Delivering genomic medicine in the United Kingdom National Health Service: a systematic review and narrative synthesis

Abstract

Purpose: We sought to assess the readiness of the United Kingdom(UK) National Health Service to implement a Genomic Medicine Service. Weconducted a systematic literature review to identify what is known about factorsrelated to the implementation of genomic medicine in routine health care and todraw out the implications for the UK and other settings. Methods: Relevant studies were identified in Web of Science and PubMed fromtheir date of inception to April 2018. The review included primary researchstudies using quantitative, qualitative, or mixed methods, and systematicreviews. A narrative synthesis was conducted. Results: Fifty-five studies met our inclusion criteria. The majority ofstudies reviewed were conducted in the United States. We identified fourdomains: (1) systems, (2) training and workforce needs, (3) professionalattitudes and values, and (4) the role of patients and the public. Conclusion: Mainstreaming genomic medicine into routine clinical practicerequires actions at each level of the health-care system. Our synthesisemphasized the organizational, social, and cultural implications of reformingpractice, highlighting that demonstration of clinical utility andcost-effectiveness, attending to the compatibility of genomic medicine withclinical principles, and involving and engaging patients are key to successfulimplementation.