Pharmakogenetische Tests in der zukünftigen medizinischen Versorgung: Implikationen für Patienten und Ärzte

Zusammenfassung

Ziel: Die Art der Einbindung pharmakogenetischer Untersuchungen in den medizinischen Alltag wird maßgeblich davon beeinflusst werden, ob und unter welchen Rahmenbedingungen Patienten und Ärzte diese akzeptieren. Ein Literatur-Review sollte die Frage beantworten, welche Implikationen und Konsequenzen Patienten und Ärzte bzw. Wissenschaftler bei der Anwendung pharmakogenetischer Untersuchungen erwarten oder vermuten. Methodik: Umfassende Literaturrecherche in MEDLINE (Stichworte: Pharmacogenetics, Delivery of Health Care, Ethics, Attitude, Patient Acceptance of Health Care) nach empirischen und theoretischen Arbeiten, die psychische, familiäre, soziale und ethische Implikationen pharmakogenetischer Untersuchungen beschreiben, um relevante Themen als Grundlage weiterer empirischer Arbeiten zu extrahieren. Ergebnisse und Schlussfolgerungen: Neben antizipierten Vorteilen könnten folgende Faktoren die Akzeptanz pharmakogenetischer Untersuchungen beeinflussen: Erwartung negativer psychosozialer Konsequenzen sowie Sorge um Diskriminierung oder Nichteinhaltung des Datenschutzes. Zudem dürften die Information über Testergebnisse und die Vermittlung der Implikationen pharmakogenetischer Untersuchungen aufgrund ihrer Komplexität eine Herausforderung in der Arzt-Patienten-Beziehung darstellen. Da sich diese Gesichtspunkte vornehmlich aus theoretisch-konzeptionellen Arbeiten ableiten, sind empirische Untersuchungen zur Einstellung von Patienten und Ärzten sowie zum medizinischen und gesundheitsökonomischen Nutzen pharmakogenetischer Untersuchungen dringend erforderlich.

Abstract

Purpose: Since public acceptance of pharmacogenetic testing will largely influence their implementation in routine medical care, common implications of pharmacogenetic testing from patients’, physicians’ and scientists’ perspective are reviewed. Methods: Broad literature review (MEDLINE; MeSH terms: Pharmacogenetics, Delivery of Health Care, Ethics, Attitude, Patient Acceptance of Health Care) of empirical and theoretical studies describing psychological, family-related, social, and ethical consequences of pharmacogenetic testing to describe relevant aspects for further empirical studies. Results: Apart from anticipated benefit, acceptance of pharmacogenetic testing might be influenced by the following: Expectation of negative psychosocial consequences, fear of discrimination or violation of privacy. Due to its great complexity, understanding of test results and explanation of their impact pose new challenges for physician-patient relations. Since most studies are conceptual, empirical studies exploring attitudes of patients/physicians and determining medical as well as economic value of pharmacogenetic testing are imperative.

Schlüsselwörter

Pharmakogenetik - Ethik - Arzt-Patienten-Beziehung - genetische Beratung - Informed Consent - Allgemein- und Familienmedizin

Key words

Pharmacogenetics - ethics - physician-patient relations - genetic counselling - informed consent - family practice

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