Background: Major depressive disorder (MDD) is commonly treated with antidepressants, but many patients undergo trial-and-error to find the medication best suited for them. Pharmacogenomic (PGx) testing was developed to provide prescribing guidance for a variety of medications including antidepressants. PGx testing is not yet part of standard depression care in Canada, but clinical implementation efforts are ongoing. Patient perspectives, as well as the views of people with professional expertise about this technology, are critical to health technology assessment (HTA) and policy decisions, and can inform implementation.
Methods: This dissertation produces actionable patient and key informant (i.e., clinician, scientists, policy actor, industry member) perspectives evidence for future HTA and policy- making through three independent studies: a systematic review and qualitative meta-synthesis of patient experiences of treatment-resistant depression (TRD), and two qualitative description studies about patient and key informant perspectives on PGx testing to guide antidepressant prescribing.
Results: Trial-and-error of medications often leaves patients feeling hopeless but desperate to get better. Patients and key informants both felt the main benefit of PGx testing is its potential to reduce the time between diagnosis and successful treatment. The main findings of this research were concrete suggestions for how PGx testing may be integrated in the health system. Participants preferred this technology be deployed in primary care, with patients with TRD identified as a possible priority population. The ideal PGx test would incorporate genetic variants common in non-white populations to ensure equity of health outcomes, and mechanisms to facilitate equity of access (eg., public funding) were considered important.
Conclusions: Patients and key informants both described benefits of PGx testing to guide antidepressant prescribing. Patients typically raised more concerns than key informants. Future research is needed around some of the ethical and social issues related to PGx testing, as well as to address feasibility questions. / Dissertation / Doctor of Philosophy (PhD) / Pharmacogenomic (PGx) testing may facilitate targeted prescribing of antidepressants by identifying genetic factors that play a role in how a person responds to these drugs. However, this technology is not yet widely or systematically used in clinical care. This dissertation focuses on how PGx testing might be implemented in primary care in Ontario, Canada. It examines which patients this type of genetic testing may be most appropriate for, and collects and analyzes the views of patients with depression and experts on PGx testing about this technology. The main benefit of PGx testing was its potential to help people get better faster, and primary care was uniformly considered an appropriate care setting for the use of this technology. There were some concerns that people may not fully understand the limitations of PGx testing. Future research is needed to understand how this technology might fit into clinician workflows across the healthcare system.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29886 |
| Date | January 2024 |
| Creators | Cernat, Alexandra |
| Contributors | Vanstone, Meredith, Health Policy |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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