Clinical Implementation of Carrier Status Using Next Generation Sequencing (NextGen)
This study is conducting a randomized controlled trial (RCT) with up to 400 subjects (women & partners) seeking pre-conception carrier testing to assess the impact of the program using Whole Genome Sequencing (WGS).
- The investigators hypothesize that whole genome sequencing will increase the detection of carrier status for Mendelian recessive and x-linked conditions.
- The investigators hypothesize that parents will act on the knowledge of their carrier status by making different reproductive choices than parents who do not receive this information.
- The investigators hypothesize that the psychosocial risks are increased among parents who receive expanded carrier screening using Next Generation Sequencing (NGS) compared with usual care.
|Genetic Disorders||Genetic: Whole Genome Sequencing Genetic: Carrier status testing|
|Study Design:||Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Screening
|Official Title:||Clinical Implementation of Carrier Status Using Next Generation Sequencing|
- Number of patients that receive carrier testing and have results to return [ Time Frame: Annually for 4 years ]The investigators will record the number of patients that have both single carrier status testing (usual care) and WGS testing and track how many patients have results to return.
- Patient satisfaction [ Time Frame: Annually for 4 years ]Through surveys, interviews, and observations with patients, the investigators will assess their satisfaction with the testing and return of results process.
- Provider satisfaction [ Time Frame: Annually for 4 years ]Through interviews and observations with providers, the investigators will assess the participants' satisfaction with the testing and return of results process.
- Cost-analysis [ Time Frame: Year 4 ]The investigators will evaluate the impact of expanded carrier test using WGS on subsequent health care utilization, and compare the cost of delivery of WGS to usual care.
|Study Start Date:||January 2014|
|Estimated Study Completion Date:||May 2017|
|Primary Completion Date:||January 2017 (Final data collection date for primary outcome measure)|
Active Comparator: Usual care
Requested carrier status testing.
Genetic: Carrier status testing
Carrier status testing
Experimental: Whole Genome Sequencing
These participants will receive the carrier status testing they requested from their provider, plus whole genome sequencing.
Genetic: Whole Genome Sequencing
Participants will receive Whole Genome SequencingGenetic: Carrier status testing
Carrier status testing
Project 1-Clinical Intervention and Outcomes Aim 1: To conduct a randomized controlled trial (RCT) with up to 400 subjects (women & partners) seeking pre-conception carrier testing to assess the impact of the program using Whole Genome Sequencing (WGS).
Aim 2: To develop processes for delivering information from WGS directly into the patient's electronic medical record, and establish innovative reporting strategies that are informative for clinicians and couples acting on this information.
Aim 3: To measure for the integration of sequence information in clinical care for both carrier status and secondary findings including:
- Patient reported outcomes (PRO) on the impact on quality of life, satisfaction with care, timeliness of reporting, and use of the genomic information.
- Process outcomes such as timeliness, number of reportable findings, and time of interpretation.
Project 2 -WGS technology, informatics, and Return of Results Committee (RORC)
Aim 1: To generate whole genome sequence and interpret variants on samples randomized from the Kaiser Permanente Northwest (KPNW) preconception carrier screening cohort.
- To perform whole genome sequencing, assembly, and variant detection for each sample.
- To provide variant data on each sample with annotation and ranking of clinical significance.
- To validate data using an orthogonal platform for findings relevant to carrier status and actionable secondary findings.
Aim 2: To develop and implement a return of results committee (RORC) that incorporates evidence to assess criteria for reporting carrier status for reproductive decision making and secondary findings.
Project 3 - Ethical and Psychosocial Implications
Aim 1: To evaluate, patient and clinical perspectives on informational needs, satisfaction, knowledge, and decision-making relating to the choice to obtain results of carrier status from WGS in four categories of genetic conditions.
Aim 2: To evaluate, from patient and clinician perspectives, the immediate and downstream ethical, psychosocial, and behavioral consequences of expanded carrier screening using WGS.
Aim 3: To evaluate the impact of expanded carrier test using WGS on subsequent health care utilization, and to compare the cost of delivery WGS to usual care.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01902901
|United States, Oregon|
|Kaiser Permanente Northwest|
|Portland, Oregon, United States, 97227|
|Principal Investigator:||Katrina Goddard, PhD||Kaiser Permanente|
|Principal Investigator:||Benjamin Wilfond, MD||Seattle Children's Hospital|