Interdisciplinary Collaboration Among Nursing and Computer Science to Refine a Pharmacogenetics Clinical Decision Support Tool Via Mobile Application.

In previous work, a prototype clinical decision support mobile application was created that accepts a patient's genomic profile information and provides information and rationale for the prescription of certain oncology medications. The response to the instrument was overwhelmingly positive by healthcare providers in the oncology field who tested the instrument. This article reports on the interdisciplinary collaboration among nursing and computer science to redesign and reimplement a new version of the instrument with expanded functionality and improved usability. This article describes the functionality, usability considerations, and usability evaluation of the instrument over three versions. The current version is Web-based and responsive to different screen sizes (desktop, tablet, mobile), features improved usability, and expands the number of gene-drug recommendations provided based on Clinical Pharmacogenetics Implementation Consortium dosing guidelines. This project represents a successful new collaboration between the nursing and computer science disciplines.

Refinement of a pharmacogenomics app for dosing guidelines for oncology: findings from the usability evaluation.

Background: This study extended a precision medicine clinical decision support mobile application (app) for use with oncology medications. Two gene variants (CYP2D6 and DPYD) associated with pharmacogenomic dosing algorithms in oncology was added to a prototype app. Usability of the app was evaluated. The use of smartphones and mobile apps for prescribing medications has exponentially increased since the introduction of physician order entry. Decision support apps have improved provider performance and studies have shown broader adoption is crucial for the success of these tools. Therefore, successful use of mobile apps will depend on perceptions of users. Rogers' Diffusion of Innovation theory will be the guiding framework for this study. Methods: The main research variable is usability as measured by effectiveness, efficiency, and satisfaction. A mixed method design was used. The setting was inpatient and outpatient oncology practices within North Carolina. The sample included registered nurses and nurse practitioners within the oncology field. A functioning mobile app was extended based on the Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines to address the most common gene variants seen in oncology patients. Usability testing is divided into two main categories, inspection and testing methods. Prior to the field study, a heuristic evaluation was conducted. This evaluation inspected the user interface, comparing the elements and aspects of it to a set of principles, heuristics, as a guideline to evaluate the usability of the mobile app. Results: The testing evaluation was conducted with a sample of 51 health care providers to evaluate usability, measured by the System Usability Scale and open-ended questions. Descriptive statistics was used to summarize usefulness and end-user perceived ease of use. In addition, a thematic analysis of the open-ended questions was conducted. Conclusions: The development of this mobile app is relevant to nurses who have prescriptive privileges, as well as an educational tool for nurses to understand the rationale behind prescribing certain medications and alternate dosages by providing specific recommendations. Translation of precision medicine into practice will benefit patients by improving care, reducing adverse reactions, and lowering costs.

Prototype Development and Usability Evaluation of a Clinical Decision Support Tool for Pharmacogenomic Pharmacy in Practice.

Pharmacogenetics, a subset of precision medicine, provides a way to individualize drug dosages and provide tailored drug therapy to patients. This revolution in prescribing techniques has resulted in a knowledge deficit for many healthcare providers on the proper way to use pharmacogenetics in practice. This research study explored the potential adoption of clinical decision support system mobile apps by clinicians through investigating the initial usability of the PGx prototype application in an effort to address the lack of such tools used in practice. The study method included usage of a clinical decision support system programmed within our pharmacogenomics drug dosage application (called PGx) in a simulated environment. Study participants completed the System Usability Scale survey to report on the perceived usefulness and ease of use of the mobile app. The PGx app has a higher perceived usability than 85% of all products tested, considered very good usability for a product. This general usability rating indicates that the nurse practitioner students find the application to be a clinical decision support system that would be helpful to use in practice.

Focus group testing of a mobile app for pharmacogenetic-guided dosing.

BACKGROUND: A common barrier to implementation of precision medicine is the lack of use of published clinical practice guidelines. Consequently, a user-friendly mechanism to easily adopt these guidelines is imperative. PURPOSE: The purpose of this study was to evaluate the perceptions of a prototype of a clinical decision support tool through a mobile application for pharmacogenetics. METHODOLOGICAL ORIENTATION: A case study on a patient requiring pharmacogenetic testing was provided to the participants. The participants were given up to 30 minutes to identify the correct dosing in the clinical decision support tool based on clinical evidence-based guidelines. Immediately after the utilization of the mobile app, focus group interviews were conducted to identify the perceptions of the tool, obstacles associated with the tool, and suggestions for improvement of the tool. SAMPLE: Focus group interviews with 23 nurse practitioners and nurse practitioner students were conducted. Field notes and audio recordings were taken. CONCLUSIONS: Specific feedback for improvement in the font and size of text, color contrast, use of drug calculator, automatic input, and desire for further development of education portal were found within the data. The findings revealed useful feedback to adjust the prototype to improve the ease of use among nurse practitioners. IMPLICATIONS FOR PRACTICE: The revision of this mobile app will improve user friendliness to increase applicability within health care. The mobile app can be used for future research to identify improvements in patient outcomes after implementing this tool.

Thematic analysis of nurse practitioners use of clinical decision support tools and clinical mobile apps for prescriptive purposes.

BACKGROUND AND PURPOSE: An obstacle to clinical implementation of precision medicine is the absence of easily accessible peer-reviewed, comprehensive clinical practice guidelines. Therefore, an easily accessible format is needed to propel the adoption of these guidelines by healthcare providers. An understanding of the process providers take to prescribe medications will inform development of clinical decision support tools, specifically related to precision medicine. Successful use of mobile applications will depend on the buy-in from healthcare providers. The purpose of this study was to assess perceptions of trustworthiness surrounding clinical decision support tools and mobile applications through interviews with nurse practitioners. METHODS: A descriptive, qualitative research design was used. A sample of 10 nurse practitioners who actively prescribe medication was used within the study. CONCLUSIONS: The participants mentioned both negative and positive attitudes regarding these prescribing techniques. Overall four themes emerged from this thematic analysis: the use of pharmacists to help with current prescribing practices, reliance on the EMR as a clinical decision support tool, lack of mobile app use in clinical practice, but the desire to have these resources if they were affordable and reliable. IMPLICATIONS FOR PRACTICE: The participants were aware of the use of mobile apps for clinical decision support, but the adoption of these tools was limited due to the perceived lack of affordability and reliability. Therefore, to overcome these barriers to adoption of a mobile app related to precision medicine, affordability and transparent construction of an app grounded in credible sources must be developed.

Oncology Nurses' Knowledge of Pharmacogenomics Before and After Implementation of an Education Module.

OBJECTIVES: To assess the efficacy of an interactive continuing education module in improving knowledge of pharmacogenomics in oncology nursing practice. SAMPLE & SETTING: 434 inpatient and outpatient oncology nurses from a large teaching hospital in Florida and oncology nurses who practice in North Carolina. METHODS & VARIABLES: An interactive continuing education module was created based on key information elicited from a focus group of inpatient and outpatient oncology nurses regarding their lack of knowledge on pharmacogenomics. A pre-/post-test design was implemented. Purposive sampling of oncology nurses was used. RESULTS: The mean pretest score was 72.7 and the post-test score was 85.9. A statistically significant difference was found between these scores. No difference in scores were found between the oncology nurses employed at urban hospitals compared to nurses at community hospitals or outpatient settings. IMPLICATIONS FOR NURSING: Educational opportunities for pharmacogenomics should be threaded throughout nursing competencies. The continuing education module in the current article has been shown to significantly improve oncology nurses' knowledge of genomic and pharmacogenomic information.

Community change and resident needs: Designing a Participatory Action Research study in Metropolitan Boston.

The health implications of urban development, particularly in rapidly changing, low-income urban neighborhoods, are poorly understood. We describe the Healthy Neighborhoods Study (HNS), a Participatory Action Research study examining the relationship between neighborhood change and population health in nine Massachusetts neighborhoods. Baseline data from the HNS survey show that social factors, specifically income insecurity, food insecurity, social support, experiencing discrimination, expecting to move, connectedness to the neighborhood, and local housing construction that participants believed would improve their lives, identified by a network of 45 Resident Researchers exhibited robust associations with self-rated and mental health. Resident-derived insights into relationships between neighborhoods and health may provide a powerful mechanism for residents to drive change in their communities.

Pharmacogenomics: Principles and Relevance to Oncology Nursing
.

BACKGROUND: Pharmacogenomics is the fastest growing field in precision medicine. Based on current use, oncology encompasses the largest share of the precision medicine market, necessitating that oncology nurses understand the principles of pharmacogenomics and how it affects clinical practice.
. OBJECTIVES: This article will define precision medicine and pharmacogenomics and will provide examples of pharmacogenomic tests, including those associated with tumor markers, and nursing implications.
. METHODS: Educational and clinical resources are supplied for oncology nurses to expand their pharmacogenomics expertise.
. FINDINGS: The knowledge surrounding precision medicine and pharmacogenomics will position oncology nurses to engage in current research, improve practice, and educate patients. As the focus of health care remains on reducing costs and improving morbidity and mortality, the reduction in adverse drug reactions will continue to be highlighted. Tailoring medications based on individual responses will not only help improve patient outcomes but also potentially affect the cost of health care as these genetic tests become a standard of care.

Attitudes of oncology nurses concerning pharmacogenomics.

The field of oncology has been permeated with the use of pharmacogenomics. There have been a few studies on oncology nurses' attitudes surrounding this topic. A study conducted in 2015 revealed six themes: consistency, effectiveness, cost, disparity, genetic counseling needs and need for further education. Further information obtained while conducting a pilot study for continuing education related to pharmacogenomics have revealed novel perspectives surrounding pharmacogenomics among oncology nurses. The previous six themes were substantiated. Additionally, four new themes were identified: change in scope of practice, standardized communication, access to up-to-date information and advocacy. Further validation of the prior six themes and the addition of the new themes reveal the continual impact of pharmacogenomics on nursing practice. The main theme that resounding among the majority of the nurses was the need for further education. This validates the development of educational programs that focus on pharmacogenomics within oncology.

Attitudes of oncology nurses concerning pharmacogenomics.

BACKGROUND: The use of genome-guided drug therapy will certainly influence clinical practice within healthcare. However, in spite of the benefits of pharmacogenomic testing, little is known regarding what clinicians think about this promising technology. OBJECTIVE: The purpose of article was to identify themes within the attitudes of nurses in the field of oncology. MATERIALS & METHODS: The sample included 246 responses to an open-ended question. A thematic analysis of these responses was completed. RESULTS: The analysis uncovered six themes. CONCLUSION: Therefore, future research on the assessment of attitudes of oncology nurses concerning pharmacogenomics should incorporate these themes.

Knowledge and attitudes of oncology nurses regarding pharmacogenomic testing.

More than 20 different pharmacogenomic tests are being used in the oncology field. The current descriptive study was conducted with 368 oncology nurses in North Carolina to identify and test key elements of Rogers' Diffusion of Innovation Theory that play a role in the adoption of pharmacogenomic testing. Oncology nurses who participated in this study had limited knowledge of genomics and pharmacogenomic testing. Attitudes toward pharmacogenomic testing were positive overall, and the study revealed that oncology nurses in this study routinely use pharmacogenomic testing information. Variable selection methods revealed that total genomic knowledge was more accurately predicted by prior experience and personality variables, pharmacogenomic knowledge was more accurately predicted by personality variables, and attitude was more accurately predicted by prior experience and perceived need of innovation. Based on these findings, several factors play key roles in the diffusion of pharmacogenomic testing within the oncology nursing field. Therefore, assessment of these variables may benefit the widespread adoption of pharmacogenomic testing. Further research should be conducted with these variables to assess the adoption of the innovation.

Glycemic control in a medical intensive care setting: revision of an intensive care unit nurse-driven hyperglycemia protocol.

The purpose of this study was to determine whether the addition of rapid-acting insulin bolus for enteral feed coverage and a reduction in basal insulin improve glycemic control and decrease hypoglycemia in a medical intensive care unit. A quasi-experimental posttest design assessing glucose control postimplementation of a revised nurse-driven ICU hyperglycemia protocol was conducted on a 16-bed medical intensive care unit at a multicenter hospital system. A daily report of all patients on the ICU hyperglycemia protocol was automated for the inpatient diabetes management team, and pertinent data were collected. Univariate statistics were conducted for all variables. The variability in blood glucose based on different clinical variables was compared using t tests. The hypoglycemic rate was only 0.72%, and no glucose value was less than 40 mg/dL. In addition, the mean glucose value throughout the study was 160.9 ± 35.6 mg/dL. Findings from this study will hopefully provide insight on an effective way to control glucose within a medical intensive care unit as well as reduce hypoglycemia rates within this setting.

Knowledge and attitudes concerning pharmacogenomics among healthcare professionals.

Pharmacogenomics has become an area of great potential in the medical community. Therefore, the assessment of the knowledge and attitudes among healthcare professionals is essential. The purpose of this systematic literature review is to explore the knowledge and attitudes of healthcare professionals regarding pharmacogenetic testing with a specific emphasis in oncology. A total of 12 articles were found and reviewed. A majority of the articles reported only on the attitudes of healthcare professionals. Four of the articles reported on both knowledge and attitudes of healthcare professionals concerning pharmacogenetic testing, and one article reported only on the knowledge level of healthcare professionals. This systematic literature review revealed that healthcare professionals generally perceive themselves to have limited knowledge regarding pharmacogenetic testing. In addition, these articles highlighted the overwhelming ethical concerns surrounding pharmacogenomics. However, these articles also revealed that healthcare professionals believed that there were also many advantages regarding the utilization of pharmacogenomics.

Analysis of clinicians' attitudes towards pharmacogenomics.

AIM: The use of genetic information to guide a patient's drug therapy will have a great influence on clinical practice within healthcare. However, despite the prospective benefits of pharmacogenetic testing, little is known regarding what clinicians actually think about this promising technology. The purpose of this study was to assess attitudes towards pharmacogenetic testing not previously highlighted within a larger study on clinicians' knowledge and attitudes about pharmacogenetic testing conducted by an interdisciplinary group of researchers at the University of North Carolina at Chapel Hill. MATERIALS & METHODS: The sample included 184 responses to an open-ended question. A thematic analysis of these responses was completed. RESULTS: The thematic analysis identified several themes that were not previously delineated within the original study. The analysis uncovered five additional themes including: application concerns, lack of successful integration, accessibility, potential harm and optimism. CONCLUSION: Future research on the assessment of attitudes of clinicians concerning pharmacogenomics should incorporate these themes. In addition, educational activities conveying knowledge concerning pharmacogenomics needs to become readily available to healthcare providers. Finally, a study that addresses any disparity related to pharmacogenomics needs to be undertaken.

Nursing students' perceived knowledge and attitude towards genetics.

The purpose of this study was to assess the knowledge base of nursing students regarding the topic of genetics and how this may change as a student progresses through the nursing program. A 70 item multiple-choice and dichotomous survey was given to freshman, sophomore, junior, and senior nursing students at a university school of nursing in the eastern part of the United States. Two hundred and seventy five pre-licensure nursing students, 255 females and 18 males, comprised the sample. A one-way analysis of variance (ANOVA) was performed and the results concluded that there was a significant difference among the freshmen, sophomores, juniors, and seniors in regards to having at least a 'minimal' knowledge or better of medical genetic terminology and conditions. Seniors reported a higher number of terms which they had at least a 'minimal' knowledge level or better than freshmen or sophomores. Also the juniors reported a higher number of terms which they had at least a 'minimal' knowledge level or better than sophomores.