Susanne B Haga

Duke University, Durham, North Carolina, United States

Are you Susanne B Haga?

Claim your profile

Publications (62)382.88 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.
    Pharmacogenomics 11/2014; 15(14):1729-1737. · 3.43 Impact Factor
  • Patricia A Deverka, Susanne B Haga
    Clinical Chemistry 10/2014; · 7.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting. Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting. We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group. Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.
    Pharmacogenomics 09/2014; 15(13):1677-86. · 3.43 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients' health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.
    Genome Medicine 07/2014; 6(7):58. · 4.94 Impact Factor
  • Susanne B Haga, Rachel Mills, Hayden Bosworth
    [Show abstract] [Hide abstract]
    ABSTRACT: Pharmacogenetic (PGx) testing can provide information about a patient's likelihood to respond to a medication or experience an adverse event, and be used to inform medication selection and/or dosing. Promoting patient comprehension of PGx test results will be important to improving engagement and understanding of treatment decisions.
    Patient Education and Counseling 06/2014; · 2.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As the practice of medicine has become more patient-driven, patients are increasingly seeking health information within and outside of their doctor's office. Patients looking for information and support are often turning to the Internet as well as family and friends. As part of a study to understand the impact of delivery method of genomic testing for type 2 diabetes risk on comprehension and health-related behaviors, we assessed participants' information-seeking and sharing behaviors after receiving their results in-person with a genetic counselor or online through the testing company's website. We found that 32.6 % of participants sought information after receiving the genomic test results for T2DM; 80.8 % of those that did seek information turned to the Internet. Eighty-eight percent of participants reported that they shared their T2DM risk results, primarily with their spouse/partner (65 %) and other family members (57 %) and children (19 %); 14 % reported sharing results with their health provider. Sharing was significantly increased in those who received results in-person from the genetic counselor (p = 0.0001). Understanding patients' interests and needs for additional information after genomic testing and with whom they share details of their health is important as more information and clinical services are available and accessed outside the clinician's office. Genetic counselors' expertise and experience in creating educational materials and promoting sharing of genetic information can facilitate patient engagement and education.
    Journal of Genetic Counseling 06/2014; · 1.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pharmacogenetic (PGx) testing is a primary application of personalized medicine. While several studies are investigating the utility of PGx testing, the delivery approach has been less explored. However, benefits of testing will depend on delivery as it may affect availability of test results for treatment decisions, patient understanding of results and its relevance to other medications, and accurate interpretation and application by physicians. Several delivery models may be used, but it is not yet clear if one will predominate. We are conducting a study to assess two delivery models of PGx testing (physician-initiated and pharmacist-initiated) for commonly prescribed drugs in two primary care practices. We are evaluating the delivery models from three perspectives: physician, patient and practice setting. Patients offered PGx testing are eligible to complete a baseline survey about their history of medication-taking, and knowledge and attitudes about genetics and medications. Three months after testing, patients are invited to complete a follow-up survey to assess their experience and perceived value of testing. We present preliminary findings of both patient surveys. Of 63 patients for whom PGx testing was ordered, 17 completed the baseline survey (27%). Ten respondents were women, 13 were 50 years of age and older, and 11 had a Bachelor’s degree or higher. Respondents were taking an average of 2.6 prescribed medications each and 9 patients reported their overall health status to be excellent or very good. Patients were asked what factors from a provided list affected their decision to have PGx testing; factors considered by most were perceived value of the result to optimize treatment (n=11), understanding how testing would help the provider choose the best medicine for them (n=13) and recommendation from their provider (n=10). Twelve of the 17 (71%) completed the follow-up survey. Seven of those patients reported receiving results from their provider. Patients reported that physicians described the phenotype (e.g. poor metabolizer), discussed possible changes to current therapy based on the results, and discussed the relevance of the test result for future therapy, but that most physicians did not provide the genotype (n=5). Five patients felt they understood their PGx test result very well or somewhat well; however, only two patients could recall how the result impacted current treatment. Only one patient reported sharing results with other physicians although 11 indicated they were likely to share results; and none shared with their pharmacist, although 8 said they were likely to share with him/her. In conclusion, based on these pilot data, patients believe PGx testing to be useful; however, more effort is needed to clearly communicate test results and significance for treatment.
    American College of Medical Genetics; 03/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Genetic information, typically communicated in-person by genetic counselors, can be challenging to comprehend; delivery of this information online - as is becoming more common - has the potential of increasing these challenges. Methods: To address the impact of the mode of delivery of genomic risk information, 300 individuals were recruited from the general public and randomized to receive genomic risk information for type 2 diabetes mellitus in-person from a board-certified genetic counselor or online through the testing company's website. Results: Participants were asked to indicate their genomic risk and overall lifetime risk as reported on their test report as well as to interpret their genomic risk (increased, decreased, or same as population). For each question, 59% of participants correctly indicated their risk. Participants who received their results in-person were more likely than those who reviewed their results on-line to correctly interpret their genomic risk (72 vs. 47%, p = 0.0002) and report their actual genomic risk (69 vs. 49%, p = 0.002). Conclusions: The delivery of personal genomic risk through a trained health professional resulted in significantly higher comprehension. Therefore, if the online delivery of genomic test results is to become more widespread, further evaluation of this method of communication may be needed to ensure the effective presentation of results to promote comprehension. © 2014 S. Karger AG, Basel.
    Public Health Genomics 02/2014; · 2.57 Impact Factor
  • Susanne B. Haga, Rachel Mills, Hayden Bosworth
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Pharmacogenetic (PGx) testing can provide information about a patient's likelihood to respond to a medication or experience an adverse event, and be used to inform medication selection and/or dosing. Promoting patient comprehension of PGx test results will be important to improving engagement and understanding of treatment decisions. Methods The discussion in this paper is based on our experiences and the literature on communication of genetic test results for disease risk and broad risk communication strategies. Results Clinical laboratory reports often describe PGx test results using standard terminology such as ‘poor metabolizer’ or ‘ultra-rapid metabolizer.’ While this type of terminology may promote patient recall with its simple, yet descriptive nature, it may be difficult for some patients to comprehend and/or cause adverse psychological or behavioral responses. Conclusion The language used to communicate results and their significance to patients will be important to consider in order to minimize confusion and potential psychological consequences such as increased anxiety that can adversely impact medication-taking behaviors. Practice implications Due to patients’ unfamiliarity with PGx testing and the potential for confusion, adverse psychological effects, and decreased medication adherence, health providers need to be cognizant of the language used in discussing PGx test results with patients.
    Patient Education and Counseling 01/2014; · 2.60 Impact Factor
  • Susanne B Haga
    Pharmacogenomics 01/2014; 15(1):1-4. · 3.43 Impact Factor
  • Source
    Susanne B Haga, Rachel Mills, Jivan Moaddeb
    [Show abstract] [Hide abstract]
    ABSTRACT: Advances in pharmacogenetic research have improved our understanding of adverse drug responses and have led to the development of pharmacogenetic tests and targeted drugs. However, the extent of the communication process and provision of information to patients about pharmacogenetics is unclear. Pharmacogenetic information may be included in sections of a drug's package insert intended for patients, which is provided directly to patients or communicated via the health provider. To determine what pharmacogenetic information, if any, is included in patient-targeted sections of the drug label, we reviewed the labels listed in the US Food and Drug Administration's Table of Pharmacogenomic Biomarkers in Drug Labels. To date, 140 drugs include pharmacogenetic-related information in the approved label. Our analysis revealed that pharmacogenetic information is included in patient-targeted sections for a minority (n=29; 21%) of drug labels, with no obvious pattern associated with the inclusion of pharmacogenetic information. Therefore, patients are unlikely to learn about pharmacogenetics through written materials dispensed with the drug. Given that there are also inconsistencies with regard to inclusion of pharmacogenetic information in the patient counseling information section, it is also unlikely that patients are receiving adequate pharmacogenetic information from their provider. The inconsistent presence of pharmacogenetic information in patient-targeted sections of drug labels suggests a need to review the criteria for inclusion of information in patient-targeted sections in order to increase consistency and patient knowledge of pharmacogenetic information.
    Pharmacogenomics and Personalized Medicine 01/2014; 7:297-305.
  • Susanne B Haga, Jivan Moaddeb
    [Show abstract] [Hide abstract]
    ABSTRACT: The number and use of pharmacogenetic tests to assess a patient's likelihood of response or risk of an adverse event is expanding across medical specialties and becoming more prevalent. During this period of development and translation, different approaches are being investigated to optimize delivery of pharmacogenetic services. In this paper, we review pre-emptive and point-of-care delivery approaches currently implemented or being investigated and discuss the advantages and disadvantages of each approach. The continued growth in knowledge about the genetic basis of drug response combined with development of new and less expensive testing technologies and electronic medical records will impact future delivery systems. Regardless of delivery approach, the currently limited knowledge of health professionals about genetics generally or PGx specifically will remain a major obstacle to utilization.
    Pharmacogenetics and Genomics 12/2013; · 3.45 Impact Factor
  • Rachel Mills, Susanne B Haga
    [Show abstract] [Hide abstract]
    ABSTRACT: Personalized medicine continues to expand with the development and increasing use of genome-based testing. While these advances present new opportunities for diagnosis and risk assessment, they also present challenges to clinical delivery. Genetic counselors will play an important role in ushering in this new era of testing; however, it will warrant a shift from traditional genetic counseling to "genomic counseling." This shift will be marked by a move from reactive genetic testing for diagnosis of primarily single-gene diseases to proactive genome-based testing for multiple complex diseases for the purpose of disease prevention. It will also require discussion of risk information for a number of diseases, some of which may have low relative risks or weak associations, and thus, may not substantially impact clinical care. Additionally, genomic counselors will expand their roles, particularly in the area of health promotion to reduce disease risk. This additional role will require a style of counseling that is more directive than traditional counseling and require greater knowledge about risk reducing behaviors and disease screening.
    Journal of Genetic Counseling 09/2013; · 1.75 Impact Factor
  • Jennifer Q Zhao, Susanne B Haga
    Genetics in medicine: official journal of the American College of Medical Genetics 09/2013; · 3.92 Impact Factor
  • Source
    S B Haga, N M A Lapointe
    [Show abstract] [Hide abstract]
    ABSTRACT: Poor medication adherence is a well-known problem, particularly in patients with chronic conditions, and is associated with significant morbidity, mortality and health-care costs. Multi-faceted and personalized interventions have shown the greatest success. Pharmacogenetic (PGx) testing may serve as another tool to boost patients' confidence in the safety and efficacy of prescribed medications. Here, we consider the potential impact (positively or negatively) of PGx testing on medication-taking behavior.The Pharmacogenomics Journal advance online publication, 3 September 2013; doi:10.1038/tpj.2013.33.
    The Pharmacogenomics Journal 09/2013; · 5.13 Impact Factor
  • Jivan Moaddeb, Susanne B Haga
    [Show abstract] [Hide abstract]
    ABSTRACT: Over the last decade, the number of clinical pharmacogenetic tests has steadily increased as understanding of the role of genes in drug response has grown. However, uptake of these tests has been slow, due in large part to the lack of robust evidence demonstrating clinical utility. We review the evidence behind four pharmacogenetic tests and discuss the barriers and facilitators to uptake: 1) warfarin (drug safety and efficacy); 2) clopidogrel (drug efficacy); 3) codeine (drug efficacy); and 4) abacavir (drug safety). Future efforts should be directed toward addressing these issues and considering additional approaches to generating evidence basis to support clinical use of pharmacogenetic tests.
    Therapeutic advances in drug safety. 08/2013; 4(4):155-169.
  • Source
    Rachel Mills, William Barry, Susanne B. Haga
    [Show abstract] [Hide abstract]
    ABSTRACT: Patient trust in personal medical information is critical to increasing adherence to physician recommendations and medications. One of the anticipated benefits of learning of one's genomic risk for common diseases is the increased adoption of screening, preventive care and lifestyle changes. However, the equivocal results thus far reported of the positive impact of knowledge of genomic risk on behavior change may be due to lack of patients' trust in the results. As part of a clinical study to compare two methods of communication of genomic risk results for Type 2 diabetes mellitus (T2DM), we assessed patients' trust and preferred methods of delivery of genomic risk information. A total of 300 participants recruited from the general public in Durham, NC were randomized to receive their genomic risk for T2DM in-person from a genetic counselor or online through the testing company's web-site. Participants completed a baseline survey and three follow-up surveys after receiving results. Overall, participants reported high levels of trust in the test results. Participants who received their results in-person from the genetic counselor were significantly more likely to trust their results than those who reviewed their results on-line (p = 0.005). There was not a statistically significant difference in levels of trust among participants with increased genetic risk, as compared to other those with decreased or same as population risk (p = 0.1154). In the event they undergo genomic risk testing again, 55 % of participants overall indicated they would prefer to receive their results online compared to 28 % that would prefer to receive future results in-person. Of those participants preferring to receive results online, 77 % indicated they would prefer to have the option to speak to someone if they had questions with the online results (compared to accessing results online without the option of professional consultation). This is the first study to assess satisfaction with genomic risk testing by the method of delivery of the test result. The higher rate of trust in results delivered in-person suggests that online access reports may not result in serious consideration of results and lack of adoption of recommended preventive recommendations.
    Journal of Genetic Counseling 06/2013; · 1.75 Impact Factor
  • Rachel Mills, Susanne B Haga
    [Show abstract] [Hide abstract]
    ABSTRACT: One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services.
    Pharmacogenomics 06/2013; 14(8):957-68. · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose:Clinical whole-exome and whole-genome sequencing will result in a broad range of incidental findings, but clinicians' obligations to identify and disclose such findings are a matter of debate. We sought legal cases that could offer insights into clinicians' legal liability.Methods:We searched for cases in which incidental findings were related to the cause of action, using the search engines WestLaw, WestLaw Next, Lexis, and Lexis Advance.Results:We found no case law related to incidental findings from genetic testing but identified eight cases involving incidental findings in medical imaging. These cases suggest that clinicians may face liability for failing to disclose incidental findings that would have offered an opportunity for interventions to improve health outcome, if under the applicable standard of care, they fail to identify or appreciate the significance of the incidental finding or they negligently fail to notify other clinicians and/or the patient of the identified incidental finding. Other cases support liability for failure to refer appropriately to a clinician with greater expertise.Conclusions:Clinicians may face liability if they fail to disclose incidental information that could inform interventions to improve health outcome; information lacking clinical actionability is likely to have less import.Genet Med advance online publication 28 February 2013Genetics in Medicine (2013); doi:10.1038/gim.2013.7.
    Genetics in medicine: official journal of the American College of Medical Genetics 02/2013; · 3.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Public understanding of genetic concepts and associated ethical and policy issues can enable informed deliberation and decision-making. Effective strategies for increasing public understanding involve providing forums incorporating the unique perspectives and attitudes of the public, while allowing opportunities to learn first-hand from scientists about genome research and related applications. Through a partnership between the Duke Institute for Genome Sciences & Policy (IGSP) and the Museum of Life and Science in Durham, NC, we developed and piloted a program aimed to bridge the concepts of formal (public school) and informal (community-based science museum) science learning with the experiential context of family and participatory learning. Called Genome Diner, we piloted the program with 40 genetic/genomic researchers, 76 middle school students and their parents (n = 83) from Durham, NC. Program impact was assessed via pre/post surveys for each participant group. Following participation, parents were significantly more likely to correctly interpret the implications of a genome research finding, and both students and parents indicated higher interest in research as well as higher confidence in accessing and understanding genome research. Genetic literacy of parents and students was not affected by participation in the program, likely due to the relatively high knowledge scores pre-Diner: 88.3 % and 78.5 %, respectively. The interactive format of Genome Diner provided an opportunity for students and parents to explore and discuss interests and issues about genomic research alongside genome scientists, positively influencing attitudes toward genetic research and researchers themselves. These interactions are critical for maintaining public interest and knowledge about genomic research and applications.
    Journal of Genetic Counseling 02/2013; · 1.75 Impact Factor

Publication Stats

726 Citations
382.88 Total Impact Points


  • 2008–2014
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 2013
    • Vanderbilt University
      Nashville, Michigan, United States
  • 2006–2013
    • Duke University Medical Center
      • Institute for Genome Sciences and Policy
      Durham, NC, United States