Doctoral Final Examination for Ellen Romesburg, PhD(c), BSN

Exploring Communication of Genomic Information by Primary Care Nurse Practitioners in Rural Settings
Dissertation Chair: Dr. Marian Wilson, PhD, MPH, RN, PMGT-BC

Abstract

Background: The completion of the Human Genome Project and the advent of precision medicine represent two of the most promising developments in the history of medicine. These advances, however, in combination with increased popularity in genetic curiosity and testing, have exposed the shortage of genomic specialists. Patients in rural areas are increasingly dependent on primary healthcare providers for guidance and explanation of complex genomic information. This shift in expectation has revealed a gap in genomic literacy, education, and understanding among healthcare providers and the general public. Genomic testing, with all its powerful capabilities, can be emotionally taxing and involve complex ethical, legal, and social issues (ELSI) and psychosocial implications. With the shortage of genomic specialists and an increased demand from the public, it is imperative that the healthcare community finds a solution to meet emerging genomic needs.

Although nurse practitioners (NPs) deliver 42% of all rural primary health care, there is limited research investigating their experiences and perspectives regarding the use and communication of genomic information. The nursing profession must make strategic plans that promote precision health in nursing research, education, clinical practice, as well as the administrative and health policy arenas. Due to the concentration of genomic specialists in urban areas, it was crucial to investigate how rural primary care NPs are addressing the potential resource disparity in their rural communities to ensure healthcare equity. Greater understanding can lead to improvement in clinical practice and patient outcomes. This research study gathered essential information needed to inform expanded healthcare education, implementation, and policy work.