Aims: The aim of this thesis was to identify and rate themed patient preference attributes of genomic testing in precision cancer medicine (PCM). The effect of clinical treatment intent and time since completing treatment was examined as a novel hypothesis that these factors influence identified preference attribute themes and/or ratings. This thesis then benchmarked the identified preference attributes against the ATLANTIS clinical trial design, in order to assess how a current clinical trial incorporates patient preferences.
Methods: A narrative review of current cancer treatment paradigms was undertaken alongside systematic review of the literature assessing patient preferences of genomic testing in PCM. In addition, mixed methods research, using Nominal Group Technique (NGT), identified and rated preference attribute themes of genomic testing amongst cancer patients. These preference attributes were then benchmarked against genomic testing undertaken within the ATLANTIS clinical trial, to determine how a novel PCM study design incorporated the attributes.
Results: Patient preferences of genomic testing in PCM are influenced by clinical treatment intent and time since completing treatment. Patients undergoing cancer treatment with radical intent demonstrated higher preference ratings for test sensitivity (true positive) and specificity (true negative). Invasiveness of testing and test turnaround time were higher rated preference attributes amongst patients undergoing treatment with palliative intent. Ten preference attribute themes of genomic testing were identified: regulatory/NHS approval, test turnaround time, invasiveness of testing, physician approval, test sensitivity (true positive), test specificity (true negative), prevalence of variant, distance to travel, implications for family and family endorsement for testing. The novel adaptive design of the ATLANTIS trial incorporated many of the preference attribute themes of genomic testing demonstrated in this thesis.
Conclusions: Patient preferences of genomic testing in PCM are influenced by clinical treatment intent. This thesis identified and rated preference attribute themes of genomic testing for patients, as well as benchmarking these against a current UK PCM clinical trial. The adaptive design of the ATLANTIS trial incorporated many of the preference attributes, but does not allow for assessment of interaction between multiple inter-related attributes. The results of this thesis augment novel clinical trial design for studies incorporating genomic testing in order they retain patient-centred values at their core
