.”
Lisa Vitkus, FACHE, operations officer for service lines, Intermountain Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City: “Families and patients have loved the genomic testing. Historically, there has been a lot of hesitancy about genetic and genomic testing because of concern about whether the testing might lead to unintended consequences or findings. But for families and children dealing with the real-life struggles of disease or un-diagnosed disease, these concerns pale in comparison to the benefits of obtaining a diagnosis. Thanks in part to the sharing between families and patients, including sharing on social media, awareness of genomic testing is growing, and people are coming to our hospital specifically because they know genomic testing is available here.”
Even if the response has been generally positive, what has been your biggest challenge in educating patients about the benefits of genomic testing and genomics in population health, overcoming hesitancy and encouraging them to use the information to improve their health?
Loretta Erhunmwunsee: “Challenges could arise when the genomic testing does not lead directly to benefits for the patient. Cancer patients may be disappointed that their tumor mutational profile does not lend itself to benefits from certain therapies.”
Lisa Vitkus: “One of the biggest challenges has been educating our providers, many of whom were trained in a ‘pre-genomics’ era. For these clinicians, the power and utility of the testing isn’t always clear. But that is quickly changing. For instance, we have introduced pharmacogenetics as part of a new care pathway in the use of anti-depressants in mental health treatment. A test called Rx Match can analyze the drug-gene interaction for about 250 drugs to identify which drug will be most effective for a patient. This testing has been particularly beneficial for choosing the most effective selective serotonin re-uptake inhibitor to treat that specific patient’s depression. The response has been extremely positive, especially from patients, who are asking physicians to be more involved in this aspect of their care. Similar pharmacogenetic testing is now available to predict a patient’s response to opioids and anticoagulants, as well.”
How, specifically, have you addressed these challenges?
Loretta Erhunmwunsee: “I remind patients that the science is evolving and that our understanding of how to best treat cancer is improved through clinical trials and genomic testing of cancer specimens. I also remind them that we specifically need marginalized patients to undergo these tests so that we can assure that they are not left behind as precision medicine improves patient outcomes.”
Lisa Vitkus: “We have spent a lot of time educating primary care physicians and pharmacists about pharmacogenetics. The response has been positive. So far, we have completed 1,926 RxMatch tests for patients across our health system. Our genomic protocols have made significant differences in patient care and helped advance knowledge in biomedical science. During the pandemic, we’ve observed a heightened awareness of population health among patients, as well as increased interest in participating in research and clinical care informed by genomics.”
Susan Birk is a Chicago-based freelance writer specializing healthcare.
What has been your institution’s response from patients regarding genomic testing?
Loretta Erhunmwunsee, MD, assistant professor, division of thoracic surgery, and assistant professor, division of health equities, department of population health, City of Hope, Duarte, Calif.: “Patients react incredibly positively once they are educated about the benefits of genomic testing. Many are seeking it out and come to their doctor’s visits asking about it because of their own research.”
Lisa Vitkus, FACHE, operations officer for service lines, Intermountain Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City: “Families and patients have loved the genomic testing. Historically, there has been a lot of hesitancy about genetic and genomic testing because of concern about whether the testing might lead to unintended consequences or findings. But for families and children dealing with the real-life struggles of disease or un-diagnosed disease, these concerns pale in comparison to the benefits of obtaining a diagnosis. Thanks in part to the sharing between families and patients, including sharing on social media, awareness of genomic testing is growing, and people are coming to our hospital specifically because they know genomic testing is available here.”
Even if the response has been generally positive, what has been your biggest challenge in educating patients about the benefits of genomic testing and genomics in population health, overcoming hesitancy and encouraging them to use the information to improve their health?
Loretta Erhunmwunsee: “Challenges could arise when the genomic testing does not lead directly to benefits for the patient. Cancer patients may be disappointed that their tumor mutational profile does not lend itself to benefits from certain therapies.”
Lisa Vitkus: “One of the biggest challenges has been educating our providers, many of whom were trained in a ‘pre-genomics’ era. For these clinicians, the power and utility of the testing isn’t always clear. But that is quickly changing. For instance, we have introduced pharmacogenetics as part of a new care pathway in the use of anti-depressants in mental health treatment. A test called Rx Match can analyze the drug-gene interaction for about 250 drugs to identify which drug will be most effective for a patient. This testing has been particularly beneficial for choosing the most effective selective serotonin re-uptake inhibitor to treat that specific patient’s depression. The response has been extremely positive, especially from patients, who are asking physicians to be more involved in this aspect of their care. Similar pharmacogenetic testing is now available to predict a patient’s response to opioids and anticoagulants, as well.”
How, specifically, have you addressed these challenges?
Loretta Erhunmwunsee: “I remind patients that the science is evolving and that our understanding of how to best treat cancer is improved through clinical trials and genomic testing of cancer specimens. I also remind them that we specifically need marginalized patients to undergo these tests so that we can assure that they are not left behind as precision medicine improves patient outcomes.”
Lisa Vitkus: “We have spent a lot of time educating primary care physicians and pharmacists about pharmacogenetics. The response has been positive. So far, we have completed 1,926 RxMatch tests for patients across our health system. Our genomic protocols have made significant differences in patient care and helped advance knowledge in biomedical science. During the pandemic, we’ve observed a heightened awareness of population health among patients, as well as increased interest in participating in research and clinical care informed by genomics.”
Susan Birk is a Chicago-based freelance writer specializing healthcare.
The Power of Genomics: A Population Health Strategy
Elegant in its simplicity, the premise behind the use of genomics in population health management packs a powerful punch: The more information you have about a patient population at the molecular or genetic level, the better prepared you are to predict, prevent, diagnose and treat disease.