EMR documentation of physician-patient communication following genomic counseling for actionable complex disease and pharmacogenomic results.
Genomic risk information for potentially actionable complex diseases and pharmacogenomics communicated through genomic counseling (GC) may motivate physicians and patients to take preventive actions. The Ohio State University-Coriell Personalized Medicine Collaborative is a randomized trial to measure the effects of in-person GC on chronic disease patients provided with multiplex results. Nine personalized genomic risk reports were provided to patients through a web portal, and to physicians via electronic medical record (EMR). Active arm participants (98, 39% female) received GC within 1 month of report viewing; control arm subjects (101, 54% female) could access counseling 3-months post-report viewing. We examined whether GC affected documentation of physician-patient communication by reviewing the first clinical note following the patient's GC visit or report upload to the EMR. Multivariable logistic regression modeling estimated the independent effect of GC on physician-patient communication, as intention to treat (ITT) and per protocol (PP), adjusted for physician educational intervention. Counselees in the active arm had more physician-patient communications than control subjects [ITT, odds ratio (OR): 3.76 (95% confidence interval (CI): 1.38-10.22, p < 0.0094); PP, OR: 5.53 (95% CI: 2.20-13.90, p = 0.0017). In conclusion, GC appreciably affected physician-patient communication following receipt of potentially actionable genomic risk information.
Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA.
K
K
Sweet
Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA.
A C
AC
Sturm
Coriell Personalized Medicine Collaborative, Coriell Institute for Medical Research, Camden, NJ, USA.
T
T
Schmidlen
School of Communication, Ohio State University, Columbus, OH, USA.
S
S
Hovick
Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, USA.
J
J
Peng
Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA.|Geisinger Health System, Genomic Medicine Institute, Precision Health Center, Forty Fort, PA, USA.
K
K
Manickam
Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
A
A
Salikhova
Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, USA.
J
J
McElroy
Coriell Personalized Medicine Collaborative, Coriell Institute for Medical Research, Camden, NJ, USA.|Department of Biology, Temple University, Philadelphia, PA, USA.
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L
Scheinfeldt
Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA.
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AE
Toland
Department of Health Behaviour & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
J S
JS
Roberts
Coriell Personalized Medicine Collaborative, Coriell Institute for Medical Research, Camden, NJ, USA.
M
M
Christman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology; D003142:Communication; D057286:Electronic Health Records; D005260:Female; D005817:Genetic Counseling; D015894:Genome, Human; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010597:Pharmacogenetics; D010817:Physician-Patient Relations; D010820:Physicians; D057285:Precision Medicine; D018570:Risk Assessment
complex disease; counseling; electronic medical record; genetic; genomic; pharmacogenomics; physician-patient communication