Geriatricians' Perspectives on the Multiple Dimensions of Utility of Genetic Testing for Alzheimer's Disease: A Qualitative Study.
Geriatricians' Perspectives on the Multiple Dimensions of Utility of Genetic Testing for Alzheimer's Disease: A Qualitative Study.
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老年病学家对阿尔茨海默病基因检测多维度效用的看法：一项定性研究。
DOI：
10.3233/jad-220674
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发表时间：
2022
影响因子：
4
通讯作者：
Phillips, Kathryn A.
中科院分区：
文献类型：
--
作者：
Arias, Jalayne J.;Lin, Grace A.;Tyler, Ana M.;Douglas, Michael P.;Phillips, Kathryn A.
阿尔茨海默病（AD）的研究进展为基因检测提供了机会，以改善诊断和风险评估。尽管出现了新的发展，但目前尚不清楚老年病学家如何看待基因检测对患者的潜在临床和个人效用。老年病学家的观点对于理解潜在的伦理，政策和临床挑战至关重要，因为他们在治疗老年人中发挥着核心作用。我们进行了半结构化的采访加州老年病学家在不同的做法设置，收集和描述他们的观点，基因检测AD。我们使用了适应扎根理论的方法来分析记录和转录的采访。我们确定了老年病学家（n=10）对测试的临床和个人效用的看法，以及他们对老年人临床护理方法的看法。老年病学家认为AD基因检测的临床实用性很小，尽管随着疾病改善疗法的出现，这种情况可能会改变。然而，他们认识到测试的潜在个人效用（例如，协助未来的财务规划）。最后，老年病学家对患者因了解遗传状态而感到焦虑表示担忧，特别是通过DTC检测。我们的数据强调，决定进行基因检测需要考虑临床和伦理因素，包括平衡有限的临床效用和潜在的个人效用。虽然DTC测试是可用的，老年病学家认为，他们有一个重要的作用，在管理的决定，以测试和解释结果。需要进一步的研究来告知政策和伦理准则，以支持老年病医生在为考虑临床和DTC基因检测的患者提供咨询方面的关键作用。
Research advancements in Alzheimer’s disease (AD) raise opportunities for genetic testing to improve diagnostic and risk assessment. Despite emerging developments, it is unclear how geriatricians perceive the potential clinical and personal utility of genetic testing for their patients. Geriatricians’ perspectives are essential to understanding potential ethical, policy, and clinical challenges given their central role in treating older adults. We conducted semi-structured interviews with California geriatricians within different practices settings to collect and characterize their perspectives on genetic testing for AD. We used an adapted grounded theory approach to analyze recorded and transcribed interviews. We identified geriatricians’ (n=10) perspectives on the clinical and personal utility of testing, alongside their views on clinical care approaches for older adults. Geriatricians perceived minimal clinical utility of genetic testing for AD, though that may change with the availability of disease-modifying therapies. Yet, they recognized the potential personal utility of testing (e.g., assisting with future financial planning). Finally, geriatricians expressed concerns regarding patients’ anxiety from learning about genetic status, particularly through DTC testing. Our data highlight that the decision to order genetic testing requires clinical and ethical considerations, including balancing limited clinical utility with the potential personal utility. Although DTC testing is available, geriatricians perceive that they have an important role in managing the decision to test and interpreting the results. Further research is needed to inform policy and ethical guidelines to support geriatricians’ critical role to counsel patients considering clinical and DTC genetic testing.