Physicians should consider patient benefits, drawbacks before ordering genetic tests
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MIAMI BEACH, Fla. — Physicians should consider the potential harms of genetic testing before administering these tests to patients, according to a presenter at South Beach Symposium.
“There’s a lot of evaluation in mRNA and gene expression changes, but what about when we’re actually evaluating the DNA,” William Damsky MD, PhD, assistant professor of dermatology at Yale School of Medicine, said during a presentation at South Beach Symposium. “I think this is more complex for patients to process, and so educating our patients about genetic testing is important, but first we really need to educate ourselves.”
When considering genetic testing, clinicians are often motivated by the potential benefits, according to Damsky. However, it is important to be aware of the potential harms.
First and foremost, genetic testing should be guided by the best interests of the patient, scientific evidence and ethical standards, Damsky said. Potential harms include implications for other family members, cost, employment discrimination and insurance discrimination.
There is also a risk of coming across incidental findings such as variants of uncertain significance or data that may have implications on the patient’s identity. Additionally, patients often feel anxiety when undergoing genetic testing, especially if an abnormal variant appears that clinicians cannot explain.
In an effort to combat these potential harms, it is important that physicians understand why they are ordering a genetic test. Physicians should consider pretest probability and whether there is something they are specifically looking for that may affect their decision making.
Additional considerations include the sensitivity and specificity of the test as well as the physicians perceived abilities to accurately interpret the results. Feeling confident and comfortable explaining these concepts to patients is of the utmost importance.
“Genomics, genetics and basic scientific investigation hold incredible power,” Damsky said. “And going through these motions and these thoughts with patients is something that takes practice.”