title: A qualitative study of healthcare providers' perspectives on the implications of genome-wide testing in pediatric clinical practice.
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.
authors.affiliation: Center for the Integration of Genetic Health Care Technologies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, marian.reiff@uphs.upenn.edu.
authors.forename: Marian
authors.initials: M
authors.lastname: Reiff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mueller
authors.forename: Surabhi
authors.initials: S
authors.lastname: Mulchandani
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Spinner
authors.forename: Reed E
authors.initials: RE
authors.lastname: Pyeritz
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Bernhardt
mesh_terms: D002648:Child; D005260:Female; D005820:Genetic Testing; D015894:Genome, Human; D006801:Humans; D008297:Male; D036301:Qualitative Research; D035501:Uncertainty
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