BACKGROUND AND OBJECTIVES: Genetic testing is expanding among ill neonates, yet the influence of genetic results on medical decision-making is not clear. With this study, we sought to determine how different types of genetic information with uncertain implications for prognosis influence clinicians' decisions to recommend intensive versus palliative care. METHODS: We conducted a national study of neonatologists using a split sample experimental design. The questionnaire contained 4 clinical vignettes. Participants were randomly assigned to see one of 2 versions that varied only regarding whether they included the following genetic findings: (1) a variant of uncertain significance; (2) a genetic diagnosis that affects neurodevelopment but not acute survival; (3) a genetic versus nongenetic etiology of equally severe pathology; (4) a pending genetic testing result. Physicians answered questions about recommendations they would make for the patient described in each vignette. RESULTS: Vignette versions that included a variant of uncertain significance, a diagnosis foreshadowing neurodevelopmental impairment, or a genetic etiology of disease were all associated with an increased likelihood of recommending palliative rather than intensive care. A pending genetic test result did not have a significant effect on care recommendations. CONCLUSIONS: Findings from this study of hypothetical cases suggest neonatologists apply uncertain genetic findings or those that herald neurodevelopmental disability in problematic ways. As genetic testing expands, understanding how it is used in decision-making and educating clinicians regarding appropriate use are paramount.
BACKGROUND AND OBJECTIVES: Genetic testing is expanding among ill neonates, yet the influence of genetic results on medical decision-making is not clear. With this study, we sought to determine how different types of genetic information with uncertain implications for prognosis influence clinicians' decisions to recommend intensive versus palliative care. METHODS: We conducted a national study of neonatologists using a split sample experimental design. The questionnaire contained 4 clinical vignettes. Participants were randomly assigned to see one of 2 versions that varied only regarding whether they included the following genetic findings: (1) a variant of uncertain significance; (2) a genetic diagnosis that affects neurodevelopment but not acute survival; (3) a genetic versus nongenetic etiology of equally severe pathology; (4) a pending genetic testing result. Physicians answered questions about recommendations they would make for the patient described in each vignette. RESULTS: Vignette versions that included a variant of uncertain significance, a diagnosis foreshadowing neurodevelopmental impairment, or a genetic etiology of disease were all associated with an increased likelihood of recommending palliative rather than intensive care. A pending genetic test result did not have a significant effect on care recommendations. CONCLUSIONS: Findings from this study of hypothetical cases suggest neonatologists apply uncertain genetic findings or those that herald neurodevelopmental disability in problematic ways. As genetic testing expands, understanding how it is used in decision-making and educating clinicians regarding appropriate use are paramount.
Authors: Laurel K Willig; Josh E Petrikin; Laurie D Smith; Carol J Saunders; Isabelle Thiffault; Neil A Miller; Sarah E Soden; Julie A Cakici; Suzanne M Herd; Greyson Twist; Aaron Noll; Mitchell Creed; Patria M Alba; Shannon L Carpenter; Mark A Clements; Ryan T Fischer; J Allyson Hays; Howard Kilbride; Ryan J McDonough; Jamie L Rosterman; Sarah L Tsai; Lee Zellmer; Emily G Farrow; Stephen F Kingsmore Journal: Lancet Respir Med Date: 2015-04-27 Impact factor: 30.700
Authors: K A Schulman; J A Berlin; W Harless; J F Kerner; S Sistrunk; B J Gersh; R Dubé; C K Taleghani; J E Burke; S Williams; J M Eisenberg; J J Escarce Journal: N Engl J Med Date: 1999-02-25 Impact factor: 91.245
Authors: Zöe Powis; Kelly D Farwell Hagman; Virginia Speare; Taylor Cain; Kirsten Blanco; Layla S Mowlavi; Emily M Mayerhofer; David Tilstra; Timothy Vedder; Jesse M Hunter; Marilyn Tsang; Lina Gonzalez; Gerald Vockley; Sha Tang Journal: Genet Med Date: 2018-03-22 Impact factor: 8.822
Authors: Jan M Friedman; Yvonne Bombard; Martina C Cornel; Conrad V Fernandez; Anne K Junker; Sharon E Plon; Zornitza Stark; Bartha Maria Knoppers Journal: Genet Med Date: 2018-06-12 Impact factor: 8.822