How to Discuss Pharmacogenetics with Your Patients
As the medical community works toward fully embracing precision medicine, pharmacogenetics is anticipated to be the foundation of this important movement in personalized medicine.
As the medical community works toward fully embracing precision medicine, pharmacogenetics is anticipated to be the foundation of this important movement in personalized medicine. Within the past few years, pharmacogenetic testing in community pharmacies has become more mainstream. There are many lab products and payment models from which to choose; therefore, as pharmacists and patient advocates, we must be well informed to help our patients navigate the options to find what is best for them.
Following best practices, once you have an order from a primary care provider (PCP) and the patient’s report is ready, now what? How will you explain decades of pharmacogenetic science and drug metabolism to the patient? Where will you go to find the most up-to-date pharmacogenetic guidelines? How will you get prepared?
For pharmacogenetic testing in community pharmacy to be successful, I think pharmacists need to be mindful of their responsibilities to patients and prescribers. Pharmacists who counsel patients on pharmacogenetic test results should initiate and close communication loops to ensure the highest level of patient safety and transparency of information with prescribers. If patients receive their genetic test results without counseling from a trained professional, they may lose confidence in their medications and decide to self-adjust or discontinue them due to misinterpretation of the test results. This is a major concern regarding direct-to-consumer testing.
Pretest education may be important for patients to ensure they really understand what a pharmacogenetic test is and is not. These tests are typically specific to medications and do not diagnose, or assess for the likelihood of, cancer, Alzheimer’s disease, or other disease states; therefore, it is important for your patients to understand exactly what to expect from their results. Here is an example of how this information could be presented to a patient:
This pharmacogenetic test searches your genes for variations that may change how you metabolize or break down a medication. The test results will divide the medications into categories designated by red, yellow, and green. So, if you get a “green check” for a medication on a pharmacogenetic test, all it means is that you break down this medication as we expect and all the standard precautions apply. However, getting a “go light” on a pharmacogenetic test does not mean the medication will work for you 100% or that it will not cause any unwanted side effects.
Another reason for pretest education is to ensure that patients understand that pharmacogenetics is only 1 piece of the puzzle. We know drug metabolism is affected by many factors, such as smoking, liver function, kidney function, age, gender, and other drugs. The patient’s PCP should have a complete picture of the patient’s medical profile; therefore, the PCP has the final say on the best course of action in the patient’s care. It should be emphasized that identification of a genetic implication does not mean that the patient will not respond to a medication or experience an adverse drug event.
To improve comprehension, 5 strategies can be used when talking to patients about genetic results1:
- Use effective risk-communication strategies by tailoring the information to the patient’s needs and concerns.
- Inform patients what, if any, genetic implications should be discussed with their PCP.
- Educate patients on relevant results for potential treatments or preventive care counseling.
- Coordinate with the patient’s PCP, as necessary.
- Give the patient a summary of the results.
For best practices when talking with patients about their genetic results, pharmacists can rely on the following guidelines. It is important for pharmacists to use a standardized process so that patients can have a high-quality experience no matter where they choose to receive their genetic counseling. Consider employing the following techniques when counselling patients on their genetic test results:
- Assess the patient’s current knowledge and provide genetic education, as needed. Show the patient a chart with the 4 types of metabolizers.
- Provide adequate disclaimers. Pharmacogenetics is just one piece of a large puzzle to determine the appropriate medication therapy for an individual. Patients cannot rely on this test alone; therefore, it is important for them to talk with their health care provider about changes to their medications. Tell patients that getting cleared to take a medication based on a pharmacogenetic test does not mean it is free from adverse effects or that it will be 100% effective. Clearance just means that the patient will break down the drug as expected and the standard precautions apply.
- Collaborate with medical providers. Before taking a sample, tell the patient that you would like to reach out to, and collaborate with, his or her primary care provider in order to personalize the patient’s medication therapy.
- Emphasize patient education. Train patients how to use the test results because they can be used for the rest of their life.
The only way that the test results can be useful and valuable is if patients use them. Therefore, patients should be sure to share this information with all their current and future health care providers.
Olivia Santoso Bentley, PharmD, AAHIVP, CFts, is the director of clinical services for Rx Clinic Pharmacy, a leader of the Pharmacogenetic Center of Excellence, and a clinical pharmacist consultant to the Rxight™ Pharmacogenetic Program from MD Labs. She has advanced training and certification in pharmacogenetics and precision medicine, was the 2015 PDS Team Leader of the Year, and is the 2016 Next-Generation Pharmacist® Rising Star finalist.
- Mills R, Voora D, Peyser B, Haga SB. Delivering pharmacogenetic testing in a primary care setting. Pharmgenomics Pers Med. 2013;6:105-112. doi: 10.2147/PGPM.S50598.