Clinical and Ethical Considerations in Pharmacogenetic Testing: Views of Physicians in 3 "Early Adopting" Departments of Psychiatry
Clinical and Ethical Considerations in Pharmacogenetic Testing: Views of Physicians in 3 "Early Adopting" Departments of Psychiatry
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DOI：
10.4088/jcp.08m04695whi
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发表时间：
2010-06-01
影响因子：
5.3
通讯作者：
Roberts, Laura Weiss
中科院分区：
文献类型：
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作者：
Hoop, Jinger G.;Lapid, Maria I.;Roberts, Laura Weiss
目的：影响药物反应和代谢的多态性的药物遗传学检测现已在临床上可用，其在精神病学中的应用有望得到更广泛的应用。目前，使用这些新测试的临床和伦理标准很少。作为对测试达成共识的一步，我们评估了三个精神病学学术部门的精神科医生的态度和做法，这些部门的药物遗传学测试在临床上是可用的。我们假设测试将主要用于治疗难治性疾病，临床医生会认为这种测试风险很小。方法：在2006-2007学年，我们邀请了3个精神病学院系的住院医生和教师，他们被认为是药物遗传检测的“早期采用者”，完成了一项基于互联网的调查，包括关于临床实践和对检测效用、风险和必要保障措施的看法的问题。结果：75名受访患者12个月内平均进行药物遗传学检测20.86次。检测被认为在难治性抑郁症和药物不耐受的情况下最有用。对于检测的风险，特别是关于疾病易感性的二次信息的风险，缺乏共识。受访者赞同使用一些保障措施，包括保密、测试前和测试后咨询以及知情同意，但对其他保障措施缺乏共识。女性和那些在前一年没有要求检测的人比男性和那些最近要求检测的人更关心风险和安全措施的需要。结论：早期采用药物遗传学检测的精神科医生认可药物遗传学检测的临床应用和一些患者保障措施的使用，但对其他保障措施和风险缺乏共识。临床精神病学杂志2010；71(6):745-753 (C)版权所有2010年医师研究生出版社，Inc。
Objective: Pharmacogenetic testing for polymorphisms affecting drug response and metabolism is now clinically available, and its use in psychiatry is expected to become more widespread. Currently, few clinical and ethical standards exist for the use of these new tests. As a step toward building consensus about testing, we assessed the attitudes and practices of psychiatrists at 3 academic departments of psychiatry where pharmacogenetic testing is clinically available. We hypothesized that testing would be used primarily in treatment-resistant illness and that clinicians would believe such tests carried little risk.Method: Residents and faculty at 3 departments of psychiatry considered to be "early adopters" of pharmacogenetic testing were invited during the academic year 2006-2007 to complete an Internet-based survey, including questions regarding clinical practices and opinions about testing utility, risks, and necessary safeguards.Results: The 75 respondents had ordered pharmacogenetic testing a mean of 20.86 times in the previous 12 months. Testing was judged most useful in cases of treatment-resistant depression and medication intolerance. There was a lack of consensus about the risks of testing, particularly the risk of secondary information about disease susceptibility. Respondents endorsed the use of several safeguards, including confidentiality, pretest and posttest counseling, and informed consent, but consensus about other safeguards was lacking. Women and those who had not ordered testing in the prior year were more concerned about risks and need for safeguards than were men and those who had recently ordered testing.Conclusions: Physicians at early adopting departments of psychiatry endorsed the clinical utility of pharmacogenetic testing and the use of some patient safeguards, but showed a lack of consensus about other safeguards and risks. J Clin Psychiatry 2010;71(6):745-753 (C) Copyright 2010 Physicians Postgraduate Press, Inc.