Technology assessment and resource allocation for predictive genetic testing: A study of the perspectives of Canadian genetic health care providers

<p>Abstract</p> <p>Background</p> <p>With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada.</p> <p>Methods</p> <p>The authors conducted semi-structured interviews with 16 senior lab directors and clinicians at publically funded Canadian predictive genetic testing facilities. Participants were drawn from British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Given the community sampled was identified as being relatively small and challenging to access, purposive sampling coupled with snowball sampling methodologies were utilized.</p> <p>Results</p> <p>Surveyed lab directors and clinicians indicated that predictive genetic tests were funded provincially by one of two predominant funding models, but they themselves played a significant role in how these funds were allocated for specific tests and services. They also rated and identified several factors that influenced allocation decisions and patients' decisions regarding testing. Lastly, participants provided recommendations regarding changes to existing allocation models and showed support for a national evaluation process for predictive testing.</p> <p>Conclusion</p> <p>Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate.</p

Illness representations, coping and psychosocial outcome in chronic pain

Research has recognised the importance of understanding the chronic pain experience using a biopsychosocial model. This approach acknowledges the impact of cognitive factors on psychosocial adjustment to chronic pain. This literature review explores the difficulties encountered by individuals adapting to a life with pain. It evaluates the evidence pertaining to the idea that beliefs about illness and coping strategies affect psychosocial outcome in chronic pain. The review considers the role of cognitive factors in self-regulating illness using the Common-Sense Model of Illness Representations (CSM). An evaluation of this model as it applies to chronic conditions is provided. Reviewing the literature reveals that despite numerous studies examining the CSM in chronic illness, there is a paucity of research applying it specifically to chronic pain. This review highlights the potential usefulness of exploring the CSM in this population in order to consider both the empirical value of the CSM and gain further knowledge regarding useful psychotherapeutic interventions in chronic pain.On this basis, the present study sought to investigate the CSM in a sample of adults with chronic pain. A significant relationship between a number of illness representations (beliefs about illness) and psychosocial outcomes was found. A subset of these met criteria for mediation. The findings imply that particular illness representations (identity, consequences and emotional representation) are associated with the coping strategy catastrophising, which in turn is associated with an increased tendency for depression, anxiety and reduced quality of life. Due to the cross-sectional design, causal inferences cannot be made. However, the findings imply partial support for the CSM in a chronic pain population. Directions for future research are highlighted, as well as implications for psychotherapeutic interventions which could help reduce unhelpful beliefs and maladaptive coping strategies