Subjects

Abstract

Purpose

Physicians increasingly receive genomic test results they did not order, which we term “unsolicited genomic results” (UGRs). We asked physicians how they think such results will affect them and their patients.

Methods

Semistructured interviews were conducted with adult and pediatric primary care and subspecialty physicians at four sites affiliated with a large-scale return-of-results project led by the Electronic Medical Records and Genomics (eMERGE) Network. Twenty-five physicians addressed UGRs and (1) perceived need for actionability, (2) impact on patients, (3) health care workflow, (4) return of results process, and (5) responsibility for results.

Results

Physicians prioritize actionability of UGRs and the need for clear, evidence-based “paths” for action coupled with clinical decision support (CDS). They identified potential harms to patients including anxiety, false reassurance, and clinical disutility. Clinicians worried about anticipated workflow issues including responding to UGRs and unreimbursed time. They disagreed about who was responsible for responding to UGRs.

Conclusion

The prospect of receiving UGRs for otherwise healthy patients raises important concerns for physicians. Their responses informed development of an in-depth survey for physicians following return of UGRs. Strategic workflow integration of UGRs will likely be necessary to empower physicians to serve their patients effectively.

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Acknowledgements

The authors would like to thank Josie Timmons for her contributions. This project was funded in part by several grants of the eMERGE consortium—U01HG8672 (Vanderbilt University Medical Center), U01HG8666 (Cincinnati Children’s Hospital Medical Center), U01HG8679 (Geisinger), and U01HG008701 (Coordinating Center). Financial support was also provided in part by the Office of Medical Student Research at Vanderbilt University School of Medicine.

Author information

Affiliations

  1. Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    • Douglas B. Pet MD
  2. Boston Children’s Hospital, Boston, Massachusetts, USA

    • Ingrid A. Holm MD, MPH
  3. Harvard Medical School, Boston, Massachusetts, USA

    • Ingrid A. Holm MD, MPH
  4. Geisinger, Danville, Pennsylvania, USA

    • Janet L. Williams MS, LGC
  5. Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    • Melanie F. Myers PhD
  6. University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA

    • Melanie F. Myers PhD
  7. Vanderbilt University Medical Center, Nashville, Tennessee, USA

    • Laurie L. Novak PhD, MHSA
    • , Georgia L. Wiesner MD, MS
    •  & Ellen W. Clayton MD, JD
  8. University of Louisville School of Medicine, Louisville, Kentucky, USA

    • Kyle B. Brothers MD, PhD
  9. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA

    • Georgia L. Wiesner MD, MS
  10. Vanderbilt University School of Law, Nashville, Tennessee, USA

    • Ellen W. Clayton MD, JD

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Disclosure

The authors declare no conflicts of interest.

Corresponding author

Correspondence to Ellen W. Clayton MD, JD.

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https://doi.org/10.1038/s41436-018-0047-z