With recent advances in genotyping methods, specifically improvements in DNA microarrays and chip- scanning instrumentation, it is now technically possible and economically feasible to test large numbers of patients for several thousand known mutations associated with Mendelian disease phenotypes. This possibility suggests numerous clinical applications of large-scale mutation arrays in molecular diagnosis and genetic risk assessment, such as prenatal testing for the most common mutations responsible for severe genetic disorders, screening for autosomal recessive or X-linked mutations, and predictive testing for a range of adult-onset disorders. If large-scale mutation testing is to be integrated effectively into clinical care, however, several significant ethical issues must first be addressed. Large-scale mutation testing will generate an enormous amount of diagnostic information. Given the large number of mutations examined, it will not be possible to counsel patients on technical features of each individual component of a large-scale mutation array, such as false-positive and false-negative rates, as would be done in more traditional genetic testing procedures. Nor will it be possible to advise patients on specific medical interventions or confirmatory diagnostic tests associated with identifying each of several thousand possible mutations prior to testing, as frequently would be done in other situations in which genetic testing is recommended. Since large-scale mutation testing will require a departure from these and other professional standards in clinical genetics, it is vitally important that this new form of genetic testing be introduced in a deliberative manner that is informed by the expectations, needs, and values of both patients and genetic professionals. This research study will examine patient and professional understandings of diagnostic results from large-scale clinical mutation testing.
Its aims are to: (1) describe the attitudes and beliefs of patients and genetic professionals regarding the types of diagnostic possibilities that should be discussed with patients prior to large-scale clinical mutation testing, and (2) characterize the attitudes and beliefs of patients and genetic professionals regarding the types of diagnostic results that should be returned following large-scale clinical mutation testing. These empirical results will be used to develop practical recommendations regarding the presentation of diagnostic results from large-scale clinical mutation testing. Systematic data on patients' and professionals' understandings of this new form of genetic testing are critically important, as these data will inform genetic-counseling practices, decisions about the return of diagnostic results, and judgments about the appropriate use of large-scale mutation testing in patient care. Narrative This research study will examine patients' and professionals' attitudes and beliefs regarding the presentation of diagnostic results from large-scale mutation testing. Systematic data on patient and professional understandings of this new form of genetic testing are critically important, as these data will inform genetic-counseling practices, decisions about the return of diagnostic results, and judgments about the introduction of new genomic technologies into patient care. ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Human Genome Research Institute (NHGRI)
Type
Research Project (R01)
Project #
1R01HG004500-01
Application #
7348251
Study Section
Ethical, Legal, and Social Implications of Human Genetics Study Section (ELS)
Program Officer
Thomson, Elizabeth
Project Start
2008-05-12
Project End
2011-04-30
Budget Start
2008-05-12
Budget End
2009-04-30
Support Year
1
Fiscal Year
2008
Total Cost
$380,000
Indirect Cost
Name
Cleveland Clinic Lerner
Department
Other Basic Sciences
Type
Schools of Medicine
DUNS #
135781701
City
Cleveland
State
OH
Country
United States
Zip Code
44195
Brothers, Kyle B; Holm, Ingrid A; Childerhose, Janet E et al. (2016) When Participants in Genomic Research Grow Up: Contact and Consent at the Age of Majority. J Pediatr 168:226-31.e1
Green, Robert C; Goddard, Katrina A B; Jarvik, Gail P et al. (2016) Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine. Am J Hum Genet 98:1051-1066
Amendola, Laura M; Jarvik, Gail P; Leo, Michael C et al. (2016) Performance of ACMG-AMP Variant-Interpretation Guidelines among Nine Laboratories in the Clinical Sequencing Exploratory Research Consortium. Am J Hum Genet 98:1067-1076
Amendola, Laura M; Lautenbach, Denise; Scollon, Sarah et al. (2015) Illustrative case studies in the return of exome and genome sequencing results. Per Med 12:283-295
Jarvik, Gail P; Amendola, Laura M; Berg, Jonathan S et al. (2014) Return of genomic results to research participants: the floor, the ceiling, and the choices in between. Am J Hum Genet 94:818-26
Henderson, Gail E; Wolf, Susan M; Kuczynski, Kristine J et al. (2014) The challenge of informed consent and return of results in translational genomics: empirical analysis and recommendations. J Law Med Ethics 42:344-55
Koay, Pei P; Sharp, Richard R (2014) Managing Expectational Language: Translational genetic professionals consider the clinical potential of next-generation sequencing technologies. New Genet Soc 33:126-148
McGowan, Michelle L; Glinka, Allison; Highland, Janelle et al. (2013) Genetics patients' perspectives on clinical genomic testing. Per Med 10:339-347
Cho, D; McGowan, M L; Metcalfe, J et al. (2013) Expanded carrier screening in reproductive healthcare: perspectives from genetics professionals. Hum Reprod 28:1725-30
McGowan, Michelle L; Cho, Deborah; Sharp, Richard R (2013) The changing landscape of carrier screening: expanding technology and options?. Health Matrix Clevel 23:15-33

Showing the most recent 10 out of 14 publications