Table 2. . Categories and findings including barriers and enablers across the included papers.
| Category | Finding | Ref. |
|---|---|---|
| Knowledge (an awareness of the existence of something) | ||
| Lack of genetic knowledge (B) | Lack of knowledge and awareness | [39,42,43,47,49,50] |
| HCP PGx knowledge and awareness | [55] | |
| Profound lack of knowledge of direct-to-consumer genetic tests | [43] | |
| Limited experience with PGx (B) | Personal unfamiliarity with genomic medicine | [44] |
| Limited encounters with genetics in practice | [47] | |
| Limited experience with personalized medicine | [43] | |
| Level of comfort with genetic testing | [47] | |
| Varying level of knowledge | [44,45] | |
| Preparation and knowledge | [45] | |
| Training and education (B) | Lack of genomic education | [42] |
| PGx/Genetic education | [41,47,49] | |
| Education | [47] | |
| Resources/support | [47] | |
| Rapidly changing PGx knowledge and need for continuing education | [45] | |
| Patient and provider education material | [41] | |
| Patient education material – for frequent Q&As | [45] | |
| Policies for responsibilities and ownership of PGx data | [45] | |
| Patients lack of genetic knowledge (B) | Unfamiliar with term PGx | [52] |
| General interest in PGx testing (E) | Greater role for genetics | [47] |
| Shifting patterns of work to allow new advances | [47] | |
| General interest in PGx testing | [48] | |
| Potential of using PGx | [49] | |
| Positive attitude toward PGx | [51] | |
| PGx test results rapidly obtained to be valuable | [42] | |
| Perceived role in delivering PGx | [55] | |
| Social and professional roles (a coherent set of behaviors and displayed personal qualities of an individual in a social or work setting) | ||
|---|---|---|
| Skill mix (B) | More access for pharmacists (and other HCP) to genetic information | [54] |
| Pharmacists to have major role in PGx | [42] | |
| Division of responsibility | [50] | |
| PCP’s role in personalized medicine | [43] | |
| PCP role – education, counselling, testing and referrals to specialists | [47] | |
| Pool of experts (B) | Pool of experts in general practice | [49] |
| Need for buddy or connection into a genetic service | [43] | |
| Professional relationships (E) | Relationship with healthcare professional | [48] |
| High regard for physicians who adopted pharmacogenomics | [48] | |
| Relationship with healthcare professional | [48] | |
| Opportunities for pharmacists | [50] | |
| Patient–doctor relationship | [39,43] | |
| Acting upon PGx and reporting to patients | [55] | |
| Pharmacist added value and learning by doing | [55] | |
| Professional interaction improvement | [55] | |
| Behavioral regulation (anything aimed at managing or changing objectively observed or measured actions) | ||
|---|---|---|
| Negative impact of PGx (B) | Adverse impact resulting from negative results | [40] |
| Repercussions of positive test result – labeled, stigmatized, develop fatalistic perceptions | [38] | |
| Anxiety about genetic information | [42] | |
| Ambivalence – depression and genetic research (targeted PGx research and meds designed to treat) | [51] | |
| Impact on patient perspectives and shared decision-making | [49] | |
| Patient views (B) | Consumer demand | [52] |
| Conflation of disease risk and drug reaction | [51] | |
| Concerns when starting a new medication | [48] | |
| Therapeutic benefit | [48] | |
| Behavioral change (B) | Patients use a positive test result as rationalization for giving up | [38] |
| Managing results expectations | [41] | |
| Reluctant to change current practice | [50] | |
| Reliance on genetic testing (B) | Reliance on genetic test rather than patient history | [38] |
| Undermining the importance of psychological and behavioral determinants of both smoking/quitting | [38] | |
| Incentive to use medicines instead of conversation therapy | [51] | |
| Medical mistrust (B) | Medical mistrust by marginalized population (pt. view) | [53] |
| Beliefs about consequences (acceptance of the truth, reality or validity about outcomes of a behavior in a given situation) | ||
|---|---|---|
| Reduces adverse drug reactions (E) | Avoid adverse drug reactions | [41] |
| Reduce side effects | [41] | |
| Improve compliance through less side effects | [41] | |
| Reduction of adverse events | [42] | |
| Concept of individualized medicine | [44] | |
| Adverse effects | [46] | |
| Tolerate adverse effects | [48] | |
| Value of PGx testing in primary care | [49] | |
| Reduce adverse effects | [51] | |
| Reduction of adverse drug effects | [52] | |
| Reduces adverse effects | [53] | |
| Pharmacotherapy improvement | [55] | |
| Reduces trial and error (E) | Aid in therapeutic choice | [40] |
| Increase patient’s confidence in their care | [40] | |
| Reduce trial and error | [53] | |
| Improved effectiveness | [52] | |
| Patient benefit (E) | Patient motivation | [38,40] |
| Benefit patients who had exhausted other treatment options | [38] | |
| Improve patient adherence to treatment | [40] | |
| Relieve patients of personal blame | [38] | |
| Use as preventative tool through raising patient awareness | [38] | |
| Create a placebo effect for patients | [40] | |
| Quick access to results, cost-effective options | [38] | |
| Implications for future medication management | [39] | |
| Competitive edge | [39] | |
| Environmental context and resources (any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence and adaptive behavior) | ||
|---|---|---|
| EHR implementation (B) | Priority for EHR implementation | [44] |
| Clinical decision support in EMR | [39] | |
| Workflow issues (B) | Translating results into clinical decisions | [45] |
| PGx integrated into EMR – integrating electronic alerts | [42] | |
| Workflow issues for CDS, unwilling to have interruptions on their workflow | [44] | |
| Reporting results (B) | Clearer layout | [41] |
| Information overload | [45] | |
| Electronic capture of genomic information | [49] | |
| Ordering/interpreting tests (B) | Ordering and interpreting tests | [38,45] |
| Ability to understand and explain PGx test results | [41,45,46] | |
| Specific training to report PGx results | [41] | |
| Interpreting genetic information | [38] | |
| Unclear procedures outside of the study | [55] | |
| Cost concerns (B) | Cost of PGx testing | [39–42,44,45,47,48,50,52,53] |
| Cost–effectiveness | [47,49] | |
| Who pays? | [44,45,52,54] | |
| Insurance coverage | [41,42] | |
| Insurance loading (paying extra premiums based on personal medical data) | [49] | |
| Insurability and costs | [52] | |
| Undetermined reimbursement for test and consult | [55] | |
| Limitations (B) | Limitations/implications of genetic testing | [47] |
| Concerns about consenting to PGx test | [48] | |
| Population level benefits limited by reducing target population | [40] | |
| Ancillary findings (B) | Dealing with ancillary findings | [46,48] |
| Technical issues (B) | Restricted time constraints | [38,41,46] |
| Accessibility of PGx test results/easily accessible personalized med tools | [43,46] | |
| Flexible testing options | [41] | |
| Turnaround times | [40,41] | |
| When and whom to test? | [50] | |
| Access to testing (pt. view) | [52] | |
| Pre-emptive vs reactive | [39] | |
| Pre-emptive | [50] | |
| Technical issues | [41] | |
| Clinical utility (B) | Lack of evidence – clinical utility | [50,55] |
| Need for evidence | [44] | |
| Utility dependent on prognostic accuracy | [40] | |
| No incremental utility over standard care | [40] | |
| Clinical utility of tests | [40,52] | |
| Accuracy of the test | [48] | |
| Guideline development/accessibility (B) | Accessible PGx guideline | [42] |
| Lack of genetic referral guidelines | [43] | |
| Guidance document | [39] | |
| Infrastructure inefficiencies (guideline factors, incentives and resources) | [55] | |
| Decision-making (E) | Another aspect of clinical decision making | [40] |
| Guiding primary care medical decision-making | [41] | |
| Individualize medication treatments | [41] | |
| Informed decision making | [41] | |
| Efficient decision making | [41] | |
| Increased patient autonomy | [41] | |
| Follow-up | [55] | |
| Less fear and anxiety about trying a new medication | [41] | |
| Valuable tool in the future | [41] | |
| Social influences (those interpersonal processes that can cause individuals to change their thoughts, feelings or behaviors) | ||
|---|---|---|
| Employment discrimination (B) | Genetic information not shared with employers | [54] |
| Insurance, employment discrimination | [53] | |
| Genetic discrimination and confidentiality | [38] | |
| Health insurance, employment discrimination and stigma | [38] | |
| Confidentiality/privacy of data (B) | Information stored in a confidential manner | [42,54] |
| Storage and future use of information | [52] | |
| Disclosure, privacy and confidentiality | [52] | |
| Data and privacy concerns | [41] | |
| Privacy and personal pharmacogenomic information (pt. view) | [48] | |
| Data ownership responsibility and liability | [45] | |
| Abuse of test results (B) | Test information not used in a harmful manner to patients | [38] |
| Use of information over time | [39] | |
| Social inequalities (B) | Social inequalities | [42] |
B: Barrier; E: Enabler; EHR: Electronic health record; HCP: Healthcare professional; PCP: Primary care professional; PGx: Pharmacogenomics.