Dataset Information

Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics.

ABSTRACT:

Introduction

Genomic testing is becoming widely available as a diagnostic tool, although widespread implementation is not yet established in nephrology.

Methods

An anonymous electronic survey was administered to investigate experience and confidence with genomic tests, perceived clinical utility of genomic services, preferences for service delivery models, and readiness for implementation among nephrologists. Questions were guided by a comprehensive literature review and published tools, including a validated theoretical framework for implementation of genomic medicine: Consolidated Framework for Implementation Research (CFIR).

Results

Responses were received from 224 clinicians, of which 172 were eligible for analysis. Most clinicians (132 [76%]) had referred at least one patient to a genetics clinic. Despite most clinicians (136 [85%]) indicating that they believed genetic testing would be useful, only 39 (23%) indicated they felt confident to use results of genomic testing, with pediatric clinicians feeling more confident compared with adult clinicians (12 of 20 [60%] vs. 27 of 149 [18%]), P < 0.01, Fisher exact). A multidisciplinary renal genetics clinic was the preferred model among clinicians surveyed (98 of 172 [57%]). A key implementation barrier highlighted related to the hospital or organizational culture and/or environment. Specific barriers noted in quantitative and qualitative responses included inadequate staffing, learning resources, and funding.

Conclusions

Our findings suggest support for genomic testing among nephrologists, with a strong preference for a multidisciplinary model (involving a nephrologist, clinical geneticist, and genetic counselor). Broad-ranging interventions are urgently required to shift the current culture and ensure successful implementation of genomics in nephrology, including reducing knowledge gaps, increased funding and resources, disease-specific guidelines, and streamlining of testing processes.

SUBMITTER: Jayasinghe K

PROVIDER: S-EPMC7879212 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics.

Jayasinghe Kushani K Quinlan Catherine C Mallett Andrew J AJ Kerr Peter G PG McClaren Belinda B Nisselle Amy A Mallawaarachchi Amali A Polkinghorne Kevan R KR Patel Chirag C Best Stephanie S Stark Zornitza Z

Kidney international reports 20201110 2

<h4>Introduction</h4>Genomic testing is becoming widely available as a diagnostic tool, although widespread implementation is not yet established in nephrology.<h4>Methods</h4>An anonymous electronic survey was administered to investigate experience and confidence with genomic tests, perceived clinical utility of genomic services, preferences for service delivery models, and readiness for implementation among nephrologists. Questions were guided by a comprehensive literature review and published ...[more]

PMID: 33615052

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Project description:BackgroundThere is a high prevalence of psychosocial issues affecting patients with kidney failure.ObjectiveWe sought to examine Canadian nephrologists' attitudes and opinions regarding the importance of renal patient psychosocial care, nephrologists' roles, and experience with psychosocial care in addition to what barriers, if any, prevent these physicians from providing psychosocial care to their patients.DesignA self-administered, survey questionnaire.SettingOnline.SampleCanadian Society of Nephrology members who predominantly work in clinical care with adult, in-center hemodialysis patients.MeasurementsMeasurements of the survey include demographics, training, and nephrologists' opinions regarding their role in administering psychosocial care, potential administrative and patient time constraints, accessibility of other health care workers for this activity, and factors that influence or impede physicians' ability to address their patients' psychosocial needs.MethodsA self-administered survey was sent to almost 500 members of the Canadian Society of Nephrology between November 2018 and December 2018. The survey questionnaire was designed to gather opinions and attitudes on psychosocial care delivery as well as potential influencing factors on nephrologists' ability to provide this care. A univariate statistical analysis was used to analyze survey responses.ResultsA total of 30 nephrologists responded to the survey, generating a 6% response rate. Respondents varied across provinces, with the majority being staff nephrologists (80%). While over 94% of respondents either agreed or strongly agreed that focus on psychosocial care improves patient outcomes, only 43% felt that staff nephrologists were suited to provide this care to patients; 97% of respondents believed social workers to be the most suited to provide this. Lack of additional supporting health care members, the need for additional training, too many administrative duties, and empathy fatigue were some of the predominant barriers respondents felt prevented them from addressing the psychosocial care of their patients.LimitationsA low response rate for the survey was obtained, roughly 6%, limiting our ability to draw definitive conclusions. Survey answers by respondents may be different from those by nonrespondents. Answers may be subject to social desirability and/or selection bias.ConclusionNephrologists believe that the current psychosocial care of patients in hemodialysis units is inadequate. However, further research is necessary to elucidate the barriers nephrologists face in providing psychosocial care and the changes required to most effectively implement optimal psychosocial care for patients with kidney failure in hemodialysis units.

Project description:Dairy farm systems have intensified to meet growing demands for animal products, but public opposition to this intensification has also grown due, in part, to concerns about animal welfare. One approach to addressing challenges in agricultural systems has been through the addition of new technologies, including genetic modification. Previous studies have reported some public resistance towards the use of these technologies in agriculture, but this research has assessed public attitudes toward individual practices and technologies and few studies have examined a range of practices on dairy farms. In the present study, we presented participants with four scenarios describing dairy practices (cow-calf separation, the fate of excess dairy calves, pasture access and disbudding). Citizens from Canada and the United States (n = 650) indicated their support (on a 7-point scale) toward five approaches (maintaining standard farm practice, using a naturalistic approach, using a technological approach, or switching to plant-based or yeast-based milk production) aimed at addressing the welfare issues associated with the four dairy practices. Respondents also provided a text-based rationale for their responses and answered a series of demographic questions including age, gender, and diet. Participant diet affected attitudes toward milk alternatives, with vegetarians and vegans showing more support for the plant-based and yeast-based milk production. Regardless of diet, most participants opposed genetic modification technologies and supported more naturalistic practices. Qualitative responses provided insight into participants' values and concerns, and illustrated a variety of perceived benefits and concerns related to the options presented. Common themes included animal welfare, ethics of animal use, and opposition toward technology. We conclude that Canadian and US citizens consider multiple aspects of farm systems when contemplating animal welfare concerns, and tend to favor naturalistic approaches over technological solutions, especially when the latter are based on genetic modification.

Dataset Information

Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics.

Introduction

Methods

Results

Conclusions

Publications

Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics.

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