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A Qualitative Study of Healthcare Providers’ Perspectives on the Implications of Genome-Wide Testing in Pediatric Clinical Practice

  • Original Research
  • Published:
Journal of Genetic Counseling

Abstract

The utilization of genome-wide chromosomal microarray analysis (CMA) in pediatric clinical practice provides an opportunity to consider how genetic diagnostics is evolving, and to prepare for the clinical integration of genome-wide sequencing technologies. We conducted semi-structured interviews with 15 healthcare providers (7 genetic counselors, 4 medical geneticists, and 4 non-genetics providers) to investigate the impact of CMA on clinical practice, and implications for providers, patients and families. Interviews were analyzed qualitatively using content analysis. Most providers reported that genomic testing enhanced their professional experience and was beneficial to patients, primarily due to the improved diagnostic rate compared with earlier chromosomal studies. Other effects on practice included moving towards genotype-first diagnosis and broadening indications for chromosomal testing. Opinions varied concerning informed consent and disclosure of results. The duty to disclose incidental findings (IFs) was noted; however concerns were raised about potential psychosocial harms of disclosing pre-symptomatic findings. Tensions were revealed between the need for comprehensive informed consent for all families and the challenges of communicating time-consuming and potentially anxiety-provoking information regarding uncertain and incidental findings that may be relevant only in rare cases. Genetic counselors can play an important role in liaising with families, health professionals and testing laboratories, providing education and guidance to non-genetics providers, and enabling families to receive adequate pre-and post-test information and follow-up care.

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Acknowledgments

This study was funded by the National Human Genome Research Institute of the National Institutes of Health (NIH) supplement PA-04-126 to Penn CIGHT P50 HG004487. The opinions in this report do not reflect the views of the NIH.

Conflict of interest

The authors declare no conflict of interest with respect to the manuscript.

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Authors and Affiliations

  1. Center for the Integration of Genetic Health Care Technologies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Marian Reiff, Reed E. Pyeritz & Barbara A. Bernhardt

  2. Basser Research Center for BRCA, University of Pennsylvania, Philadelphia, PA, USA

    Rebecca Mueller

  3. Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA

    Surabhi Mulchandani & Nancy B. Spinner

  4. Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Penn Tower Room 1112, 399 South 34th Street, Philadelphia, PA, 19104, USA

    Marian Reiff

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  1. Marian Reiff
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  2. Rebecca Mueller
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  3. Surabhi Mulchandani
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  4. Nancy B. Spinner
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  5. Reed E. Pyeritz
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  6. Barbara A. Bernhardt
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Correspondence to Marian Reiff.

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Reiff, M., Mueller, R., Mulchandani, S. et al. A Qualitative Study of Healthcare Providers’ Perspectives on the Implications of Genome-Wide Testing in Pediatric Clinical Practice. J Genet Counsel 23, 474–488 (2014). https://doi.org/10.1007/s10897-013-9653-8

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  • DOI: https://doi.org/10.1007/s10897-013-9653-8

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