Whole genome sequencing (WGS) and whole exome sequencing (WES) services are currently available to and being utilized by physicians and their patients in both research and clinical settings, and recently to anyone in the general public via direct-to-consumer companies. But the widespread availability and use of WGS and WES in the practice of clinical medicine is imminent. In the very near future, sequencing of individual genomes will be inexpensive and ubiquitous, and patients will be looking to the medical establishment for interpretations, insight and advice to improve their health. Developing standards and procedures for the use of WGS information in clinical medicine is an urgent need, but there are numerous obstacles related to integrity and storage of WGS data, interpretation and responsible clinical integration. The MedSeq Project is an exploratory trial of WGS in clinical medicine. At the conclusion of this study, we will have helped create innovative protocols and novel outcome measures that can be applied safely in future large-scale multi-site randomized clinical trials with larger numbers of physicians from broad specialties and with more economically and ethnically diverse patients. Together with our colleagues from across the nation through the U01 consortium formed as a result of this funding from the NIH, we will have invented a process of implementation and evaluation whereby the fruits of the Human Genome Project can be applied for the first time to the daily practice of medicine for the betterment of human health. The objectives of the MedSeq Project are to: <ol> <li>Recruit, consent and enroll 2 study groups:</li> <ol> <li>10 primary care physicians and 100 of their healthy middle-aged patients </li> <li>10 cardiologists and 100 of their patients with cardiomyopathy.</li> </ol> <li>Randomize each study group to receive standard of care versus standard of care plus WGS.</li> <li>Monitor the entire protocol for subject safety.</li> <li>Only half the enrolled patients were selected for sequencing. Fifty subjects were selected from the primary care cohort and fifty were selected from the cardiomyopathy cohort. Whole genome sequencing was performed at 30x coverage in Illumina's CLIA-certified laboratory on these 100 individuals.</li> <li>Generate and optimize an algorithm for interpreting WGS data covering the spectrum of human genetic variation, in terms of both previously reported and novel variants likely to influence the health of patients.</li> <li>Create patient reports and provide an interface for communicating clinically relevant genomic information to practicing physicians.</li> <li>Describe physicians' and patients' attitudes toward, and preferences for, the disclosure of WGS results at the start of the study.</li> <li>Evaluate physicians' experiences with receiving and interpreting patients' genetic test results and how they communicate these results to their patients.</li> <li>Explore how patients respond to and use WGS results by administering validated scales of psychological impact, personal utility, and behavioral responses, as well as economic and health outcomes.</li> </ol> Although we do not have a large enough sample size for statistical comparisons of outcomes, we will conduct exploratory comparisons: Exploratory Hypotheses: <ul> <li>Patients who receive WGS results will show equivalent levels of distress compared to patients who receive family history only.</li> <li>Patients with higher genetic literacy and better understanding will report greater satisfaction and less decisional regret.</li> <li>Patients who receive WGS will (a) be more likely to change health behaviors and (b) utilize more health care resources than those who do not receive WGS.</li> </ul>

CSER-MedSeq

The MedSeq Project: a randomized trial of integrating whole genome sequencing into clinical medicine

A systematic approach to the reporting of medically relevant findings from whole genome sequencing

'Someday it will be the norm': physician perspectives on the utility of genome sequencing for patient care in the MedSeq Project.

Summarizing polygenic risks for complex diseases in a clinical whole-genome report