To explore the clinical uptake of pharmacogenetic/pharmacogenomic toxicity testing to reduce adverse drug reaction incidences, this paper analyzes data collected through semi-structured face-to-face interviews with clinicians and/or clinician-scientists, primarily in the context of cancer treatment in multi-ethnic California (US), Vancouver (Canada) and Singapore. Recurrent themes in the data include the following: first, the scientific evidence for drug-gene interactions is perceived to be generally weak. Second, the primacy of medical treatment’s efficacy over toxicity is the predominant frame through which clinicians consider testing. Third, physicians tailor their decisions according to each patient’s tolerance levels for toxicity. Fourth, racially and ethnically based toxicity risk estimates are a factor shaping the clinical uptake of genetic tests, but they are controversial. These factors contribute to the low clinical uptake of toxicity testing for predictive purposes. We argue that the decision-makers’ framing and perception are additional features to be considered in Hedgecoe’s (2008) “clinical usefulness” framework.

中文翻译：

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癌症治疗中药物毒性基因检测的临床实用性：决策者的框架、知识和认知

为了探索药物遗传学/药物基因组学毒性测试的临床应用以减少药物不良反应发生率，本文分析了通过与临床医生和/或临床医生科学家进行半结构化面对面访谈收集的数据，主要是在癌症治疗的背景下多民族加利福尼亚（美国）、温哥华（加拿大）和新加坡。数据中反复出现的主题包括：首先，药物-基因相互作用的科学证据被普遍认为是薄弱的。其次，药物治疗的疗效优于毒性是临床医生考虑进行测试的主要框架。第三，医生根据每位患者对毒性的耐受水平来调整他们的决定。第四，基于种族和民族的毒性风险评估是影响基因检测临床应用的一个因素，但它们存在争议。这些因素导致用于预测目的的毒性测试的临床应用率较低。我们认为，决策者的框架和感知是 Hedgecoe (2008) 的“临床有用性”框架中需要考虑的附加特征。