Well-informed patients key to accepting gene-based drug dosing

The acceptance of pharmacogenetic testing by patients or parents of patients depends on baseline knowledge about pharmacogenetics, but not on parenthood, found a new study.

Pharmacogenetics is the study of how a patient's genes can affect drug reaction and dosage. It promises to optimize patient response to therapy, but this is the first study to really investigate how patients perceive this kind of genetic testing, and whether those perceptions differ when it comes to parents and their children.

The new study out of Western University in London, Ontario, Canada, illustrates the need for a lot more education around pharmacogenetics. The research, led by Michael Rieder, MD, PhD, of Western's Schulich School of Medicine & Dentistry was published in Pediatrics (2014; doi:10.1542/peds.2013-1416).

"Pharmacogenetic testing has become widely used and gene-based drug dosing is becoming a reality for a number of common health problems. This study confirms what we suspected; Whether or not you're a parent, your degree of acceptability of genetic testing was determined by your knowledge of it. That is to say—if you understand what the test is for, and the concept of gene-based drug dosing, you're far more open to it, than if you don't understand it," said Rieder.

The researchers surveyed three groups: 236 medical students representing those having greater educational exposure to pharmacogenetics, 1,226 lay people who are parents, and 105 lay people with no children. A second survey was completed by 229 parents. The surveys did not use the term pharmacogenetics, but rather asked about "DNA testing to guide therapy." The study concluded that the acceptability of pharmacogenetic testing, either for oneself or one's child, seemed to depend on baseline pharmacogenetic knowledge, but not on parenthood.

The main concern for all respondents was the need for informed consent. Other findings included that pharmacogenetics was more accepted when the disease was severe, that there was a strong desire and demand for separate consent for pharmacogenetics testing, and that more education about pharmacogenetics is needed in medical schools. Also, the acceptability of genetic testing did not differ whether the testing was for the parent or the child.

Rieder said pharmacogenetics should take a lesson from pediatric oncology. He says health care workers in that division do a good job in the way they frame the discussions around care, treatment, and consent. "When they have to make a diagnosis, they spend a lot of time explaining what tests they're going to do, the risks, and what therapies are available. And they're successful. Their patients comply with treatment, they get involved in studies, they're informed, and they want to know what's going on."

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