Precision medicine in Australia: now is the time to get it right

In reply: We thank Nindra and colleagues1 for their commentary on our call to action2 regarding the need for an implementation science research approach to translation of precision medicine into the health care system. Although we acknowledge that access to laboratory genomic testing is vital for precision medicine, there are additional broader systemic issues that also need to be managed in research and planning to ensure scalability, equity of access, and success.

Two examples of health systems level approaches to precision oncology include the Genomics Evidence Neoplasia Information Exchange (GENIE) study3 and the Geisinger Health System.4 These provide some useful lessons and demonstrate some of these broader systemic barriers to precision oncology beyond access to genomic testing alone. GENIE found key barriers, such as patient access to re‐imbursed therapies, clinician readiness for genomics, and technical issues with electronic health record use of molecular tumour information for oncology care. The ProvenCare precision medicine approach taken by Geisinger used evidence‐based care guidelines to devise protocols and implemented these through electronic health record systems across six sites.4 This provided a single model for effective delivery of care and reduced variation in management for patients with non‐small cell lung cancer and showed a 90% uptake of care elements in all sites for patients.4

In addition, understanding the barriers and enablers at the clinician and consumer level is required to enable effective models of care. Research into cancer specialists’ attitudes towards the use of genetic information in precision medicine shows high acceptability, with 63.7% favouring its use in treatment and prognostic information, but with concerns over access and results delivery, cost, knowledge and potential misuse.5 These concerns need to be addressed, along with issues related to the entire patient journey from screening, diagnosis, testing and through to treatment, in order to enable effective models of care.

As we discussed in our article,2 precision medicine implementation research requires a holistic approach recognising the diversity of many factors across the health system including variation in Australian health system structures, variation in health professional practices and patient engagement, as well as access issues for culturally and linguistically diverse groups.