Genomics and patient care: Evolving roles and scopes of practice for healthcare professionals

In the rapidly advancing realm of precision medicine, healthcare professionals (HCPs) are witnessing a transformative shift in their roles. This approach, which tailors treatment to the individual's genetic makeup, lifestyle, and environment, demands a new set of skills and knowledge from HCPs – including physicians, nurses, and pharmacists. They are now at the forefront of integrating complex genetic information into patient care, navigating ethical dilemmas, and maintaining an up-to-date understanding of technological innovations. This blog post explores how precision medicine is reshaping the responsibilities and expertise of HCPs, and what this means for patient care.

Key role changes for physicians, nurses, and pharmacists

Physicians

In the era of precision medicine, physicians are evolving into interpreters of genomic data, tailoring personalised treatment plans to each patient's unique genetic profile. Key roles changes here include: 

• Genomic data interpretation: Physicians are increasingly required to interpret complex genomic data, integrating this information into their diagnostic and treatment processes. This skill was once the domain of genetic specialists but is now crucial for physicians to personalise patient care.
• Personalised treatment planning: The traditional model of treating based on broad population data is giving way to personalised treatment plans based on many more data points. Physicians must consider individual genetic profiles, environmental factors, and lifestyle choices to devise proactive, predictive treatment strategies.
• Continual learning and adaptation: The rapid evolution of precision medicine requires physicians to engage in continuous learning. Staying updated with the latest advancements in genomics, biotechnology, and data analysis is essential for providing cutting-edge care.

Nurses

Nurses in precision medicine are key educators and advocates for patients, bridging complex genomic information and personalised care with a focus on holistic patient wellbeing. Key roles changes here include: 

• Patient education and advocacy: Nurses play a pivotal role in educating patients about their genetic profiles and the implications for their health and treatment options. They also act as patient advocates, helping individuals navigate the complexities of personalised care.
• Care coordination: In precision medicine, nurses often take on the role of care coordinators. They work closely with various specialists, integrating information to ensure that all aspects of a patient's personalised care plan are addressed and implemented effectively.
• Specialised skills in genomics: Nurses are increasingly expected to acquire specialised knowledge in genomics to assist in risk assessment, early detection of genetic conditions, and management of genetically influenced treatments.

Pharmacists

Pharmacists play a crucial role in precision medicine, leveraging their expertise in pharmacogenomics to optimise medication efficacy and safety for individualised patient care. Key roles changes here include: 

• Pharmacogenomics expertise: Pharmacists in the era of precision medicine must have a strong understanding of pharmacogenomics – how a person's genetic makeup affects their response to medications. This knowledge is critical for advising on medication selection and dosages.
• Personalised medication management: With the advent of precision medicine, pharmacists are more involved in creating personalised medication management plans. This involves considering individual genetic profiles, potential drug interactions, and the efficacy of medications on a personalised level.
• Interprofessional collaboration: Pharmacists are increasingly collaborating with physicians, nurses, and other healthcare professionals to provide comprehensive care. They contribute valuable insights into medication-related decisions within the precision medicine framework.

Pharmacists, particularly those in clinical settings, play a pivotal role in precision medicine by serving as essential connectors between care and information. They act as trusted advisors, helping to navigate and reduce barriers to accessing precision medicine treatments. Recognising the importance of this role, the American Society of Health-System Pharmacists (ASHP) has formulated guidelines that underscore the need for effective education and counselling skills in pharmacists. These guidelines recommend that pharmacists establish strong rapport with patients, thoroughly assess their understanding of their treatment, and consider the patients' physical, mental capabilities, and any potential obstacles to ensure optimal care in the precision medicine landscape.

New specialities in healthcare

As existing roles evolve, precision medicine has given rise to new specialised fields within healthcare as well. Genetic counsellors, genomic nurses, and pharmacogenomic specialists are integrating into the traditional healthcare framework, forming interdisciplinary teams that offer more comprehensive and personalised patient care.

Genetic counsellors

Genetic counsellors are professionals who specialise in analysing genetic data and interpreting its implications for individual patients. They play a crucial role in precision medicine by guiding patients and their families through the complexities of genetic information. These counsellors assess the risk of genetic disorders, explain the results of genetic testing, and help patients understand the potential impact on their health and lifestyle. By providing personalised information and support, genetic counsellors assist patients in making informed decisions about their healthcare.

Genomic nurses

Genomic nurses are registered nurses with specialised training in genomics. Their expertise allows them to integrate genomic information into patient assessments and care plans. These nurses are instrumental in identifying patients who may benefit from genetic counselling or testing, educating patients about the implications of genetic findings, and incorporating this information into the nursing care. Genomic nurses also play a key role in research and policy development, contributing to the advancement of genomic healthcare practices.

Pharmacogenomic specialists

Pharmacogenomic specialists are pharmacists or other healthcare professionals who specialise in understanding how genetic factors influence a patient's response to medications. This field is critical in precision medicine for optimising drug therapy, minimising adverse drug reactions, and enhancing medication efficacy. Pharmacogenomic specialists work closely with physicians, nurses, and patients, providing expert advice on medication choices and dosages tailored to the genetic makeup of individual patients. They are key players in ensuring that medication therapy is as safe and effective as possible.

Adoption of evolving and new roles

Despite the growing recognition and potential of precision medicine, its integration into routine clinical practice faces significant challenges. One notable hurdle is the reluctance among healthcare professionals to fully embrace this approach. This hesitancy stems from several factors, including the complexity of genomic data, the rapid pace of technological advancements, and the need for a deeper understanding of how these elements translate into patient care.

The root of this issue may lie in the educational foundation provided in medical schools. Traditional medical education often lacks comprehensive training in genomics and personalised medicine, leaving many physicians underprepared to implement these practices effectively in their clinical work. To bridge this gap, there's a growing consensus that the principles of precision medicine should be introduced early in medical education, ideally starting at the undergraduate level.

Recognising this need, the International Consortium for Personalised Medicine (ICPerMed) has set forth a vision to transform medical education by 2030. This plan aims to cultivate a new generation of healthcare providers who are not only well-informed about the nuances of precision medicine but are also empowered to apply this knowledge in clinical settings.

To achieve this, ICPerMed proposes substantial changes in medical curricula. These changes include:

• Integrating genomics into medical training: Introducing courses that focus on genomics, bioinformatics, and the interpretation of genetic data. This education would enable future physicians to understand and utilise genetic information in diagnosing and treating patients.
• Emphasising personalised treatment approaches: Training medical students in developing individualised treatment plans. This involves understanding how a patient’s unique genetic makeup can influence their response to different treatments and medications.
• Fostering interdisciplinary collaboration: Encouraging collaboration with genetic counsellors, pharmacogenomic specialists, and other emerging roles in healthcare. This interdisciplinary approach is crucial for delivering comprehensive precision medicine.
• Ethical, legal, and social implications: Educating on the ethical, legal, and social implications of precision medicine. This includes understanding patient consent, data privacy, and the equitable distribution of these advanced medical services.
• Hands-on experience with cutting-edge technology: Providing practical experience with the latest technologies and research methods used in precision medicine. This hands-on approach would help future doctors stay abreast of ongoing advancements.

The aim of these transformative changes is to embed precision medicine as a cornerstone of clinical practice. By equipping the upcoming generation of healthcare providers with the skills and knowledge to fully harness the capabilities of precision medicine, we can significantly elevate the standards of patient care and drive forward the frontiers of medical science.

Conclusion

The advancement of healthcare is closely tied to the successful integration of precision medicine, which brings forth evolving roles for healthcare professionals. This approach fosters collaboration among providers, patients, and the pharmaceutical industry, aiming to transform healthcare systems to focus more on individual patient needs and preferences. Such a shift not only enhances personalised care but also deepens our understanding of how genomic information affects disease. Although challenges persist in the widespread adoption of precision medicine, targeted strategies and dedicated efforts could lead to a future where treatments are more effective, care is more proactive and preventive, and patient outcomes are significantly improved.