Pharmacogenomic education among genetic counseling training programs in North America

Abstract

The increasing number of genetic counselors participating directly in clinical pharmacogenomic post-test counseling prompted our evaluation of pharmacogenomic education across genetic counseling training programs in North America. Thirtyone program leadership participants from both the United States (U.S.) and Canada responded to a survey assessing pharmacogenomics education and the role of genetic counselors. Eighty-five percent of respondents agreed pharmacogenomics is currently within the scope of genetic counseling practice, and 96.3% indicated their training programs currently provide education on pharmacogenomics, with the majority reporting < 7 hr of education. Lectures on pharmacogenomics were the most common method for didactics; however, some programs also included practical modalities (e.g., case studies, clinical rotations) and online resources. Barriers to expanding pharmacogenomic education included the constrained timeline of training, and lack of resources and local expertise. Moreover, participants suggested that genetic counselors ideally should be able to order pharmacogenomic tests and counsel patients on pharmacogenomics, including result interpretation, as they believe pharmacogenomics does fall within the scope of practice of genetic counseling. Our novel results also confirm that training program leadership support a pharmacogenomic service delivery model that includes a combined effort between genetic counselors and pharmacists to utilize their synergistic expertise. However, this model likely still necessitates expanding pharmacogenomic didactics in genetic counseling training programs through more practical training and/or by leveraging online pharmacogenomic courses dedicated to supporting clinical implementation.

Knowledge and attitudes on implementing cardiovascular pharmacogenomic testing

“…Cardiology providers in this study reported high levels of familiarity with pharmacogenomics, despite only half of respondents reporting that they felt their genetics education prepared them well to order pharmacogenomic testing, which was generally higher than previously reported among PCPs and other specialists 9,10 . However, this level of familiarity with pharmacogenomics has increased in recent years, 10 which could be due to the fact that 50% of respondents had 5 or fewer years of experience and training programs are integrating pharmacogenomics education into their curriculum more frequently 15,16 . This contrasts with previous studies, which reported that only 26% of PCPs had confidence in using pharmacogenomic information into prescribing decisions 6 …”

“…The survey was developed by a multidisciplinary team and included multiple choice questions that assessed demographics; objective knowledge questions on clopidogrel (Plavix) and CYP2C19 ; provider experience ordering genetic and pharmacogenomic testing; familiarity and comfort with panel‐based pharmacogenomic testing and return of results; provider utilized pharmacogenomic resources (e.g., the Pharmacogenomics Knowledge Base [PharmGKB] and the Clinical Pharmacogenetics Implementation Consortium [CPIC]); and perceived barriers to implementing clinical pharmacogenomic testing (Supplementary Material S1). Provider knowledge and attitude questions on genetics and pharmacogenomics were adapted from previously reported surveys 5,9,10,15 . Likert scale responses were used to assess reported knowledge and familiarity with pharmacogenomic testing and comfort with interpreting and returning pharmacogenomic test results.…”

Assessing the impact of pre‐test education on patient knowledge, perceptions, and expectations of pharmacogenomic testing to guide antidepressant use

“…While genetic counselors are required to have knowledge of PGx (ACGC, 2019), the current PGx testing delivery model generally does not include pre‐test genetic counseling. Studies have reported genetic counselors feel that they should have a role in PGx testing; however, patients who undergo PGx testing should not be seen initially by a genetic counselor, due to limited resources (Callard et al, 2012), and expanded training and collaboration with pharmacists is needed to best serve these patients (Loudon et al, 2021). As testing demand grows, genetic counselors may best utilize their unique training by developing balanced resources and counseling strategies for patients having PGx testing.…”

“…Finally, we did not assess some factors that affect treatment effectiveness, such as access to healthcare services and medication adherence (Sirey et al, 2017;Winner et al, 2015). et al, 2012), and expanded training and collaboration with pharmacists is needed to best serve these patients (Loudon et al, 2021).…”

Maturing pharmacogenomic factors deliver improvements and cost efficiencies

“…These soon became obsolete without continued review and refinement. This, in turn, attracted US regulatory scrutiny and demonstrated the complex requirements around the education of physicians (Stanek et al, 2012 ; Rohrer Vitek et al, 2017 , 2021 ; Karas Kuzelicki et al, 2019 ), pharmacists (McCullough et al, 2011 ; Benzeroual et al, 2012 ; Nickola et al, 2012 ), nurses (Calzone et al, 2010 ), and genetic counselors (Haga et al, 2012 ; Loudon et al, 2021 ) that would ultimately lead to successful, scaled implementation. In the end, meaningful training and education for a variety of healthcare providers were established as critical to the health and economic benefits of emerging delivery models (Green and Guyer, 2011 ).…”