EXPLORING COMMUNICATION OF GENOMIC INFORMATION BY PRIMARY CARE NURSE PRACTITIONERS IN RURAL SETTINGS

Ellen C Romesburg

Background: The completion of the Human Genome Project and the advent of precision medicine represent two of the most promising developments in the history of medicine. These advances, however, in combination with increased popularity in genetic curiosity and testing, have exposed the shortage of genomic specialists. Patients in rural areas are increasingly dependent on primary healthcare providers for guidance and explanation of complex genomic information. This shift in expectation has revealed a gap in genomic literacy, education, and understanding among healthcare providers and the general public. Genomic testing, with all its powerful capabilities, can be emotionally taxing and involve complex ethical, legal, and social issues (ELSI) and psychosocial implications.  With the shortage of genomic specialists and an increased demand from the public, it is imperative that the healthcare community finds a solution to meet emerging genomic needs. Although nurse practitioners (NPs) deliver 42% of all rural primary health care, there is limited research investigating their experiences and perspectives regarding the use and communication of genomic information. The nursing profession must make strategic plans that promote precision health in nursing research, education, clinical practice, as well as the administrative and health policy arenas. Due to the concentration of genomic specialists in urban areas, it was crucial to investigate how rural primary care NPs are addressing the potential resource disparity in their rural communities to ensure healthcare equity. Greater understanding can lead to improvement in clinical practice and patient outcomes. This research study gathered essential information needed to inform expanded healthcare education, implementation, and policy work. Aims: 1. Explore primary care nurse practitioners’ experiences and challenges surrounding the communication of genomic information with patients in rural healthcare settings. 2. Discover primary care nurse practitioners’ perspectives of ELSI and psychosocial implications surrounding genomic return of results and access to resources for patients in rural areas. Methods: To accomplish aims 1 and 2, this study used a qualitative methodology guided by Rogers’ Diffusion of Innovations theoretical framework. A nationwide sample of NPs were recruited until data saturation was achieved, resulting in a final cohort of ten participants. Semi-structured, one-on-one interviews were conducted via Zoom videoconferencing software with primary care NPs practicing in rural areas. The subsequent data was transcribed and analyzed by a three-person team and followed Braun & Clarke’s (2023) six phases of thematic analysis. Findings: Data analysis identified three central themes and several critical sub-themes: NPs as Gatekeeper: Weighing Patient Priorities (sub themes: Prioritization of Patient Needs, NPs Perceived Barriers), NPs Preparation for Genomic Practices (sub themes: Lack of Confidence with Genomics, Reliance on Specialists and Online Resources, Perceived Needs for Genomic Implementation into Practice), and NPs Values and Beliefs Regarding Genomics. Collectively, these findings illustrate the need for improved NP genomic education and the creation of policies and guidelines to facilitate genomic implementation while acknowledging and respecting the time constraints, professional responsibilities, beliefs, and values of NPs in rural primary care. Implications: These findings provide information that can be used as a multifaceted roadmap for genomic integration into rural primary care by NPs through targeted educational interventions, standardized clinical guidelines, and regulatory policies. By addressing these professional areas and personal values and beliefs, the healthcare community can empower rural NPs to bridge the gap between genomic advancements and underserved populations, ensuring that the benefits of genomics in primary care are delivered effectively and ethically to all communities.

EXPLORING COMMUNICATION OF GENOMIC INFORMATION BY PRIMARY CARE NURSE PRACTITIONERS IN RURAL SETTINGS

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