Genomic technology has not yet reached its potential to impact patients along the full spectrum of healthcare. The limiting factor was once mainly technological: sequencing was expensive and time consuming ($2.7 billion and 13 years for the Human Genome Project). With the advent of affordable (~$1000) genomic, exomic and pharmacogenomic sequencing, the barriers to clinical use of this technology have become mainly interpretive and logistical: (1) How can physicians convert raw genomic data into actionable clinical information?, and (2) Where will patients be able to access genomic services?
“Siloing” of genomic services within specialist practices or at tertiary care, academic medical centres presents a further barrier to full deployment of genomic services [1]. There is ongoing work to move some genomic services into primary care [1]. Primary care environments offer the potential for team-based care that is accessible, coordinated, and evidence-based. Primary care physicians, however, remain deeply uncomfortable with providing genomic services [2]. Indeed, despite preventive care guidelines that recommend primary care physicians refer patients to genetic counselling services [3], primary care physicians often fail to meet this need [4, 5].
One approach to expanding access to genomic services is to embed a genetic counsellor directly into a primary care clinic. Similar approaches to embedding services within primary care have demonstrated good results for other aspects of care (e.g. embedding of integrative behavioural health specialists) [6].
In this issue, Slomp and colleagues describe a model for understanding the team dynamics that influence collaboration with an embedded genetic counsellor in primary care as part of the GenCOUNSEL study [7]. Using a semi-structured interview approach, they analyze the attitudes of primary care staff towards collaboration with a genetic counsellor embedded at the Cool Aid Community Health Center in British Columbia, Canada. Their analyses covered a wide variety of staff including physicians, nurses, medical assistants, pharmacists, counsellors, dieticians, research coordinators, physiotherapists and administrative staff. They describe collaboration as a continuum from disinterest/resistance to pre-collaboration to initial collaboration to effective collaboration. No participant was beyond the pre-collaborative stage (“cautious curiosity”) at the beginning of the study, but nearly all had moved to initial or effective collaboration by the end of the study.
This study has some limitations that should be considered. Most importantly, this study captures a particular timepoint at a single location in a vulnerable patient population (Cool Aid serves a large proportion of persons suffering from unstable housing or substance use). It seems reasonable to think these results may generalize to situations that are sociodemographically similar, for example, North American urban safety net clinics. Further work understanding the team dynamics at other (international) sites would be beneficial to parse out which attitudes are specific to the Cool Aid clinic and/or North America, and which are more generally applicable. Further analyses of team dynamics from the perspective of genetic counsellors embedded in primary care would also be beneficial.
Considering the discomfort many primary care physicians experience with effectively using and communicating genomic information, the need for a team-based approach to offering genomic services in primary care will likely only increase. Slomp and colleagues have provided a reference point to consider how team dynamics will influence effective collaboration with genetic counsellors embedded in primary care.
References
Battista RN, Blancquaert I, Laberge AM, van Schendel N, Leduc N. Genetics in health care: an overview of current and emerging models. Public Health Genomics. 2012;15:34–45.
Mainous AG 3rd, Johnson SP, Chirina S, Baker R. Academic family physicians’ perception of genetic testing and integration into practice: a CERA study. Fam Med. 2013;45:257–62.
Forbes C, Fayter D, de Kock S, Quek RG. A systematic review of international guidelines and recommendations for the genetic screening, diagnosis, genetic counseling, and treatment of BRCA-mutated breast cancer. Cancer Manag Res. 2019;11:2321–37.
Parente DJ. BRCA-related cancer genetic counseling is indicated in many women seeking primary care. J Am Board Fam Med. 2020;33:885–93.
Bellcross CA, Kolor K, Goddard KA, Coates RJ, Reyes M, Khoury MJ. Awareness and utilization of BRCA1/2 testing among U.S. primary care physicians. Am J Prev Med. 2011;40:61–66.
Schrager SB. Integrating behavioral health into primary care. Fam Pract Manag. 2021;28:3–4.
Slomp C, Morris E, GenCOUNSEL Study, Price M, Elliott AM, Austin J. The stepwise process of integrating a genetic counsellor into primary care. Eur J Hum Genet. 2022. https://doi.org/10.1038/s41431-022-01040-x
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author declares no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Parente, D.J. Demolishing the silo: towards team-based genomics in primary care. Eur J Hum Genet 30, 752–753 (2022). https://doi.org/10.1038/s41431-022-01071-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41431-022-01071-4