Lessons from the Field: Use of Genetics/Genomics in APN clinical practice and implications for Nurse Practitioner Education

Knowledge discovery from the Human Genome Project has increased clinical applications of genetics in both complex common conditions and diseases identified with mendelian traits. The projected growth in genetic health needs will extend beyond genetic specialists and necessitate the integration of genomic information into the practice of all health care providers. Collaborative initiatives, such as the Genomic Applications in Practice and Prevention Network (GAPPNet™) are underway to accelerate the development and availability of information on genetic/genomic applications to clinical practitioners. The purpose of this presentation is to describe current practices of personalized genetic health care by one group of APNs, identify needs, facilitators and barriers to integration of genetic knowledge into practice and describe implications for nurse practitioner education. A 2009 qualitative descriptive study used content analysis of 15 semi-structured transcribed interviews of US Midwestern APNs from a range of primary care practice settings to identify current APN practice and perspectives on future integration of genetics. APNs varied on the amount of current application of genetics in the clinical setting. Greater emphasis on genetic assessment and testing was noted in prenatal and pediatric settings, or for patients diagnosed with diseases with a ‘well-publicised’ genetic role, such as breast cancer. Family history as a proxy for genetic risk was common, as was referring patients with identified genetics service needs. Challenges to integration include system limitations, APN knowledge deficits, and perceived clinical priority. Gaps exist between the information-seeking behaviours of the APN participants and genomic resources. While there are increasing numbers of genetic/genomic curricular and/or educational materials available, including some clinical genetic/genomic resources, APNs mostly remain either unaware of their existence or have not found them readily usable in busy clinical settings. These findings highlight the need for targeted approaches in education and practice that not only increase APNs awareness of currently available resources but also work to improve accessibility of user-friendly information at the point of care. Future developments potentially will facilitate more rapid application of genetic/genomic discoveries into APN clinical practice and ensure the delivery of increasingly personalized care.