Cheryl VerStrate on the Pitfalls of Direct-to-Consumer Genetic Tests

Healthcare professionals understand that direct-to-consumer genomic tests (DTCGT) are not as comprehensive as patients may believe and yield some unforeseen ethical complications by eliminating pretest counseling. However, patients may not realize this, according to Cheryl VerStrate, DNP, AGPCNP-BC, OCN. Because of this, according to VerStrate, nurses should be prepared to teach their patients that DTCGT tests are usually based on single nucleotide variant technology and, therefore, are not as comprehensive as clinical genomic testing for germline risk.

In an interview with Oncology Nursing News, VerStrate explained how she talks to patients about these tests and why it is so important for nurses to be prepared to discuss DTCGT with their patients. VerStrate is a hematology/oncology nurse practitioner with a background in cancer genetics and an assistant professor at the Kirkhof College of Nursing at Grand Valley State University in Grand Rapids, Michigan. Recently, she co-authored an article that was published in the Clinical Journal of Oncology Nursing, highlighting the disadvantages of at-home genomic tests.

In the publication, VerStrate and her co-author offered some case studies to illustrate why patients may be drawn towards these types of tests. For example, a patient who was recently referred for clinical genomic testing may be unable to take time away from work and not want to wait for over a month for an appointment slot that works with their schedule. This patient may say, “Why wait for an appointment when I can complete DTCGT much sooner?”

To that end, VerStrate and recomends that the nurse responds by saying, “Genomic testing may have significant implications for your future insurability, disease risk, medical management, and family dynamics, and can have a substantial psychological impact. Undergoing pretesting counseling will help you better understand these concerns and decide whether you want pursue testing at this time.” Nurses may go on to remind patients that this is not an emergency and thanking the time for counseling will help them make a good decision. They may also remind them that telehealth options may be a convenient option for patients and allow them less time away from work.

Nurses may also meet patients who want help interpreting DTCGT results. They may be concerned because a family member received a pathogenic finding using DTCGT or believe they have a low risk of cancer because their DTCGT results came back negative. Ultimately, nurses are encouraged to tell their patients that confirmatory testing in the clinical setting is necessary to determine whether these results hold weight, and that DTCGT results alone should not be used in clinical decision-making.

Reference

1. VerStrate CA, Mahon SM. Direct-to-consumer genomic testing through an ethics lens: oncology nursing considerations. Clin J Oncol Nurs. 2023;27(4):380-388. doi:10.1188/23.CJON.380-388