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Precision Medicine in Rural Settings: Patient Perspectives on Clinician-Ordered Genetic Testing.

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Rural residents find genetic testing acceptable and appropriate, but healthcare system barriers limit access. Improving the organization and delivery of genetic services is key to reducing rural inequities in precision medicine.

Keywords:
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Area of Science:

  • Genetics
  • Precision Medicine
  • Rural Health

Background:

  • Genetic testing is vital for precision medicine, but its use in rural areas is understudied.
  • Geographic and access barriers in rural settings may impact genetic testing experiences.
  • Understanding determinants of genetic testing is crucial for equitable precision medicine access.

Purpose of the Study:

  • To explore contextual determinants and pre-implementation outcomes of clinician-ordered genetic testing among rural residents.
  • To assess the acceptability and appropriateness of genetic testing in rural populations.

Main Methods:

  • Semi-structured interviews with 30 rural residents in the Mountain West who discussed genetic testing.
  • Thematic analysis using a hybrid deductive-inductive approach.
  • Frameworks used: Practical, Robust Implementation and Sustainability Model and Implementation Outcomes Framework.

Main Results:

  • Most participants perceived genetic testing as acceptable and appropriate, especially when it reduced uncertainty or aided decisions.
  • Factors influencing acceptability included convenience, cost, insurance, emotional readiness, and personal values.
  • Appropriateness was linked to clinician communication, explanation of relevance, and shared decision-making.

Conclusions:

  • Rural residents generally view genetic testing positively, but patient-driven access highlights constrained rural healthcare infrastructure.
  • Rural inequities in precision medicine uptake stem more from healthcare system delivery than patient attitudes.
  • Enhancing genetic service organization, communication, and delivery is essential for rural precision medicine equity.