Knowledge, Attitudes and Education of Pharmacists Regarding Pharmacogenetic Testing

Mary W Roederer; Marcia Van Riper; John Valgus; George Knafl; Howard McLeod

Personalized Medicine. 2012;9(1):19-27.

Methods

With the increase in evidence supporting the use of pharmacogenetics in clinical practice, a panel of experts from the University of North Carolina (UNC; NC, USA) Center for Genomics and Society and the UNC Institute for Pharmacogenomics and Individualized Therapy (IPIT), created a survey that addressed not only knowledge of pharmacogenetics, but also attitudes regarding pharmacogenetic testing. The survey was evaluated by an interdisciplinary group of nurses, physicians and pharmacists with expertise in pharmacogenetic testing and pilot-tested with five clinicians prior to the beginning of data collection. The survey included: six background information questions, two questions designed to assess overall perceptions of understanding regarding genetics and pharmacogenetics, ten basic knowledge questions (five about genetics and five about pharmacogenetics), eight questions concerning attitudes about pharmacogenetic testing (four about pharmacogenetic testing in general and four focusing on pharmacogenetic testing to guide warfarin therapy), four questions for clinicians with prescriptive privileges, and two questions developed to assess interest in future educational offerings regarding pharmacogenetic testing.

The Institutional Review Board at the UNC at Chapel Hill determined that the Institutional Review Board approval was not required because responses to the survey were anonymous. An email invitation to participate with a link to an online survey through the survey engine, Survey Monkey, was distributed to 9516 pharmacists licensed in the state of North Carolina, USA, via the NC Board of Pharmacy distribution list in February of 2009.^[102]

Statistical Analysis

Descriptive statistics were generated for all respondents as a group, including frequencies for categorical variables and means for continuous variables. Knowledge scores (i.e., total correct out of the five genetics questions, out of the five pharmacogenetics questions, and out of all ten questions) were compared across selected categorical respondent characteristics using one-way analysis of variance tests. When associated F tests were significant, post hoc analyses were conducted using Duncan's multiple range test to identify respondent groups with different mean knowledge. All statistical analyses were performed using SAS software system version 9.2. In all circumstances p-values of less than 0.05 were used to define significance.

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Table 1. Types of prior genetics education ^† (n = 728).
Type of genetics education	Respondents (%)
No genetics education	47.0
Undergraduate genetics course	26.1
Continuing education course	14.2
Seminar or workshop	8.7
Grand rounds	6.5
Other	9.6

^†More than one response allowed.

Table 2. Questions on attitudes about phamacogentic testing.
Question number	Mean value and standard deviation	Question assessing attitude regarding pharmacogenetic testing
1	Mean: 3.5; standard deviation: 1.0	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the number of adverse drug reactions?
2	Mean: 3.0; standard deviation: 1.3	How concerned are you that unauthorized persons may gain access to the results of a patient's pharmacogenetic testing?
3	Mean: 2.4; standard deviation: 1.2	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the cost of developing new drugs?
4	Mean: 2.6; standard deviation: 1.3	How concerned are you that pharmacogenetic testing may result in discrimination by employers and/or insurance companies?
5	Mean: 3.5; standard deviation: 1.0	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the time it takes to find the optimal dose of warfarin for patients?
6	Mean: 3.7; standard deviation: 1.0	How comfortable would you be having genetic information incorporated into the determination of your patient's initial warfarin dose?
7	Mean: 3.5; standard deviation: 1.0	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the adverse reactions experienced by patients on warfarin?
8	Mean: 3.9; standard deviation: 1.1	If you were the patient being started on warfarin, how comfortable would you be having genetic information incorporated into the determination of your initial dose of warfarin?

Contains the eight questions related to attitudes about pharmacogenetic testing. There were five possible responses for each question ranging from 1: not likely to 5: very likely for questions 1, 3, 5 and 7; 1: not concerned to 5: very concerned for questions 2 and 4; and 1: not comfortable to 5: very comfortable for questions 6 and 8. The response to questions 2 and 4 were reverse coded so that larger values for all eight questions corresponded to more positive attitudes. A total positive attitude score was then computed as the average of the eight attitude questions. Cronbach's a for this attitude scale was acceptable at 0.71. Within the table individual mean scores for each question are reported, along with standard deviation.

Box 1. True or false questions assessing knowledge.
*Questions assessing genetics knowledge*
Humans are over 99% identical at the DNA level ^† Mean: 0.5; standard deviation: 0.5 Most cells in the body contain 47 chromosomes ^‡ Mean: 0.6; standard deviation: 0.5 Every time the human body produces a sperm or an egg, approximately 3 billion nucleotides (bases) must be copied and packaged so they can be passed along to future offspring ^† Mean: 0.4; standard deviation: 0.5 The nucleotides (bases) in DNA, always match up the same way – 'A' always pairs with 'C' and 'G' always pairs with 'T' ^‡ Mean: 0.4; standard deviation: 0.5 A number of genetic conditions, such as sickle cell anemia, are caused by a mutation in a single gene ^† Mean: 0.7; standard deviation: 0.4
*Questions assessing pharmacogenetics knowledge*
Subtle differences in a person's genome can have a major impact on how the person responds to medications ^† Mean: 0.8; sstandard deviation: 0.4 Genetic determinants of drug response change over a person's lifetime ^‡ Mean: 0.4; standard deviation: 0.5 Genetic variations can account for as much as 95% of the variability in drug disposition and effects ^† Mean: 0.5; standard deviation: 0.5 The package insert for warfarin includes a warning about altered metabolism in individuals who have specific genetic variants ^† Mean: 0.5; standard deviation: 0.5 Pharmacogenetic diagnostic testing is currently available for most medications ^‡ Mean: 0.7; standard deviation: 0.5
^†The questions that are the true statements. ^‡The questions that are false statements. The means and standard deviations for the response to each question, where 1 point is awarded to correct responses, are reported for each question.

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