54. APPROACHES TO DISCUSSING PSYCHIATRIC PHARMACOGENOMIC TESTING: PERCEPTIONS OF PEOPLE WITH LIVED EXPERIENCES OF MAJOR DEPRESSIVE DISORDER

Background Medication selection for major depressive disorder (MDD) is often a trial-and-error process. Pharmacogenomic (PGx) testing uses genetic information to identify medication that may better suit the patient. However, little information exists on how best to implement PGx testing in a psychiatric context. To address this gap, we explored the perspectives of individuals with MDD on approaches to psychiatric PGx counseling through a qualitative, semi-structured interview-based study. Methods Participants with MDD were recruited online and asked to watch three simulated PGx sessions (conducted by a physician, a pharmacist, and a genetic counselor) in a random order. Interviews were audio recorded, transcribed verbatim, checked for accuracy, and analyzed to generate descriptive and latent codes. Adequate information power was reached after 12 interviews. Interpretive description with reflexive thematic analysis was used to inductively generate models of participants’ perceptions, yielding two conceptual models. Results One model defined participants’ views of interactions with healthcare practitioners (HCPs) in the PGx testing process. They felt that high-quality communication empowered patients to actively engage in the process. In contrast, they thought that low-quality communication may cause the patient to agree to testing without comprehensive understanding and may undermine trust in their clinicians and the healthcare system as a whole. A second model delineated preferred roles for HCPs. Participants believed a patient's established primary physician recommending PGx and a genetic counselor involved in pre-test counseling to contextualize risk factors and clarify testing objectives and implications. After testing, participants wanted a pharmacist available to provide medication expertise in discussing PGx results and their impact to treatment. Discussion Current psychiatric PGx practice often does not involve this type of collaboration. These findings support a multidisciplinary team-based approach to implement patient-centered PGx care in psychiatry and also creates a potential opening for genetic counseling implementation in the psychiatric space.