Dear Editor:

I write in response to the Topic of The Genetic Revolution. We live in a DNA culture. Since the 1980, genetic engineering, cloning, gene therapy, and forensic DNA evidence have become hot topics of discussion. The completion of the mapping of the human genome will probably fuel even more public interest in genetics. Technological advancements such as the invention of the polymerase chain reaction (PCR) have revolutionized molecular biology, making it possible for almost anyone to quickly and inexpensively study DNA. Medical researchers have been frenetically deciphering a seemingly endless array of human diseases ever since. At times it seems there is no health problem on earth for which a genetic cause or cure is not being sought.

One of the benefactors of the knowledge gained from this genetic revolution has been the field of genetic testing. The utilization of genetic testing in clinical settings continues to grow. Meanwhile, there is a wealth of often-conflicting information about genetic disorders available to today's health care consumer via the media and the Internet. Patients seeking the latest tests and treatments expect their primary care providers to have the expertise to offer sound genetic advice. Unfortunately, there is evidence to suggest that health care practitioners may not know enough about genetics themselves to authoritatively answer these questions.

Studies indicate that primary care providers may lack the necessary expertise to be able to offer and interpret genetic tests to their patients (Biesecker & Marteau, 1999). Advanced practice nurses may be as poorly-prepared as physicians, according to a 1995 study in which only 15% of nurses had a genetics course available to them, and 63% of nurses felt that genetics was not adequately covered in their nursing curriculum (Johnson & Brensinger, 2000). In 1997, the National Institutes of Health Task Force on Genetic Testing acknowledged this shortcoming when it recommended that health care providers be required to indicate their competence before being permitted to order or counsel patients about predictive genetic tests. In order to accomplish this, medical and nursing schools will need to develop genetics curricula, and integrate genetics into both clinical training and basic science courses (Holtzman & Watson, 1997). Better training of health professionals is needed in order to assure minimum competency in not only genetics and disease prevention but also the ethical, legal, and social issues related to it (Centers for Disease Control and Prevention, 1997).

Despite this apparent shortage of adequately trained personnel to counsel patients, genetic testing is more popular than ever. At the same time, as more genetic tests are developed, keeping abreast of this new technology is becoming more difficult, particularly since genetic tests are frequently marketed long before sufficient data can be collected to definitively support their use (Biesecker & Marteau, 1999; Holtzman & Watson, 1997). Nevertheless, our patients rely on us for unbiased information, and we must be prepared to provide them with the information they need.

The proposed changes in basic nursing programs will benefit future graduates, but what about those of us working in, or about to enter, advanced practice without a strong background in genetics? We can attend genetics conferences, seminars, or continuing education classes. We can work with our employers to create additional learning opportunities where such programs do not already exist. As advanced practice nurses, if we chose to utilize genetic testing into our practice, we owe it to our patients to seek whatever additional training we need in order to do so competently. Only by educating ourselves will we be able to help our patients reap the benefits of advanced medical technology. Additional genetics training at both the basic and advanced practice level will help ensure future nursing professionals are equipped to meet this challenge.

Allyson C. Fox
RN/Adult Nurse Practitioner Student
Providence, NC

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References

Biesecker, B. B., & Marteau, T. M. (1999). The future of genetic counseling: an international perspective. Nature Genetics, 22(2), 133-137.

Centers for Disease Control and Prevention. (1997, October 1). Translating advances in human genetics into public health action: A strategic plan. Atlanta, GA: Author. Retrieved March 22, 2001 from the World Wide Web: http://www.cdc.gov/genetics/about/strategic.htm

Holtzman, N. A., & Watson, M. S. (Eds.). (1997, September). Promoting safe and effective genetic testing in the United States. Final report of the task force on genetic testing. Bethesda, MD: National Human Genome Research Institute. Retrieved March 22, 2001 from the World Wide Web: http://www.nhgri.nih.gov/ELSI/TFGT_final/

Johnson, K. A., & Brensinger, J. D. (2000). Genetic counseling and testing. Implications for clinical practice. Nursing Clinics of North America, 35(3), 615-626.

Go to the topic.
Reply by author Jean Jenkins.

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