1932

Abstract

The development of massively parallel sequencing–based genomic sequencing tests has increased genetic test availability and access. The field and practice of genetic counseling have adapted in response to this paradigm-shifting technology and the subsequent transition to practicing genomic medicine. While the key elements defining genetic counseling remain relevant, genetic counseling service delivery models and practice settings have evolved. Genetic counselors are addressing the challenges of direct-to-consumer and consumer-driven genetic testing, and genetic counseling training programs are responding to the ongoing increased demand for genetic counseling services across a broadening range of contexts. The need to diversify both the patient and participant groups with access to genetic information, as well as the field of genetic counseling, is at the forefront of research and training program initiatives. Genetic counselors are key stakeholders in the genomics era, and their contributions are essential to effectively and equitably deliver precision medicine.

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2021-08-31
2024-12-09
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Literature Cited

  1. 1. 
    Accred. Counc. Genet. Couns. (ACGC) 2019. Practice-based competencies for genetic counselors Doc., ACGC, McLean, VA. https://www.gceducation.org/practice-based-competencies
    [Google Scholar]
  2. 2. 
    Accred. Counc. Genet. Couns. (ACGC) 2019. Standards of accreditation for graduate programs in genetic counseling Doc., ACGC, McLean, VA. https://www.gceducation.org/standards-of-accreditation
    [Google Scholar]
  3. 3. 
    Accred. Counc. Genet. Couns. (ACGC) 2020. Program directory.. Accreditation Council for Genetic Counselors https://www.gceducation.org/program-directory
    [Google Scholar]
  4. 4. 
    Accred. Counc. Genet. Couns. (ACGC) 2020. Revised standards FAQs. Accreditation Council for Genetic Counselors https://www.gceducation.org/standards-faqs
    [Google Scholar]
  5. 5. 
    Adam S, Birch PH, Coe RR, Bansback N, Jones AL et al. 2019. Assessing an interactive online tool to support parents’ genomic testing decisions. J. Genet. Couns. 28:10–17
    [Google Scholar]
  6. 6. 
    All of Us Res. Program Investig 2019. The “All of Us” Research Program. N. Engl. J. Med. 381:668–76
    [Google Scholar]
  7. 7. 
    Allen CG, Gabriel J, Flynn M, Cunningham TN, Wang C. 2018. The impact of raw DNA availability and corresponding online interpretation services: a mixed-methods study. Transl. Behav. Med. 8:105–12
    [Google Scholar]
  8. 8. 
    Allyse MA, Robinson DH, Ferber MJ, Sharp RR. 2018. Direct-to-consumer testing 2.0: emerging models of direct-to-consumer genetic testing. Mayo Clin. Proc. 93:113–20
    [Google Scholar]
  9. 9. 
    Am. Coll. Med. Genet. Board Dir 2004. ACMG statement on direct-to-consumer genetic testing. Genet. Med. 6:60
    [Google Scholar]
  10. 10. 
    Am. Coll. Med. Genet. Genom. Board Dir 2016. Direct-to-consumer genetic testing: a revised position statement of the American College of Medical Genetics and Genomics. Genet. Med. 18:207–8
    [Google Scholar]
  11. 11. 
    Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT et al. 2018. The Clinical Sequencing Evidence-Generating Research consortium: integrating genomic sequencing in diverse and medically underserved populations. Am. J. Hum. Genet. 103:319–27
    [Google Scholar]
  12. 12. 
    Assoc. Genet. Couns. Program Dir 2019. The genetic counseling admissions match: summary results of the match for positions beginning in 2019 Doc., Natl. Match. Serv. Toronto: Can. https://agcpd.org/Uploads/2019%20Executive%20Summary%20Admissions%20Match.pdf
    [Google Scholar]
  13. 13. 
    Attard CA, Carmany EP, Trepanier AM. 2019. Genetic counselor workflow study: the times are they a-changin’?. J. Genet. Couns. 28:130–40
    [Google Scholar]
  14. 14. 
    Bamshad MJ, Ng SB, Bigham AW, Tabor HK, Emond MJ et al. 2011. Exome sequencing as a tool for Mendelian disease gene discovery. Nat. Rev. Genet. 12:745–55
    [Google Scholar]
  15. 15. 
    Biesecker BB, Lillie SE, Amendola LM, Donohue KE, East KE et al. 2020. A review and definition of ‘usual care’ in genetic counseling trials to standardize use in research. J. Genet. Couns. https://doi.org/10.1002/jgc4.1363
    [Crossref] [Google Scholar]
  16. 16. 
    Bombard Y, Clausen M, Shickh S, Mighton C, Casalino S et al. 2020. Effectiveness of the Genomics ADvISER decision aid for the selection of secondary findings from genomic sequencing: a randomized clinical trial. Genet. Med. 22:727–35
    [Google Scholar]
  17. 17. 
    Brett GR, Metcalfe SA, Amor DJ, Halliday JL. 2012. An exploration of genetic health professionals’ experience with direct-to-consumer genetic testing in their clinical practice. Eur. J. Hum. Genet. 20:825–30
    [Google Scholar]
  18. 18. 
    Capalbo A, Valero RA, Jimenez-Almazan J, Pardo PM, Fabiani M et al. 2019. Optimizing clinical exome design and parallel gene-testing for recessive genetic conditions in preconception carrier screening: translational research genomic data from 14,125 exomes. PLOS Genet 15:e1008409
    [Google Scholar]
  19. 19. 
    Carey M. 2019. Strategic plan 2019–2021 Doc., Natl. Soc. Genet. Couns Chicago: https://www.nsgc.org/d/do/8993
    [Google Scholar]
  20. 20. 
    Channaoui N, Bui K, Mittman I. 2020. Efforts of diversity and inclusion, cultural competency, and equity in the genetic counseling profession: a snapshot and reflection. J. Genet. Couns. 29:166–81
    [Google Scholar]
  21. 21. 
    Channaoui N, Khan A, Wiesman C, Bui K, Cunningham M et al. 2020. Summary report of the 2019 Diversity and Inclusion Task Force of the National Society of Genetic Counselors. J. Genet. Couns. 29:192–201
    [Google Scholar]
  22. 22. 
    Christensen KD, Vassy JL, Jamal L, Lehmann LS, Slashinski MJ et al. 2016. Are physicians prepared for whole genome sequencing? A qualitative analysis. Clin. Genet. 89:228–34
    [Google Scholar]
  23. 23. 
    Clarke A, Thirlaway K. 2011.. ‘ Genomic counseling’? Genetic counseling in the genomic era. Genome Med 3:7
    [Google Scholar]
  24. 24. 
    Cloutier M, Gallagher L, Goldsmith C, Akiki S, Barrowman N, Morrison S. 2017. Group genetic counseling: an alternate service delivery model in a high risk prenatal screening population. Prenat. Diagn. 37:1112–19
    [Google Scholar]
  25. 25. 
    Cohen SA, Gustafson SL, Marvin ML, Riley BD, Uhlmann WR et al. 2012. Report from the National Society of Genetic Counselors Service Delivery Model Task Force: a proposal to define models, components, and modes of referral. J. Genet. Couns. 21:645–51
    [Google Scholar]
  26. 26. 
    Cohn EG, Husamudeen M, Larson EL, Williams JK. 2015. Increasing participation in genomic research and biobanking through community-based capacity building. J. Genet. Couns. 24:491–502
    [Google Scholar]
  27. 27. 
    Conta J, Sternen D, Stasi S, Candadai SC, Wellner M, Dickerson J. 2019. An integrated approach to genetic test stewardship: the role of laboratory genetic counselors in test preauthorization and ordering. Am. J. Clin. Pathol. 152:S148
    [Google Scholar]
  28. 28. 
    Crellin E, McClaren B, Nisselle A, Best S, Gaff C, Metcalfe S. 2019. Preparing medical specialists to practice genomic medicine: education an essential part of a broader strategy. Front. Genet. 10:789
    [Google Scholar]
  29. 29. 
    East K, Chung W, Foreman K, Gilmore M, Gornick M et al. 2017. Guide to interpreting genomic reports: a genomics toolkit Rep., Clin. Seq. Explor. Res. Consort https://cser-consortium.org/system/files/attachments/cser_provider_toolkit.pdf.pdf
    [Google Scholar]
  30. 30. 
    Erwin DJ, LaMaire C, Espana A, Eble TN, Dhar SU. 2020. Financial barriers in a county genetics clinic: problems and solutions. J. Genet. Couns. 29:678–88
    [Google Scholar]
  31. 31. 
    Farwell Hagman KD, Lamb Thrush D, Freeze S, Dorsainville DL, Eichmeyer J et al. 2020. Facing the challenge of genetic counselors’ need for rapid continuing education about genomic technologies. J. Genet. Couns. 29:838–48
    [Google Scholar]
  32. 32. 
    Faucett WA, Peay H, Coughlin CR. 2019. Genetic testing: consent and result disclosure for primary care providers. Med. Clin. N. Am. 103:967–76
    [Google Scholar]
  33. 33. 
    Field T, Brewster SJ, Towne M, Campion MW. 2016. Emerging genetic counselor roles within the biotechnology and pharmaceutical industries: As industry interest grows in rare genetic disorders, how are genetic counselors joining the discussion?. J. Genet. Couns. 25:708–19
    [Google Scholar]
  34. 34. 
    Haga SB, Kim E, Myers RA, Ginsburg GS. 2019. Primary care physicians’ knowledge, attitudes, and experience with personal genetic testing. J. Pers. Med. 9:29
    [Google Scholar]
  35. 35. 
    Hallquist MLG, Tricou EP, Hallquist MN, Savatt JM, Rocha H et al. 2020. Positive impact of genetic counseling assistants on genetic counseling efficiency, patient volume, and cost in a cancer genetics clinic. Genet. Med. 22:1348–54
    [Google Scholar]
  36. 36. 
    Harris A, Kelly SE, Wyatt S 2013. Counseling customers: emerging roles for genetic counselors in the direct-to-consumer genetic testing market. J. Genet. Couns. 22:277–88
    [Google Scholar]
  37. 37. 
    Heck PR, Meyer MN. 2019. Population whole exome screening: primary care provider attitudes about preparedness, information avoidance, and nudging. Med. Clin. N. Am. 103:1077–92
    [Google Scholar]
  38. 38. 
    Hindorff LA, Bonham VL, Ohno-Machado L. 2018. Enhancing diversity to reduce health information disparities and build an evidence base for genomic medicine. Pers. Med. 15:403–12
    [Google Scholar]
  39. 39. 
    Hooker GW, Ormond KE, Sweet K, Biesecker BB. 2014. Teaching genomic counseling: preparing the genetic counseling workforce for the genomic era. J. Genet. Couns. 23:445–51
    [Google Scholar]
  40. 40. 
    Hoskovec JM, Bennett RL, Carey ME, DaVanzo JE, Dougherty M et al. 2018. Projecting the supply and demand for certified genetic counselors: a workforce study. J. Genet. Couns. 27:16–20
    [Google Scholar]
  41. 41. 
    Hsieh V, Braid T, Gordon E, Hercher L 2020. Direct-to-consumer genetic testing companies tell their customers to ‘see a genetic counselor’. How do genetic counselors feel about direct-to-consumer genetic testing?. J. Genet. Couns. https://doi.org/10.1002/jgc4.1310
    [Crossref] [Google Scholar]
  42. 42. 
    Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Song M, Anderson L et al. 2020. Developing a culturally targeted video to enhance the use of genetic counseling in Latina women at increased risk for hereditary breast and ovarian cancer. J. Community Genet. 11:85–99
    [Google Scholar]
  43. 43. 
    Ingles J, Yeates L, Semsarian C. 2011. The emerging role of the cardiac genetic counselor. Heart Rhythm 8:1958–62
    [Google Scholar]
  44. 44. 
    Katsila T, Patrinos GP. 2015. Whole genome sequencing in pharmacogenomics. Front. Pharmacol. 6:61
    [Google Scholar]
  45. 45. 
    Kaye C, Bodurtha J, Edick M, Ginsburg S, Keehn A et al. 2019. Regional models of genetic services in the United States. Genet. Med. 22:381–88
    [Google Scholar]
  46. 46. 
    Lemke AA, Amendola LM, Kuchta K, Dunnenberger HM, Thompson J et al. 2020. Primary care physician experiences with integrated population-scale genetic testing: a mixed-methods assessment. J. Pers. Med. 104:165
    [Google Scholar]
  47. 46a. 
    Lemke AA, Amendola LM, Thompson J, Dunnenberg HM, Kuchta Ket al 2021. Patient-reported outcomes and experiences with population genetic testing offered through a primary care network. Genet. Test. Mol. Biomark 25:15660
    [Google Scholar]
  48. 47. 
    Liu HY, Zhou L, Zheng MY, Huang J, Wan S et al. 2019. Diagnostic and clinical utility of whole genome sequencing in a cohort of undiagnosed Chinese families with rare diseases. Sci. Rep. 9:19365
    [Google Scholar]
  49. 48. 
    Lynce F, Isaacs C. 2016. How far do we go with genetic evaluation? Gene, panel, and tumor testing. Am. Soc. Clin. Oncol. Educ. Book 35:e72–78
    [Google Scholar]
  50. 49. 
    Mann S. 2020. Creation of the Minority Genetic Professionals Network to increase diversity in the genetics work force. J. Genet. Couns. 29:202–5
    [Google Scholar]
  51. 50. 
    Marshall CR, Bick D, Belmont JW, Taylor SL, Ashley E et al. 2020. The Medical Genome Initiative: moving whole-genome sequencing for rare disease diagnosis to the clinic. Genome Med 12:48
    [Google Scholar]
  52. 51. 
    McCuaig JM, Armel SR, Care M, Volenik A, Kim RH, Metcalfe KA. 2018. Next-generation service delivery: a scoping review of patient outcomes associated with alternative models of genetic counseling and genetic testing for hereditary cancer. Cancers 10:435
    [Google Scholar]
  53. 52. 
    McWalter K, Cho MT, Hart T, Nusbaum R, Sebold C et al. 2018. Genetic counseling in industry settings: opportunities in the era of precision health. Am. J. Med. Genet. C 178:46–53
    [Google Scholar]
  54. 53. 
    Middleton A, Mendes Á, Benjamin CM, Howard HC. 2017. Direct-to-consumer genetic testing: Where and how does genetic counseling fit?. Pers. Med. 14:249–57
    [Google Scholar]
  55. 54. 
    Mikat-Stevens NA, Larson IA, Tarini BA. 2015. Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature. Genet. Med. 17:169–76
    [Google Scholar]
  56. 55. 
    Mills R, Haga SB. 2014. Genomic counseling: next generation counseling. J. Genet. Couns. 23:689–92
    [Google Scholar]
  57. 56. 
    Mittman IS, Downs K. 2008. Diversity in genetic counseling: past, present and future. J. Genet. Couns. 17:301–13
    [Google Scholar]
  58. 57. 
    Myers MF, Bernhardt BA. 2012. Direct-to-consumer genetic testing: introduction to the special issue. J. Genet. Couns. 21:357–60
    [Google Scholar]
  59. 58. 
    Nagy R, Peay H, Hicks M, Kloos J, Westman R et al. 2015. Genetic counselors’ and genetic counseling students’ attitudes around the clinical doctorate and other advanced educational options for genetic counselors: a report from the genetic counseling advanced degree task force. J. Genet. Couns. 24:626–34
    [Google Scholar]
  60. 59. 
    Natl. Hum. Genome Res. Inst 2020. Notice of Special Interest (NOSI): availability of administrative supplements for providing research experiences in genomic research for genetic counselors Not. NOT-HG-20-028 Natl. Hum. Genome Res. Inst Bethesda, MD: https://grants.nih.gov/grants/guide/notice-files/NOT-HG-20-028.html
    [Google Scholar]
  61. 60. 
    Natl. Inst. Health All of Us Res. Program 2019. NIH funds genetic counseling resource ahead of million-person sequencing effort News Release, Aug. 21 Natl. Inst. Health All of Us Res. Program Bethesda, MD: https://allofus.nih.gov/news-events-and-media/announcements/nih-funds-genetic-counseling-resource-ahead-million-person-sequencing-effort
    [Google Scholar]
  62. 61. 
    Natl. Soc. Genet. Couns. (NSGC) 2019. At-home genetic testing position statement. National Society of Genetic Counselors https://www.nsgc.org/p/bl/et/blogaid=1119
    [Google Scholar]
  63. 62. 
    Natl. Soc. Genet. Couns. (NSGC) 2020. Diversity, equity and inclusion resources. National Society of Genetic Counselors https://www.nsgc.org/p/cm/ld/fid=704
    [Google Scholar]
  64. 63. 
    Natl. Soc. Genet. Couns. (NSGC) 2020. Professional Status Survey 2020 Rep., NSGC Chicago: https://www.nsgc.org/p/cm/ld/fid=68
    [Google Scholar]
  65. 64. 
    O'Daniel JM. 2010. The prospect of genome-guided preventive medicine: a need and opportunity for genetic counselors. J. Genet. Couns. 19:315–27
    [Google Scholar]
  66. 65. 
    Ormond KE. 2013. From genetic counseling to “genomic counseling. .” Mol. Genet. Genom. Med. 1:189–93
    [Google Scholar]
  67. 66. 
    Ormond KE, Hallquist MLG, Buchanan AH, Dondanville D, Cho MK et al. 2019. Developing a conceptual, reproducible, rubric-based approach to consent and result disclosure for genetic testing by clinicians with minimal genetics background. Genet. Med. 21:727–35
    [Google Scholar]
  68. 67. 
    Paganoni S, Nicholson K, Leigh F, Swoboda K, Chad D et al. 2017. Developing multidisciplinary clinics for neuromuscular care and research. Muscle Nerve 56:848–58
    [Google Scholar]
  69. 68. 
    Palmer CGS, McConkie-Rosell A, Holm IA, LeBlanc K, Sinsheimer JS et al. 2018. Understanding adult participant and parent empowerment prior to evaluation in the Undiagnosed Diseases Network. J. Genet. Couns. 27:1087–101
    [Google Scholar]
  70. 69. 
    Palmer EE, Schofield D, Shrestha R, Kandula T, Macintosh R et al. 2018. Integrating exome sequencing into a diagnostic pathway for epileptic encephalopathy: evidence of clinical utility and cost effectiveness. Mol. Genet. Genom. Med. 6:186–99
    [Google Scholar]
  71. 70. 
    Peshkin BN, Ladd MK, Isaacs C, Segal H, Jacobs A et al. 2021. The Genetic Education for Men (GEM) trial: development of web-based education for untested men in BRCA1/2-positive families. J. Cancer Educ. 36:72–84
    [Google Scholar]
  72. 71. 
    Phillips KA, Deverka PA, Hooker GW, Douglas MP. 2018. Genetic test availability and spending: Where are we now? Where are we going?. Health Aff. 37:710–16
    [Google Scholar]
  73. 72. 
    Pirzadeh-Miller S, Robinson LS, Read P, Ross TS. 2017. Genetic counseling assistants: an integral piece of the evolving genetic counseling service delivery model. J. Genet. Couns. 26:716–27
    [Google Scholar]
  74. 73. 
    Popejoy AB, Fullerton SM. 2016. Genomics is failing on diversity. Nature 538:161–64
    [Google Scholar]
  75. 74. 
    Posey JE, O'Donnell-Luria AH, Chong JX, Harel T, Jhangiani SN et al. 2019. Insights into genetics, human biology and disease gleaned from family based genomic studies. Genet. Med. 21:798–812
    [Google Scholar]
  76. 75. 
    Puryear L, Downs N, Nevedal A, Lewis ET, Ormond KE et al. 2018. Patient and provider perspectives on the development of personalized medicine: a mixed-methods approach. J. Community Genet. 9:283–91
    [Google Scholar]
  77. 76. 
    Ramos E, Weissman SM. 2018. The dawn of consumer-directed testing. Am. J. Med. Genet. C 178:89–97
    [Google Scholar]
  78. 77. 
    Rehm HL, Berg JS, Brooks LD, Bustamante CD, Evans JP et al. 2015. ClinGen—the Clinical Genome Resource. N. Engl. J. Med. 372:2235–42
    [Google Scholar]
  79. 78. 
    Resta R, Biesecker BB, Bennett RL, Blum S, Hahn SE et al. 2006. A new definition of genetic counseling: National Society of Genetic Counselors’ task force report. J. Genet. Couns. 15:77–83
    [Google Scholar]
  80. 79. 
    Rhoads S, Rakes AL. 2020. Telehealth technology: reducing barriers for rural residents seeking genetic counseling. J. Am. Assoc. Nurse Pract. 32:190–92
    [Google Scholar]
  81. 80. 
    Riconda D, Grubs RE, Campion MW, Cragun D. 2018. Genetic counselor training for the next generation: Where do we go from here?. Am. J. Med. Genet. C 178:38–45
    [Google Scholar]
  82. 81. 
    Schmidlen T, Schwartz M, DiLoreto K, Kirchner HL, Sturm AC. 2019. Patient assessment of chatbots for the scalable delivery of genetic counseling. J. Genet. Couns. 28:1166–77
    [Google Scholar]
  83. 82. 
    Schmidlen T, Sturm AC, Hovick S, Scheinfeldt L, Scott Roberts J et al. 2018. Operationalizing the reciprocal engagement model of genetic counseling practice: a framework for the scalable delivery of genomic counseling and testing. J. Genet. Couns. 27:1111–29
    [Google Scholar]
  84. 83. 
    Schmidt JL, Maas R, Altmeyer SR. 2019. Genetic counseling for consumer-driven whole exome and whole genome sequencing: a commentary on early experiences. J. Genet. Couns. 28:449–55
    [Google Scholar]
  85. 84. 
    Schwartz MLB, McCormick CZ, Lazzeri AL, Lindbuchler DM, Hallquist MLG et al. 2018. A model for genome-first care: returning secondary genomic findings to participants and their healthcare providers in a large research cohort. Am. J. Hum. Genet. 103:328–37
    [Google Scholar]
  86. 85. 
    Shendure J, Ji H 2008. Next-generation DNA sequencing. Nat. Biotechnol. 26:1135–45
    [Google Scholar]
  87. 86. 
    Smith CE, Fullerton SM, Dookeran KA, Hampel H, Tin A et al. 2016. Using genetic technologies to reduce, rather than widen, health disparities. Health Aff. 35:1367–73
    [Google Scholar]
  88. 87. 
    Stoll K, Kubendran S, Cohen SA. 2018. The past, present and future of service delivery in genetic counseling: keeping up in the era of precision medicine. Am. J. Med. Genet. C 178:24–37
    [Google Scholar]
  89. 88. 
    Sturm AC, Schmidlen T, Scheinfeldt L, Hovick S, McElroy JP et al. 2018. Early outcome data assessing utility of a post-test genomic counseling framework for the scalable delivery of precision health. J. Pers. Med. 8:25
    [Google Scholar]
  90. 88a. 
    Suckiel SA, O'Daniel JM, Donohue KE, Gallagher KM, Gilmore MJet al 2021. Genomic sequencing results disclosure in diverse and medically underserved populations: themes, challenges, and strategies from the CSER consortium. J. Pers. Med 11:202
    [Google Scholar]
  91. 89. 
    Tan DS, Mok TS, Rebbeck TR. 2016. Cancer genomics: diversity and disparity across ethnicity and geography. J. Clin. Oncol. 34:91–101
    [Google Scholar]
  92. 90. 
    Tandy-Connor S, Guiltinan J, Krempely K, LaDuca H, Reineke P et al. 2018. False-positive results released by direct-to-consumer genetic tests highlight the importance of clinical confirmation testing for appropriate patient care. Genet. Med. 20:1515–21
    [Google Scholar]
  93. 91. 
    Uhlmann WR, Schwalm K, Raymond VM. 2017. Development of a streamlined work flow for handling patients’ genetic testing insurance authorizations. J. Genet. Couns. 26:657–68
    [Google Scholar]
  94. 92. 
    Univ. Minn 2015. MCDB&G PhD/MS in genetic counseling joint degree program. University of Minnesota https://cbs.umn.edu/genetic-counseling/program-information/phdprogram
    [Google Scholar]
  95. 93. 
    US Bur. Labor Stat 2020. Genetic counselors: job outlook. Occupational Outlook Handbook Washington, DC: US Bur. Labor Stat., US Dep. Labor. https://www.bls.gov/ooh/healthcare/genetic-counselors.htm#tab-6
    [Google Scholar]
  96. 94. 
    US Dep. Health Hum. Serv 2017. Sex, race, and ethnic diversity of U.S. health occupations (2011–2015) Rep., Natl. Cent. Health Workforce Anal., Health Resour Serv. Adm., US Dep. Health Hum. Serv. Rockville, MD: https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/diversityushealthoccupations.pdf
    [Google Scholar]
  97. 95. 
    US Dep. Health Hum. Serv 2019. The Electronic Medical Records and Genom. (eMERGE) genomic risk assessment and management networkclinical sites (U01 clinical trial required) Fund. Oppor. RFA-HG-19-013 Natl. Inst. Health, US Dep. Health Hum. Serv. Bethesda, MD: https://grants.nih.gov/grants/guide/rfa-files/rfa-hg-19-013.html
    [Google Scholar]
  98. 96. 
    US Dep. Health Hum. Serv 2020. Investigator-initiated research on genetic counseling processes and practices (R01 clinical trial optional) Fund. Oppor. RFA-HG-20-048 Natl. Inst. Health, US Dep. Health Hum. Serv. Bethesda, MD: https://grants.nih.gov/grants/guide/rfa-files/RFA-HG-20-048.html
    [Google Scholar]
  99. 97. 
    US Dep. Health Hum. Serv 2020. Investigator-initiated research on genetic counseling processes and practices (R21 clinical trial optional) Fund. Oppor. RFA-HG-20-049 Natl. Inst. Health, US Dep. Health Hum. Serv., Bethesda Maryland: https://grants.nih.gov/grants/guide/rfa-files/RFA-HG-20-049.html
    [Google Scholar]
  100. 98. 
    US Gov. Account. Off 2010. Direct-to-consumer genetic tests: misleading test results are further complicated by deceptive marketing and other questionable practices Rep. GAO-10-847T Gov. Account. Off Washington, DC: https://www.gao.gov/products/GAO-10-847T
    [Google Scholar]
  101. 99. 
    US House Rep. Comm. Energy Commer 2010. Direct-to-consumer genetic testing and the consequences to the public health: hearing before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives Hear., July 22, 111th Congr., 2nd Sess. https://www.govinfo.gov/content/pkg/CHRG-111hhrg78125/html/CHRG-111hhrg78125.htm
    [Google Scholar]
  102. 100. 
    Va. Commonw. Univ 2015. Dual degree Ph.D. in human genetics/M.S. in genetic counseling. Virginia Commonwealth University https://gen.vcu.edu/graduate-and-training-programs/dual-degree-program-in-human-genetics–genetic-counseling
    [Google Scholar]
  103. 101. 
    Valverde K, Mueller R, Paciotti B, Conway L 2016. An exploratory study of employers’ attitudes towards a clinical doctorate in genetic counseling. J. Genet. Couns. 25:179–88
    [Google Scholar]
  104. 102. 
    Vassy JL, Christensen KD, Schonman EF, Blout CL, Robinson JO et al. 2017. The impact of whole-genome sequencing on the primary care and outcomes of healthy adult patients: a pilot randomized trial. Ann. Intern. Med. 167:159–69
    [Google Scholar]
  105. 103. 
    Wham D, Vu T, Chan-Smutko G, Kobelka C, Urbauer D, Heald B. 2010. Assessment of clinical practices among cancer genetic counselors. Fam. Cancer 9:459–68
    [Google Scholar]
  106. 104. 
    Wicklund C, Trepanier A. 2014. Adapting genetic counseling training to the genomic era: more an evolution than a revolution. J. Genet. Couns. 23:452–54
    [Google Scholar]
  107. 105. 
    Wynn J, Chung WK. 2019. Developing effective and efficient genomic educational tools for our diverse population. Ann. Transl. Med. 7:S304
    [Google Scholar]
  108. 106. 
    Wynn J, Lewis K, Amendola LM, Bernhardt BA, Biswas S et al. 2018. Clinical providers’ experiences with returning results from genomic sequencing: an interview study. BMC Med. Genom. 11:45
    [Google Scholar]
  109. 107. 
    Yanes T, McInerney-Leo AM, Law M, Cummings S. 2020. The emerging field of polygenic risk scores and perspective for use in clinical care. Hum. Mol. Genet. 29:R165–76
    [Google Scholar]
  110. 108. 
    Yorczyk A, Robinson LS, Ross TS. 2015. Use of panel tests in place of single gene tests in the cancer genetics clinic. Clin. Genet. 88:278–82
    [Google Scholar]
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