Susanne B Haga

Duke University Medical Center, Durham, North Carolina, United States

Are you Susanne B Haga?

Claim your profile

Publications (72)413.68 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing type 2 diabetes risk for many patients; however, to date, there is little evidence that genetic testing positively affects type 2 diabetes prevention. Genetic information may not fit patients' illness representations, which may reduce the chances of risk-reducing behavior changes. The present study aimed to examine illness representations in a clinical sample who are at risk for type 2 diabetes and interested in genetic testing. The authors used the Common Sense Model to analyze survey responses of 409 patients with type 2 diabetes risk factors. Patients were interested in genetic testing for type 2 diabetes risk and believed in its importance. Most patients believed that genetic factors are important to developing type 2 diabetes (67%), that diet and exercise are effective in preventing type 2 diabetes (95%), and that lifestyle changes are more effective than drugs (86%). Belief in genetic causality was not related to poorer self-reported health behaviors. These results suggest that patients' interest in genetic testing for type 2 diabetes might produce a teachable moment that clinicians can use to counsel behavior change.
    Journal of Health Communication 04/2015; 20(6):1-8. DOI:10.1080/10810730.2015.1018563 · 1.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Some have proposed the integration of pharmacogenetic (PGx) testing into medication therapy management (MTM) to enable further refinement of treatments to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This "enhanced" MTM might also reduce patient concerns about side effects and increase confidence that the medication is effective, addressing 2 key factors that impact patient adherence: concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. In this commentary, we consider some of the challenges to the integration and delivery of PGx testing in MTM services.
    04/2015; 21(4):346-52.
  • Rachel A Mills, Jivan Moaddeb, Susanne Haga
  • Source
    Rachel A Mills, Jivan Moaddeb, Susanne Haga
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Increasingly, pharmacogenetic (PGx) testing is being utilized in a number of clinical settings including primary care clinics, specialty care clinics, and pharmacies. However, few resources have been developed to educate providers and patients about testing. Given the limited familiarity and understanding of PGx testing, it is important to have educational materials available for patients and providers to promote informed decision-making and appropriate use of testing, respectively. Educational resources about PGx testing can increase provider knowledge, address patient limitations in health and genomic literacy, and promote patient-provider communication about PGx testing and results, which may improve drug adherence. We propose that these resources may be combined into a “PGx Provider Toolkit” and “PGx Patient Toolkit” to facilitate delivery of PGx testing. Methods: As part of our research on delivery models of PGx testing, we have adapted and developed a number of educational materials, including an informational brochure for patients, a results card for patients, a CME presentation for physicians, a “pocket guide” for physicians, and a flipbook for pharmacists. These educational materials were developed by members of the research team who are knowledgeable and experienced in the fields of genetics, pharmacogenetics, educational outreach, and development of educational materials. Other methods, such as patient focus groups and patient and provider surveys were used to elicit feedback about the value of these materials. We continue to update and revise the materials based on user feedback and current clinical data. Results: With respect to the patient materials, two significant findings emerged from a patient focus group reviewing the informational brochure. Participants preferred “drug response testing” to “pharmacogenetic testing,” and believed any photos or graphics included should include a diverse array of people (race and age). In one clinical study, patients who underwent PGx testing were provided a results card including the genotype of interpretation of result. Of those patients surveyed, 94% found the results card very helpful and almost half (47%) showed the card or discussed results with family, friends or other providers. Physicians who offered PGx testing as part of a different study were surveyed regarding the CME seminar. A total of 74% physicians agreed or strongly agreed that the 60-minute CME on PGx was informative and provided them with the necessary information to offer PGx testing to patients and use the results appropriately. Some physicians suggested the CME should include additional information about different types and features of PGx testing and less background information about genetics to better prepare them for practice. For community pharmacists, we have adapted a flip-chart to be used to introduce PGx testing to consumers taking medications for which testing is available, and are developing a web-site (www.RxPGx.com) which will include additional resources. Analysis of the usefulness of these materials will be conducted in the near future. Conclusions: While use and review of the educational tools is voluntary, we have found that physicians and patients greatly benefit from completing a CME seminar on PGx testing, and patients value targeted educational materials, respectively. Given the limited availability of accurate, up-to-date and patient-friendly resources, it is important to continue to develop and make freely accessible educational tools that can be used in the delivery of PGx testing.
    ACMG Annual Clinical Genetics Meeting, Salt Lake City; 03/2015
  • Source
    ACMG Annual Clinical Genetics Meeting, Salt Lake City, UT; 03/2015
  • Susanne B Haga, Rachel Mills
    [Show abstract] [Hide abstract]
    ABSTRACT: As pharmacogenetic (PGx) testing is becoming integrated into routine clinical procedures for admitted hospital patients, consideration is needed as to when test results will be communicated to patients and by whom. Given the implications of PGx test results for current and future care, we propose that if results are not promptly discussed with patients when testing is completed, results should be discussed with patients during discharge care when possible, included in the printed or electronic discharge summary and a copy of the results sent to their primary provider. Nurses play an important role in discharge planning and care by providing patients with the necessary information and support to transfer from the hospital setting to an outpatient setting or to return to home and work. To promote nurses' ability to fulfill the role of communicating PGx test results, revised curricula and interprofessional and clinical decision support are needed.
    Pharmacogenomics 03/2015; 16(3):251-6. DOI:10.2217/pgs.14.173 · 3.43 Impact Factor
  • Susanne B Haga, Jivan Moaddeb
    Pharmacogenomics 03/2015; 16(4):299-301. DOI:10.2217/pgs.14.184 · 3.43 Impact Factor
  • [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. DOI:10.2217/pgs.14.118 · 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 10/2014; 7:297-305. DOI:10.2147/PGPM.S67876
  • Patricia A Deverka, Susanne B Haga
    Clinical Chemistry 10/2014; 61(1). DOI:10.1373/clinchem.2014.223412 · 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. DOI:10.2217/pgs.14.109 · 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. DOI:10.1186/s13073-014-0058-6 · 4.94 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 06/2014; 97(1). DOI:10.1016/j.pec.2014.06.007 · 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; 24(1). DOI:10.1007/s10897-014-9736-1 · 1.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 genotype guided statin therapy (GGST) are unknown. Primary care patients (n = 58) who were nonadherent to statins and their providers received SLCO1B1*5 genotyping and guided recommendations via the electronic medical record (EMR). The primary outcome was the change in Beliefs about Medications Questionnaire, which measured patients' perceived needs for statins and concerns about adverse effects, measured before and after SLCO1B1*5 results. Concurrent controls (n = 59) were identified through the EMR to compare secondary outcomes: new statin prescriptions, statin utilization, and change in LDL-cholesterol (LDL-c). GGST patients had trends (p = 0.2) towards improved statin necessity and concerns. The largest changes were the "need for statin to prevent sickness" (p < 0.001) and "concern for statin to disrupt life" (p = 0.006). GGST patients had more statin prescriptions (p < 0.001), higher statin use (p < 0.001), and greater decrease in LDL-c (p = 0.059) during follow-up. EMR delivery of SLCO1B1*5 results and recommendations is feasible in the primary care setting. This novel intervention may improve patients' perceptions of statins and physician behaviors that promote higher statin adherence and lower LDL-c.
    06/2014; 4(2):147-162. DOI:10.3390/jpm4020147
  • 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; 17(2). DOI:10.1159/000358413 · 2.46 Impact Factor
  • Susanne B Haga
    Pharmacogenomics 01/2014; 15(1):1-4. DOI:10.2217/pgs.13.211 · 3.43 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, 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; DOI:10.1097/FPC.0000000000000028 · 3.45 Impact Factor