In January, President Obama announced that $215 million will be dedicated in the 2016 budget to a new Precision Medicine Initiative. According to the White House Fact Sheet (https://www.whitehouse.gov/the-press-office/2015/01/30/fact-sheet-president-obam), the intention of precision medicine is to tailor disease prevention and healthcare treatment to differences in individuals based on genetics, environment, or lifestyle. More than 1 million Americans will have the opportunity to voluntarily participate in this "big data" venture in order to allow scientists to utilize aggregated data for development of precise new treatments and preventive interventions, targeting the specific needs of each individual. Genetic, environmental, and lifestyle characteristics gleaned from the big data can be utilized to precisely determine a recommended prevention/treatment plan, specifically tailored for each individual. According to the White House Fact Sheet, the primary objectives for the initiative include:
* More and better treatments for cancer
* Creation of a voluntary national research cohort
* Protection of participant volunteers' privacy
* Updating/modernization of the current regulatory landscape to remove barriers to volunteer participation and scientists' access to this data
* Public-private partnerships to develop the infrastructure for the Initiative
Collins and Varmus (2015) note that the Initiative has two main objectives: the short-term objective is a heightened focus on cancer prevention and treatment. The long-term objective is extending the knowledge to all health needs and diseases. Innovation will be critical to be successful in reaching the President's vision for the Initiative. For instance, Collins and Varmus (2015) note existing obstacles in cancer treatment including "unexplained drug resistance, genomic heterogeneity of tumors, insufficient means for monitoring responses and tumor recurrence, and limited knowledge about the use of drug combinations" (p. 794). Precision medicine as envisioned would allow scientists and clinicians to more effectively manage or eliminate these barriers through individualized care prescribed specifically for each patient with more confidence in expected outcomes. Likelihood of disease could be predicted and treatment initiated at an early stage when treatment could be simpler and less expensive (Marr, 2015).
The implications for the Precision Medicine Initiative are extraordinary. Application not only benefits individuals diagnosed with the multitude of gastrointestinal cancers we see each day in our practice, but opportunities to prevent, treat, manage, and even eradicate gastrointestinal diseases such as inflammatory bowel disease, irritable bowel syndrome, dyspepsia, familial polyposis, malabsorption disorders, biliary atresia, and telangiectasia to name but a few. As members of the healthcare team, nurses will be actively engaged not only in delivering precision medicine, but also in educating the public about precision medicine, and even participating as volunteers in the big data sets utilized for aggregate analysis that supports precision medicine.
In preparation for this initiative, it is imperative that nurses focus on expanding their knowledge of and comfort with genetics, genomics, and big data sets. Fortunately, the American Nurses Association (2009) has provided a useful resource available online, Essentials of Genetics and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators, that provides an overview of the essential competencies needed for nurses to proficiently provide clients with nursing care that includes genetic and genomics knowledge. In the era of precision medicine, nurses in collaboration with other members of the healthcare team will need to be able to assess patients utilizing knowledge of the relationship between genetics and genomics and the individual's healthcare needs; recognize when clients need further genetic/genomic resources and services; know when and where to refer patients; facilitate patients' autonomous, informed decision making related to genetics and genomics services; and assist clients in understanding selected genetic and genomic information.
Basic knowledge of what is known as "big data sets" is another need of practicing nurses. Precision medicine uses an individual's genetic blueprint alongside their lifestyle and environment, but additionally their individual data are compared alongside thousands to millions of others (i.e., big data) to predict illness or determine the best preventive strategy or treatment (Marr, 2015). Genta and Sonnenberg (2014)argue that a better term for "big data" is "universal data" because the expanse is so vast. Prediction of epidemics, development of new drugs or new uses for existing drugs, and cures for traditionally terminal diseases are all part of the vision for using big data sets as part of the Initiative. The Healthcare Information and Management Systems Society (HIMSS, 2015) offers a thoughtful overview of big data principles and the barriers and challenges to big data in nursing and healthcare.
President Obama's announcement of funding for the Precision Medicine Initiative opens the door for tremendous advances in healthcare in the very near future. Gastroenterology patients stand to gain great benefits from precision medicine. It is critical for gastroenterology nurses to expand their knowledge and understanding of precision medicine in order to support patients in this innovative new era of healthcare. I challenge you to take the time to read about and investigate the Precision Medicine Initiative. Invest the time and energy to learn more, actively expand your knowledge base, and engage with the advances predicted with this revolutionary approach to healthcare.
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