Translating genomic testing results for pediatric critical care: Opportunities for genetic counselors.

Author information

1: Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
2: Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA.
3: Department of Anesthesiology, Perioperative and Pain Management, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
4: Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.

Abstract

Genomic sequencing (GS), such as whole genome and exome sequencing, is rapidly being integrated into pediatric critical care settings. Results are being used to make high impact decisions including declarations of futility, withdrawal of care, and rationing of scarce resources. In this qualitative study, we conducted interviews with clinicians involved in the care of critically ill children with congenital heart disease (CHD) to investigate their views on implementation of GS into clinical practice. Interviews were transcribed and inductively analyzed for major themes using grounded theory and thematic analysis. Three major themes emerged surrounding the use of genomic information in the high-stakes, time pressured decision making that characterizes clinical care of critically ill children with CHD: (a) that clinicians felt they did not have sufficient training to accurately assess genetic results despite pressure to incorporate results into clinical decisions; (b), that they desire knowledge support from genetic specialists, such as genetic counselors, who both understand the critical care context and are available within the time constraints of critical care clinical pressures; and (c), that clinicians feel a pressing need for increased genetics education to be able to safely and appropriately incorporate GS results into clinical decisions Our data suggest that genetics specialists may need a stronger presence in the pediatric critical care setting.

KEYWORDS:

congenital heart disease (CDH); critical care; education; ethics; genetic counselors; genetics education; genome sequencing (GS); genomics; whole genome sequencing (WGS)