Clinical Genome Sequencing: Psychological Considerations

Description

Clinical Genome Sequencing: Psychological Aspects thoroughly details key psychological factors to consider while implementing genome sequencing in clinical practice, taking into account the subtleties of genetic risk assessment, patient consent and best practices for sharing genomic findings. Chapter contributions from leading international researchers and practitioners cover topics ranging from the current state of genomic testing, to patient consent, patient responses to sequencing data, common uncertainties, direct-to-consumer genomics, the role of genome sequencing in precision medicine, genetic counseling and genome sequencing, genome sequencing in pediatrics, genome sequencing in prenatal testing, and ethical issues in genome sequencing. Applied clinical case studies support concept illustration, making this an invaluable, practical reference for this important and multifaceted topic area within genomic medicine. Cover Clinical Genome Sequencing: Psychological Considerations Copyright Dedication List of Contributors 1 Genetic Testing Expanded Introduction Genomics and Single-Gene Testing The Era of Single Testing Consent to Genome Sequencing Direct-to-Consumer Testing Genomics and Personalized Medicine Genetic Counseling for Single-Gene Testing: A Paradigm for Genomic Testing? Genome Sequencing in Pediatrics Genome Sequencing and Reproductive Issues Psychological Studies in Genomics Concluding Remarks References 2 Genome Sequencing and Individual Responses to Results Use of Sequencing and How It Extends Beyond Genetic Testing Clinical Utility of Results From Sequencing Diagnosis of rare diseases and disease susceptibility Tumor identification and targeted treatment Carrier testing and screening Secondary findings Pharmacogenetic testing Psychological responses to results Reporting to relatives and cascade testing Personal Utility The future use of genome sequencing for health References Further Reading 3 Consenting Patients to Genome Sequencing Informed Consent: An Introduction Challenges of Informed Consent in Clinical Genomics What Should Informed Consent for Genomic Sequencing Ideally Look Like? Insights From Normative Documents Legislation addressing informed consent International guidance European Union regulations National legislations in European countries Professional guidelines and recommendations Need to establish a responsible consent process Overlapping areas: genetic counseling and informed consent Need for explicit informed consent for genomic sequencing and research Responsibility of different professionals in the process of informed consent: much seems to rest on the genetic clinician y... What needs to be included in the informed consent process? Empirical Studies on the Process of Informed Consent for Genomic Sequencing Informed consent documents: what can we learn about practice? Variety in elements addressed in informed consent forms Secondary and unsolicited findings in informed consent forms Readability of informed consent forms Informed consent for WES/WGS offered directly-to-consumers Stakeholders’ views and experiences of the informed consent process Healthcare professional views and experience Patients’ perspective Specific Contexts Necessitating Additional Reflection and Study Regarding Informed Consent The case of minors Genomic sequencing within the context of gene editing; Russian doll model of complications? Conclusion Acknowledgments References Further Reading 4 Judgment and Decision Making in Genome Sequencing Introduction Lessons From Research on Judgment and Decision-Making Cognitive biases Use of heuristics Trouble with numbers Sensitivity to context Recommended approaches Emotional influences Motivational factors Conserving cognitive resources Maintaining positive self-views and affirming one’s values Perceiving control over personally relevant outcomes Regarding oneself (and being regarded by others) as a rational actor Engaging in normative behavior Avoiding loss, uncertainty, and ambiguity Summary Conclusion References 5 Uncertainties in Genome Sequencing History of Uncertainty in Genetics Dimensions for Uncertainties in Genome Sequencing Personal Uncertainties in Genome Sequencing The Case of Variants of Uncertain Significance The Potential Health Threat of Uncertainties Individual Differences in Tolerance of Uncertainties Interpretation of Uncertain Genomic Information Healthcare Consequences of Uncertainties Establishing Expectations for Uncertainties Concluding Remarks References Further Reading 6 Direct-to-Consumer Genetic Testing The Online Offer of Tests Critical Appraisal of Scientific Studies on DTC Genetic Testing Polygenic Risk Scores How Accurate Are Polygenic Risk Scores? Intentions, Understanding, and Psychological Impact Intentions Understanding Psychological wellbeing Utility of Testing What Are the Concerns References 7 Assessing the Psychological Impact of Next-Generation Sequencing Information in the Clinic: An Attempt to Map Terra Incog... Introduction Background Definition of terms Indications for Next-Generation Sequencing Diagnostic testing Pharmacogenomic testing Somatic testing Population screening Incidental, secondary, or additional findings Psychological Impact of Different Types of Next-Generation sequencing Diagnostic testing Pharmacogenomic Testing Somatic Testing Population Screening Conclusion References Further Reading 8 Genetic Counseling and Genomic Sequencing Introduction What Do Patients Expect From Genomic Sequencing? Providing Genomic Counseling Balancing supportive and informational needs Personalizing personalized medicine Special considerations Returning Results From Genomic Sequencing How do families respond to results from genomic sequencing? How should results be discussed with patients and families? Information is necessary, but not sufficient Be flexible to permit families time to digest Target explanations to family literacy and interests Discuss implications of results for family members Consider which clinicians or team members should be present when results are returned Follow-up with families to support, clarify, and refer Special issues with pediatric sequencing Current Needs and Future Trends References 9 Genome Sequencing in Pediatrics: Ethical Issues Introduction Current Policy Guidelines for Genomic Testing in Minors Empirical Ethics Research on Genomic Testing in Minors Translating Empirical Results Into Normative Policies The Ethical Debate Reconsidered Conclusion References 10 Genome Sequencing in Prenatal Testing and Screening: Lessons Learned From Broadening the Scope of Prenatal Genetics From... 2012—A New Era in PND: Do Pregnant Couples Want a Broader Scope of Invasive Prenatal Genetic Testing? Methods and procedure Prenatal WES will be highly accepted among high-risk pregnant couples Are Pregnant Couples Making Informed Decisions About the Scope of Their Prenatal Genetic Test? Attitude-consistent prenatal decision-making will become more prominent aspects of informed decision-making What Is the Impact of Receiving Highly Uncertain Prenatal Genetic Test Results? We expect a high tolerance for uncertainty and we foresee a high need for swift and easily accessible post-test counseling ... 2014: A New Era in PNS: The Introduction of NIPT in the Netherlands 2017: NIPT for all Pregnant Women in the Netherlands Prenatal WES will be highly accepted among high-risk pregnant couples Measuring Informed Decision-Making in Noninvasive vs Invasive Prenatal Testing Informed decision-making is a prerequisite for reproductive autonomy and we need to create new measures to assess informed ... The Role of the Counselor in Deciding About Prenatal Genetic Testing Using WES in prenatal genetic testing will likely magnify the influence of the counselor The Psychological Impact of Deciding About the Course of a Strongly Desired Pregnancy Summary and Conclusion Acknowledgments References 11 Clinical Genetic Testing and Counseling in Psychiatry Clinical Vignette: The Impact of a Positive Family History of Mental Illness Introduction A Brief Overview of Psychiatric Genetics Early insights and genetic studies in psychiatry Chromosomal studies The candidate gene approach Mendelian genetics Genome-wide association studies Next-generation sequencing Polygenic inheritance Copy number variants A comparison to neurodegenerative disorders Current State-of-the-Art in the Clinical Psychiatric Genetics The impact of psychiatric disorders Genetic counseling for psychiatric disorders Empirical recurrence risks Syndromic forms of mental illness, and genetic testing and counseling Acceptance and commitment therapy Points of Discussion Family genetic studies complementary to large-scale case/control studies Understanding of disease etiology in neurology is derived from family studies—Why should psychiatric disorders be any diffe... More families need to be examined to sketch the landscape of mutations that may result in psychiatric disorders The genetic architecture of childhood-onset versus adult-onset psychiatric disorders Genetic testing in the psychiatric clinic in a subgroup of complex patients Clinicians working in psychiatry should be trained in human molecular genetics Genetics might change the classification system of psychiatric disorders based on the molecular disturbance rather than the... Concluding Remarks References Further Reading 12 Opportunistic Genomic Screening: Ethical Exploration* Introduction The Wider Horizon The rise of personalized medicine NGS: a catalyst for PM OGS: The ACMG’s and SFMPP’s Proposals The concept and rationale of OGS The ACMG’s proposal ACMG/OGS 1.0 ACMG/OGS 2.0 The SFMPP’s proposal Ethical Exploration Introduction: screening criteria OGS in competent adult patients Proportionality Possible benefits Risks Respect for autonomy The decision whether or not to have oneself tested beyond the initial indication “All or nothing”—that is to say: a “coercive offer” (ACMG/OGS 1.0) “Opt out” (ACMG/OGS 2.0) Deciding about the scope or content of the test Justice Need versus opportunity Equity versus opportunity OGS in children Conclusions References 13 Summary of Key Areas for Research The Healthcare Provider’s Perspective The Patient's or Consumer’s Perspective References Index Back Cover