Clinical Utility of Pharmacogenomics in Hospice Care Patients through the Lens of the Quadruple Aims of Healthcare

Hospice care utilizes a broad range of medications to maximize a patient's quality of life with pharmacogenomic (PGx) implications. This research study sought to expand on the previous research of PGx in palliative care to exclusively assess the clinical utility of PGx in hospice care. Demonstrating the clinical utility of PGx in achieving comfort faster and more effectively in hospice care is vital to public health due to the limited time patients in hospice care have. The implementation of PGx at Bethany Hospice will be evaluated through the quadruple aims of health care, defined as the betterment of patient care, improved patient experience, cost reduction, and improved provider experience (Bogetz & Friebert, 2017). As a pilot program, ten patients received PGx testing as part of clinical care, and researchers conducted chart reviews, a care manager survey, and a pharmacist survey. Chart reviews assessed patient medication lists, patient-reported depression, and pain scores, and PGx results to assess the betterment of patient care. Due to timeline of results, the care manager and pharmacist surveys could not be conducted but assess patient and provider experience. Results showed that all patients had at least one clinically actionable gene-drug interaction with a mean of 3.1 (SD=1.04) gene-drug interactions for each patient. The most common drug class for these gene-drug interactions were analgesics, antidepressants, and cardiovascular agents. Seven of the eight patients who received PGx results had at least one PGx-directed metabolizer-drug interaction, and three patients had PGx-directed drug changes. The mean patient CPIC PGx-directed metabolizer-drug interactions for common hospice drugs was 5.3 (SD=1.16). Aligned with previous research, PGx testing showed clinical utility in the betterment of patient care. Additionally, expanding on previous research, detailed descriptions of the metabolizer-drug interactions could be summarized. The care manager and pharmacist surveys were the main assessments of the other aims and could not be completed at this time. These surveys will be implemented as a future direction and hope to bolster the evidence of the clinical utility of PGx in hospice care