Genomic Competency Initiative

Division Of Basic Sciences - Nci

Investigators

Linked publications & trials

Abstract

Project 1) Nursing Capacity in Pharmacogenomics: The collaborative national study of advanced practice nurses (APRN) with Dr. Cathy Fulton at Indiana University asseses pharmacogenomic capacity. The exempt protocol is completed with findings prescented at the June 2023 American Association of Nurse Practitioners meeting. The manuscript is being submitted to the Journal of the American Association of Nurse Practitioners but delayed due to the IU statistician who had to repeat the analysis 3 times. The study recruited 266 practicing APRNs with prescriptive privileges. Findings about half N=124, 48%, reported pharmacogenomic academic training content. Despite that, most N=216, 86% reported being not at all familiar N=18, 7%, not very familiar N=80, 32%, or only somewhat familiar N=118, 47% with pharmacogenomics. Most N=209, 79% reported never utilizing CPIC Guidelines. Pharmacogenomic usage defined as ordering a pharmacogenomic test within the past year was low N=71, 28%. Why APRNs, N=162 indicated they do not anticipate ordering a pharmacogenomic test in the next year, about half, N=76, 47% indicated they did not know what test to order. Conclusions are that APRNs reporting pharmacogenomics curricular content did not impact pharmacogenomic familiarity, confidence, capacity to order a pharmacogenomic test or usage. The protocol to assess APRN pharmacogenomic curricular content is being finalized and the instrument is established. We have permission to recruit through the National Organization of Nurse Practitioner Faculties targeting American Association of Colleges of Nursing Accredited Schools, N=910. We will target Deans to identify faculty responsible for pharmacogenomic curricular content, a strategy successfully used by phamacy studies PMIDs: 31250730 and 34283786. The study involves a survey and may be amended to include targeted qualitative interviews if indicated. Outcomes will identify curricular gaps and faculty capacity deficits to inform education interventions and convene panel including experts in nursing, medicine, and pharmacy to develop a model nursing pharmacogenomic curriculum. Project 2) Global Genomics Nursing Alliance (G2NA): G2NA led by the US, UK, and 23 global nursing leaders has grown to 174 nursing leaders. The G2NA website https://g2na.org/ has funding and support from the University of South Wales; sustains quarterly education webinars; grown the countries represented; established a strategic plan; communicates through a listserv; and is conducting research. Primary efforts are aimed at establishing Global Minimal Genomic Competencies for nurses and midwives. The leadership team includes Emma Tonkin, PhD from UK and myself. The steering groups meets monthly and includes representatives from Africa, Brazil, Israel, and Japan. Methods for establishing the competencies have been established. The literature scoping review is in process. G2NA, lead by investigators at Tampere University of Applied Sciences in Finland submitted October, 2022 a COST Action European Union grant which provides funding for European and global research and capacity building initiatives. This was close to fundable range. With detailed reviewer comments the same team will resubmit with 15 country partners in October, 2023. If funded, this will facilitate the ability to convene meetings for establishing a research consortium, genomic capacity building initiatives, and establishing evidence-based best practices with a supporting resource toolkit. This will be the basis for establishing the global genomic communities of practice. Establishing a Global Genomic Nursing Science Blueprint is active but delayed. The systematic review is completed. There were 8532 papers of which: 84 duplicates were eliminated; 8448 abstracts were reviewed with 7833 excluded; 615 underwent full text review and 232 were included in the final analysis. Identified themes were collapsed into categories across five settings (clinical practice, nursing education, professional development, academic research, other) and six topical areas (knowledge and perceptions, application to practice, pre-licensure registered nurse education, advanced practice registered nurse education, nursing faculty education, continuing education, other) for more granular reporting. 22.3 percent of articles focused on educating either pre-licensure registered nursing students, advanced practice registered nursing students, nursing faculty, or providing continuing education for practicing nurses. Other articles were on storytelling, instrument development/validation, and culturally appropriate pedigree nomenclature. 126 articles from 2012-2022 were identified relating to healthcare provider-related clinical and educational outcomes. A median of 12 articles were published each year exhibiting a nearly linear growth pattern in cumulative publications on nursing and genomics. The manuscript describing the findings is being written followed by using these findings to convene a panel to establish the Global Genomic Nursing Science Blueprint to prioritize research where evidence is sparse. 4) The Genomic Nursing Competency (GNC) Update: With collaborators Laurie Badzek and the American Nurses Association (ANA), a national nursing precision health and genomic competency initiative continues. The previously updated but not published Genomic Nursing Competencies were disseminated for public comment in 11/2022. Changes were integrated and ANA digitally produced the competencies and published 6/2023 as a free e-book https://www.nursingworld.org/nurses-books/ana-books/ebook-essentials-of-genomic-nursing-competencies-/. The publication describing the Delphi study and updated competencies is in progress. ANA agreed to integrate the competencies into Scope and Standards of Practice so competencies will no longer be required. ANA is supporting the update to Genetic and Genomic Competencies for Graduate Nurses using the same Delphi methodology. Reviewers have been selected and the list approved by ANA. However, these competencies are extensive and pilot testing revealed the Delphi survey was too burdomeson. The survey is being redesigned and the launch is dependent on the next round of testing. Competencies will be revised based on the final Delphi round then disseminated for public comment and digitally published, followed by integration into Scope and Standards. Lastly, ANA collaborated wtih us to conduct a national precision health and genomics competency assessment to inform whether a national nursing genomic education initiative is required. The Genetic and Genomic Nursing Practice Survey and the newly validated Precision Health Survey were combined and the survey closed on 7/14/2023 having accrued 1066 participants. Data analysis is being planned with the genomic data being compared to the prior national nursing workforce study N=661. Findings will inform capacity building initiatives. The Cedars Sinai genomic implementation, built on the MINC study and use the Roadmap and Maturity Matrix Tool is on hold. Cedars collaborator Dr. Bernice Colman, worked with me to complete the protocol but is not submitted to the IRB. Cedars has competing demands and despite leadership approval cannot move forward now. The cancer focused MINC-2 with a phased approach beginning with Cedars in Los Angeles followed by all Cedars hospitals with cancer services remains unchanged. If this project moves forward, it will measure genomic competency and implementation at baseline and at the conclusion of the intervention and compare usual hospital planned education/competency initiatives to the intervention. Per NIH IRB guidance, the protocol will be submitted to Cedars and once approved will have an NIH reliance agreement. I am looking for other sites including Indiana University, site of my former post doc Valerie Willis.