NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
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Vassy, Jason L; Davis, Kelly J; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation Journal Article Journal of General Internal Medicine, 33 (6), pp. 877-885, 2018. @article{Vassy2018, title = {How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation}, author = {Jason L Vassy and Kelly J Davis and Christine Kirby and Ian J Richardson and Robert C Green and Amy L McGuire and Peter A Ubel}, url = {https://link.springer.com/article/10.1007/s11606-017-4295-4}, year = {2018}, date = {2018-06-01}, journal = {Journal of General Internal Medicine}, volume = {33}, number = {6}, pages = {877-885}, abstract = {Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results. |
Arora, Nonie S; Davis, Kelly J; Kirby, Christine; McGuire, Amy L; Green, Robert C; Blumenthal-Barby, J S; Ubel, Peter A Communication challenges for non geneticist physicians relaying clinical genomic results Journal Article Personalized Medicine, 14 (5), pp. 423-431, 2017. @article{Arora2017, title = {Communication challenges for non geneticist physicians relaying clinical genomic results}, author = {Nonie S Arora and Kelly J Davis and Christine Kirby and Amy L McGuire and Robert C Green and J S Blumenthal-Barby and Peter A Ubel}, url = {https://www.futuremedicine.com/doi/abs/10.2217/pme-2017-0008}, year = {2017}, date = {2017-09-15}, journal = {Personalized Medicine}, volume = {14}, number = {5}, pages = {423-431}, abstract = {Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results. |
Green, Robert C; Goddard, Katrina AB; Jarvik, Gail P; Amendola, Laura M; ..., ; Kirby, Christine Clinical sequencing exploratory research consortium: Accelerating evidence-based practice of genomic medicine Journal Article The American Journal of Human Genetics, 98 (6), pp. 1051-1066, 2016. @article{Green2016, title = {Clinical sequencing exploratory research consortium: Accelerating evidence-based practice of genomic medicine}, author = {Robert C Green and Katrina AB Goddard and Gail P Jarvik and Laura M Amendola and ... and Christine Kirby}, url = {https://www.sciencedirect.com/science/article/pii/S0002929716301069}, doi = {https://doi.org/10.1016/j.ajhg.2016.04.011}, year = {2016}, date = {2016-06-02}, journal = {The American Journal of Human Genetics}, volume = {98}, number = {6}, pages = {1051-1066}, abstract = {Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools … |
2018 |
Vassy, Jason L; Davis, Kelly J; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation Journal Article Journal of General Internal Medicine, 33 (6), pp. 877-885, 2018. @article{Vassy2018, title = {How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation}, author = {Jason L Vassy and Kelly J Davis and Christine Kirby and Ian J Richardson and Robert C Green and Amy L McGuire and Peter A Ubel}, url = {https://link.springer.com/article/10.1007/s11606-017-4295-4}, year = {2018}, date = {2018-06-01}, journal = {Journal of General Internal Medicine}, volume = {33}, number = {6}, pages = {877-885}, abstract = {Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results. |
2017 |
Arora, Nonie S; Davis, Kelly J; Kirby, Christine; McGuire, Amy L; Green, Robert C; Blumenthal-Barby, J S; Ubel, Peter A Communication challenges for non geneticist physicians relaying clinical genomic results Journal Article Personalized Medicine, 14 (5), pp. 423-431, 2017. @article{Arora2017, title = {Communication challenges for non geneticist physicians relaying clinical genomic results}, author = {Nonie S Arora and Kelly J Davis and Christine Kirby and Amy L McGuire and Robert C Green and J S Blumenthal-Barby and Peter A Ubel}, url = {https://www.futuremedicine.com/doi/abs/10.2217/pme-2017-0008}, year = {2017}, date = {2017-09-15}, journal = {Personalized Medicine}, volume = {14}, number = {5}, pages = {423-431}, abstract = {Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results. |
2016 |
Green, Robert C; Goddard, Katrina AB; Jarvik, Gail P; Amendola, Laura M; ..., ; Kirby, Christine Clinical sequencing exploratory research consortium: Accelerating evidence-based practice of genomic medicine Journal Article The American Journal of Human Genetics, 98 (6), pp. 1051-1066, 2016. @article{Green2016, title = {Clinical sequencing exploratory research consortium: Accelerating evidence-based practice of genomic medicine}, author = {Robert C Green and Katrina AB Goddard and Gail P Jarvik and Laura M Amendola and ... and Christine Kirby}, url = {https://www.sciencedirect.com/science/article/pii/S0002929716301069}, doi = {https://doi.org/10.1016/j.ajhg.2016.04.011}, year = {2016}, date = {2016-06-02}, journal = {The American Journal of Human Genetics}, volume = {98}, number = {6}, pages = {1051-1066}, abstract = {Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools … |