Counseling Patients
Ariel L. Clark, PharmD
Pharmacist-provided pharmacogenomic counseling has grown in popularity as genetic testing has increased in availability. However, there remains no clear consensus on how to properly educate patients on their results.
In a recent article published July 25, 2022, in the American Journal of Health-System Pharmacy (AJHP), Ho and colleagues sought to provide clinicians with guidance on how best to counsel patients on pharmacogenomic testing results, suggesting they rely on an acronym as they decipher the complex genomic results.
As pharmacists begin to unravel their patients’ pharmacogenomics panel, authors urge them to be “OPTIMIZED” as they share results.
O: Overview of the genetic result
Patients often seek out pharmacogenomic testing as a result of an adverse event from a medication and they are looking for answers in their results. In these instances, clinicians are encouraged to first learn what is most important to their patient.
If a patient is testing to understand how to better make choices for their care in the future, it may be an opportune time to share an overview of the results that may have the greatest impact down the road. In both instances, it is important to ensure that pharmacists, prescribers, and patients are on the same page.
P: Pharmacogenomic interactions
Genes that encode drug-metabolizing enzymes may be of particular importance when explaining results to patients as changes in these genes can disrupt the expected clinical response for a patient, either in terms of effectiveness of a medication or in a patient’s risk for adverse events.
In these instances, experts agree that clinicians should describe what their patient’s genes mean related to what medications they are taking or what medications they could take in the future.
T: Take account of gene–drug–drug interactions
In cases where patients are prescribed concomitant enzyme inhibitors or inducers, focus should be given to the results from their panel on the enzyme and the drug in question, followed by a description of the effect of the concomitant drug on the drug-enzyme reaction. Gene–drug–drug interactions account for nearly 20% of adverse events, though the implications in individual cases vary.
I: Initial drug change considerations
Changes to a patient’s drug regimen after pharmacogenomic testing can be considered but should come after careful consideration of the results by clinicians. The authors of the AJHP article suggest that pharmacists, patients, and primary care providers work together to decide what the best medication therapy decisions are for patients moving forward.
M: Manage genes with future, familial, and disease-risk implications
After addressing the drugs or genes related to a patient’s primary concern, Ho and colleagues suggest that pharmacists should then take the time to describe any high-risk genotype results that may have future implications. Include particular emphasis on alleles with a dominant inheritance pattern, though familial results may not directly correlate.
I: Interpretation and application updates over time
Another important piece of genomic counseling that pharmacists should ensure patients understand is the ever-evolving landscape of pharmacogenomics. New research and new drugs may necessitate additional counseling or further testing in time as new advances are made.
Pharmacists are encouraged to describe this reality to patients and share that, as with many other avenues in health care, interpretations—and therefore interventions—may change with time.
Z: Zero in on patient comprehension
Pharmacists are highly trained in patient counseling, and using techniques such as the teach-back method are very effective and open up opportunities for pharmacists to clarify any points of confusion, ensuring that patients have a thorough understanding of their results.
ED: Education about sharing results and supplemental information
Sharing results after testing is eased when patients’ care is delivered through a single institution via the utilization of an electronic health record. After reviewing results with patients directly, clinicians should encourage them to share their results with all of their providers, specifically those outside of a health-system. Sharing results with community pharmacists is specifically important because community pharmacists represent a critical touchpoint in patient care.
As pharmacists continue to offer pharmacogenomic counseling services to patients, it is vital to review post-test counseling recommendations to ensure that patients gain a thorough and adequate understanding of their individual results, while also highlighting the ever-changing landscape of pharmacogenomic research. Ho and colleagues note that while this method of post-test counseling requires additional refinement, the “OPTIMIZED” acronym can provide clinicians with the groundwork they need to provide the best possible patient counseling. ■