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.

Future Perspective

With new graduates matriculating from schools of pharmacy in the USA, the pharmacogenetics knowledge is changing. The accrediting body for schools of pharmacy, the American Council on Pharmaceutical Education, encourages systematic integration of pharmacogenetics into the education of doctor of pharmacy students alongside other specific drug information.^[103] From 2005 to 2010, the schools of pharmacy surveyed improved in the education of pharmacogenetics provided to doctor of pharmacy students (from 39% in 2005 to 89% in 2010).^[13,14] The level of didactic, and hopefully experiential education that incorporates principles of pharmacogenetics is likely to grow exponentially. There is a need for all pharmacists to feel comfortable interpreting medication related information that considers pharmacogenetic testing and be adept at relaying that information at the point of patient care.

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Acknowledgements
The authors wish to acknowledge individuals who were instrumental in developing the measure used in this study: JP Evans, D Jonas, K Manickam and K Weck.

Financial & competing interests disclosure
The authors wish to acknowledge support from the UNC Center for Genomics and Society (funded by the Ethical, Legal and Social Implications Research Program, National Human Genome Research Institute: P50HG004488). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research
The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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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