Transformative insights in medical knowledge have redefined the way practitioners regard disease, operationalize treatments, and monitor health. This evolution has been contextualized in the form of precision medicine—a platform of healthcare delivery now utilized by various healthcare systems across the nation. Precision Medicine operates on the principle that “more precise” healthcare generates a more meaningful representation of the patient and improves quality of care at reduced costs. Specific examples of precision medicine applications are documented throughout the scientific literature, and best exemplified in clinical oncology [1].
Despite the traditional attainment of personal and family histories during clinical encounters, the reality is that efforts to capture the true contributions of genetics, lifestyle and environment in regards to disease is erratic. Instead, integration of “complementary” data is often incomplete and poorly stratified. Such gaps are impactful in the primary care setting, where the most immediate patient needs are given highest priority, as well as in the inpatient setting, where providers are focused on acute conditions rather than personalization of care. Irrespective of clinical setting, we posit that the benefits of precision medicine cannot be fully realized unless specific strategies are put in place for both patients and practitioners to contextualize, interpret, and utilize precision healthcare.
Advancement of precision medicine reinforces the notion that evidence-based medicine and its footing on randomized clinical trials has disappointingly excluded large segments of the population, particularly individuals of minority descent or those residing in rural communities. On average, there are 1.8 clinical geneticists per one million people in the US [2], and these clinicians are often disproportionately located in large medical centers within highly populated urban areas. A national survey conducted by Shields et al. [3]. notes that minority-serving physicians were significantly less likely to have ever ordered genetic testing to screen for breast cancer, colon cancer, or Huntington’s disease in comparison to physicians who served a fewer number of minority patients. Furthermore, this group reported that minority-serving physicians were significantly less likely to have ever referred a patient for genetic testing or services [3]. Of importance is that those excluded are the very same groups for whom genomic data are not readily available, and for whom lifestyle and environmental determinants have crucial implications. As such, it is not surprising that those underrepresented in clinical research are often those who do not respond as expected to treatment, experience more adverse drug reactions, and often navigate the system without finding appropriate medical solutions [4]. Thus, the one-size-fits-all approach that currently dominates medical practice has become increasingly unfit to meet the needs of a rapidly evolving system of healthcare. We propose that coordinated efforts to expand the roles of community health workers (CHW) and patient navigators (PN) can offer unparalleled opportunities to disseminate the knowledge required for the public sector to benefit from precision healthcare.
Despite the social and environmental determinants of health that are prominently featured in the public health ecosystem, the lay public (that is, the consumers and drivers of the healthcare system) continues to lag behind in the opportunity to take advantage of precision medicine. Currently, the public is bombarded with direct-to-consumer advertising, real time “medical” guidance through the internet, access to digital devices that capture health information, and “science-based” adds that promote food, cosmetics, and dietary supplements. Unfortunately, much of this information uses terminology that is often misunderstood, particularly by consumers with lower levels of health and genomic literacy. Such constraints mirror their limitations to obtain and process the basic medical information needed to make appropriate healthcare decisions. As such, this renders the lay public ill-equipped to make informed decisions and understand genome-based technologies. For instance, though most individuals with a middle school level of education have rudimentary knowledge of Mendelian inheritance, this knowledge is insufficient to understand the concepts of monogenic inheritance or genetic disorders. These knowledge gaps are accentuated in the context of precision medicine, where concepts of polygenic inheritance and chronicity of disease are prominently featured, and complex patterns of inheritance and epigenetic mechanisms play pivotal roles in disease susceptibility and health outcomes. To bridge these critical gaps, we propose the use of CHWs and PNs.
