Doctors shouldn't have to cheat the system: Clinicians' real-world experiences of the utility of genomic sequencing

Purpose: Emerging genetic tests such as genomic sequencing (GS) can generate a broad range of benefits, but funding criteria only prioritize diagnosis and clinical management. There is limited evidence on all types of benefits obtained from GS in practice. We aimed to explore real-world experiences of Canadian clinicians across specialties on the full range of benefits obtained from the results from GS. Methods: We conducted a qualitative study using semistructured interviews with Canadian clinicians. Transcripts were thematically analyzed using constant comparison. Results: In total, 25 clinicians participated, including 12 geneticists, 7 genetic counselors, 4 oncologists, 1 neurologist, and 1 family physician. Although diagnoses and management were the most valued benefits of GS, clinicians also prioritized nontraditional utility, such as access to community supports. However, clinicians felt restricted by funding bodies, which only approved funding when GS would inform diagnoses and management. Consequently, clinicians sought ways to cheat the system to access GS (eg, research testing) but acknowledged workarounds were burdensome, drove inequity, and undermined patient care. Conclusion: Current governance structures undervalue real-world benefits of GS leading clinicians to adopt workarounds, which jeopardize patient care. These results support calls for the expansion of the definition of clinical utility and research to quantify the additional benefits. (C) 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.

Automated summary

Canadian clinicians have experienced a broad range of benefits from genomic sequencing (GS), including diagnoses, management, and nontraditional utility such as access to community supports. However, funding restrictions have forced clinicians to seek workarounds to access GS, leading to burdensome processes, inequity, and compromised patient care.