Article

Incidental findings in genetic research and clinical diagnostic tests: A systematic review

School of Nursing and Midwifery, Plymouth University, Plymouth, UK. .
American Journal of Medical Genetics Part A (Impact Factor: 2.16). 12/2012; 158A(12). DOI: 10.1002/ajmg.a.35615
Source: PubMed

ABSTRACT

Incidental findings arise when clinically relevant genetic information about a research participant or patient is identified outside the scope of the original research objective or diagnostic test being performed. These findings can relate to carrier status for a heritable condition, misattributed paternity or increased susceptibility to a medical condition. The decision whether to disclose these findings to the research subject or patient is underpinned by many ethical, moral, and potentially legal considerations. There is an urgent need for definitive guidelines for researchers and healthcare professionals. We performed a systematic review of the relevant literature concerning the disclosure of incidental findings, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, using the prescribed flowchart and checklist. At initial screening, 473 articles were retrieved. The inclusion and exclusion criteria aimed at obtaining data that were relevant and of sufficient quality were applied and a total of four relevant studies were identified, comprising 2,680 individual participants and 1,023 guidance documents. Major themes emerging from the included articles include patient autonomy, patient welfare, harmful secrets, and genetic literacy. The lack of relevant studies emphasizes the urgent need for empirical investigations into the disclosure or non-disclosure of genetic incidental findings, and the provision of guidelines to assist healthcare professionals and researchers. © 2012 Wiley Periodicals, Inc.

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Available from: Leigh Jackson
    • "The return of unexpected, or " incidental, " findings is one of many concerns accompanying the introduction of genome sequencing in health care. Others include issues around privacy , discrimination, insurability and patient and consumer protection (Jackson et al. 2012, Hens et al. 2013), all of which have relevance to holistic nursing care. "
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    ABSTRACT: Aims and objectives: The aim of this discussion paper is to enable nurses to understand how deoxyribonucleic acid analysis can be predictive for some diseases and not predictive for others. This will facilitate nurses to interpret genomic test results and explain them to patients. Background: Advances in technology mean that genetic testing is now commonly performed by sequencing the majority of an individual's genome or exome. This results in a huge amount of data, some of which can be used to predict or diagnose disease. Design: This is a discussion paper. Methods: This paper emerged from multiple discussions between the three authors over many months, culminating in a writing workshop to prepare this text. Results: The results of DNA analysis can be used to diagnose or predict rare diseases that are caused by a mutation in a single gene. However, while there are a number of genetic factors that contribute to common diseases, the ability to predict whether an individual will develop that condition is limited by the overall heritability of the condition. Environmental factors (such as lifestyle) are likely to be more useful in predicting common disease than genomic testing. Genomic tests may be of use to inform management of diseases in specific situations. Conclusions: Genomic testing will be of use in diagnosing disorders due to single gene mutations, but the use of genomic testing to predict the chance of a patient being affected in the future by a common disease is unlikely to be a realistic option within a health service setting. Relevance to clinical practice: Nurses will increasingly be involved in the use of genomic tests in mainstream patient care. However, they need to understand and be able to explain to patients the practical applications of and limitations of such tests.
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    • "Consequently , guidance is needed on what information should be discussed and consented to preceding the test; which results to disclose to the patient (which may have consequences for relatives) and the extent to which patients should decide on what should be reported back to them [Berg et al., 2011; Ormond et al., 2010; Ostrer, 2011; Thorogood et al., 2012]. Although the criteria for the informed consent procedure for NGS are currently a subject of debate within the professional community [Thorogood et al., 2012; Wright et al., 2011], no practical guidance has been described so far [Jackson et al., 2012]. "
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    ABSTRACT: High-throughput nucleotide sequencing (often referred to as next generation sequencing) is increasingly being chosen as a diagnostic tool for cases of expected but unresolved genetic origin. When exploring a higher number of genetic variants, there is a higher chance of detecting unsolicited findings. The consequential increased need for decisions on disclosure of these unsolicited findings poses a challenge for the informed consent procedure. This article discusses the ethical and practical dilemmas encountered when contemplating informed consent for next generation sequencing in diagnostics from a multidisciplinary point of view. By exploring recent similar experiences with unsolicited findings in other settings an attempt is made to describe what can be learned so far for implementing next generation sequencing in standard genetic diagnostics. The article concludes with a set of points to consider in order to guide decision-making on the extent of return of results in relation to the mode of informed consent. We hereby aim to provide a sound basis for developing guidelines for optimizing the informed consent procedure. This article is protected by copyright. All rights reserved.
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    • "What should be done with this data and what might research participants want to know? A systematic review of research about these very issues revealed a " lack of relevant studies " and an " urgent need for empirical investigations in the disclosure or nondisclosure of genetic incidental findings " [Jackson et al., 2012]. "
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    ABSTRACT: There is no universally accepted definition of what an incidental finding is [Wolf et al., 2008] and broadly speaking this could include variants of known and unknown clinical significance, variants linked to highly penetrant, serious, life-threatening conditions, non-paternity or ancestry data. For the purposes of our study, we have adopted a pragmatic distinction between ‘pertinent’ and ‘incidental’ findings as set out in this text. Whilst in the US definitions of incidental findings are becoming accepted in practice [Green et al., 2013] it is still not known how and whether these also apply elsewhere around the world.
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