Towards Genomics-Informed Care: Lessons from the US and UK for Canadian Nurses

Approximately 40% of Canadians will be diagnosed with cancer during their lifetime, underscoring the importance of earlier detection, more accurate diagnoses, and better-targeted treatments. Genomics (the study of genes and their functions) has potential to significantly reduce the impact of cancer in Canada. Oncology nurses are in a great position to ensure that patients benefit from advancements in cancer genomics, but research shows that many Canadian nurses are not yet equipped to apply these genomic practices – especially because Canada lacks specific policies in this area.

This article presents the initial findings from a three-part project led by IALH Research Fellow Lorelei Newton (Nursing) and colleagues across Canada, aimed at developing policy recommendations for the Canadian Association of Nurses in Oncology/ Association canadienne des infirmières en oncologie (CANO/ACIO) and the Canadian Association of Schools of Nursing (CASN). The goal was to create a framework based on nursing policies from the United States and the United Kingdom to guide genomic practices in Canada. The researchers focused on answering three key questions:

  1. What are the main features of the policies guiding genomics and nursing in the US and UK?
  2. What factors (policy drivers) can help promote safe and fair genomic nursing practices?
  3. How do these policies compare with Canada’s current policies for oncology nursing education and
    practice?

The results from this phase will inform the next two phases of the study, which involve gathering Canadian nurses’ and patients’ perspectives and developing policy recommendations for CANO and CASN. These further phases are discussed in separate reports.

In reviewing literature related to genomics and nursing, the research team identified 94 documents (64 from the US, 28 from the UK, and 2 covering both).

The policy documents in the study were grouped into four main categories:
1. Position Statements/Policy Advocacy Briefs: These are official statements from professional organizations that highlight important issues and advocate for change.
2. Competencies: These outline the skills and knowledge that nurses need to integrate genomics into their practice.
3. Scope and Standards of Practice: These define what nurses are allowed to do in their roles and what is expected of them.
4. Education or Curriculum Frameworks: These guide the training and education of nurses in genomics.

Key findings include:

  • US: The US has many policy documents in these categories, especially from organizations like the Oncology Nursing Society (ONS), the American Nurses Association (ANA), and the International Society of Nurses in Genetics (ISONG).
  • UK: In the UK, there were fewer position statements and advocacy briefs related to genomics and nursing. This may be because genetic counselors historically provided most genomics-related services in the UK, with less emphasis on nurses. However, the role of nurses in genomics is growing, and the UK does have important documents, like a competency framework from 2011, which provides guidance on the skills needed by nurses in this field.

Key Recommendations:
1. Embed Interdisciplinary Collaboration: Nursing leaders must ensure that genomics- informed healthcare is grounded in interdisciplinary teamwork, as nurses work closely with other healthcare providers such as genetic counselors. Developing interdisciplinary policy guidance would not only benefit patient outcomes but also position Canadian nurses to lead in global interdisciplinary policy development.
2. Address Equity Concerns: Genomic technologies, while promising, can also exacerbate health disparities. It is essential to provide clear policy guidance on how oncology nurses should address equity issues associated with genomics-informed healthcare. A comprehensive review of the available evidence is needed to formulate strategies that mitigate these inequities and ensure equitable access to genomic healthcare across diverse populations.

Conclusions:
Canadian oncology nurses must be ready to engage with genomics-informed practice, which is becoming increasingly essential in modern healthcare. To support this transition, Canada urgently requires policies that will guide the practice, education, and research related to genomics within nursing. By examining policy frameworks and drivers from the US and UK — where robust infrastructures for genomics integration exist — Canada can develop its own strategies for policy development.

The experiences of these countries show that change happens incrementally and requires sustained investment from government, health service organizations, funding bodies, nurse leaders, and interdisciplinary partners. This collaboration is crucial to accelerate the integration of genomics into\ healthcare. A solid nursing policy infrastructure will establish the necessary foundation to ensure that genomics is effectively incorporated into Canadian oncology nursing practice. This will not only enhance the capacity of oncology nurses but also set a precedent for integration into other areas of nursing practice.

Developing a genomically competent nursing workforce is vital to ensure that all Canadians can benefit fully from advancements in genomic technologies. By building this competency, the healthcare system can more effectively leverage genomic innovations to improve patient outcomes and enhance the quality of care across the country.

To read the full article, see https://onlinelibrary.wiley.com/doi/epdf/10.1111/jan.16099?src=getftr.