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Table 3 Main topics and findings discussed relating to pharmacogenomics and potential unintended negative consequences

From: Leveraging the utility of pharmacogenomics in psychiatry through clinical decision support: a focus group study

Summary of major points addressed from the focus groups
  Use of pharmacogenomics Potential negative consequences
Major points raised during discussion The results summary is generally sufficient
Physicians do consult the full report if:
Unfamiliar with vendor
Desire in-depth analysis
Clinical consideration
PGx is generally not used as a first step
Generally saved for poor responders or bizarre symptoms
Can be used to satisfy worried parents and patients
Providers-PGx trust is important to act on PGx results
Providers are more likely to trust familiar vendors
Allele and metabolizer information is important
Physical PGx reports may be handed to patients
To serve as a prop
To allow patients to supply other providers with PGx results
Current shortcomings with using PGx at the point of care
Clinicians have difficulty incorporating PDF reports in their workflow
PGx information does not integrate with patient information such as current and prospective medications at the point of prescribing
Alert fatigue
Unnecessary alerts should be avoided to limit distraction from important alerts
However, a lack of critical alerts is also negative
Difficulty to input relevant information
This type of information includes:
Ratings/scores from third party vendors
Hand-written lab reports
Addition of time to the length of visit
Providers generally only have 30 min for an examination
Providers are unlikely to use tools that increase time
Proper position of the CDS within the workflow will increase efficiency
Clinicians may lack trust in displayed data
Past experiences with CDS suggest not all relevant data are surfaced properly
Confirmation of the accuracy of information will ease some of these concerns
Frustration using CDS
Clinicians often deal with slow and inconsistent CDS
Clinicians will discard cumbersome CDS