Pharmacogenomic testing for medication selection: A rapid Qualitative Review

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Project Number:
RC1246-000

Question

  1. How are pharmacogenomic tests for medication selection understood and experienced by users (i.e., patients and clinicians)? How do patients and clinicians interpret and use the results of pharmacogenomic tests, and how do these tests fit into existing pathways and structures of care?

Key Message

This rapid qualitative evidence synthesis included 13 primary studies on the views and understanding of patients and providers on PGx testing.Overall, PGx testing was seen by patients and providers as being beneficial. Although sometimes more information in and of itself was desired, most patients and providers described PGx testing as helping narrow down their choices to the best medication to avoid adverse reactions.However, patients and providers alike expressed worries around how PGx testing would limit patient centered care by limiting patients’ choices of medications. For patients, particularly those with mental health conditions, they worried about not having their personal experiences with medications heard by providers. Having to select less effective or more expensive medications to avoid potential adverse reactions flagged by PGx test results was also raised as a substantial concern.Issues around the ordering of PGx testing revealed that providers’ opinions varied about whether to order tests at medication initiation or after. Providers described comfort and familiarity with PGx tests as affecting their decisions to order testing. The potential for genetic discrimination by insurers and employers raised concerns about privacy and confidentiality. Limited access to PGx test results was considered a key strategy for mitigating this risk.PGx test results can shape patient care over their life course. The potential for secondary findings from PGx testing made patients worry about how these results would affect them in the present and the future. The potential for the results of PGx tests to impact current and future family members also troubled patients and providers. There was limited information on the use of and views on PGx by disease or by type of testing. Findings point to the need for faster results from PGx testing in life-limiting or rapidly progressing conditions. In areas such as mental health, PGx testing was used less routinely, and generally applied where patients experience adverse reactions or limited effectiveness. Providers and patients expected PGx test results to be one of several types of information in decision making.