The NYCKidSeq project: study protocol for a randomized controlled trial incorporating genomics into the clinical care of diverse New York City children
Authors: Odgis Jacqueline A. , Gallagher Katie M. , Suckiel Sabrina A. , Donohue Katherine E. , Ramos Michelle A. , Kelly Nicole R. , Bertier Gabrielle , Blackburn Christina , Brown Kaitlyn , Fielding Lena , Lopez Jessenia , Aguiniga Karla Lopez , Maria Estefany , Rodriguez Jessica E. , Sebastin Monisha , Teitelman Nehama , Watnick Dana , Yelton Nicole M. , Abhyankar Avinash , Abul-Husn Noura S. , Baum Aaron , Bauman Laurie J. , Beal Jules C. , Bloom Toby , Cunningham-Rundles Charlotte , Diaz George A. , Dolan Siobhan , Ferket Bart S. , Jobanputra Vaidehi , Kovatch Patricia , McDonald Thomas V. , McGoldrick Patricia E. , Rhodes Rosamond , Rinke Michael L. , Robinson Mimsie , Rubinstein Arye , Shulman Lisa H. , Stolte Christian , Wolf Steven M. , Yozawitz Elissa , Zinberg Randi E. , Greally John M. , Gelb Bruce D. , Horowitz Carol R. , Wasserstein Melissa P. , Kenny Eimear E. 
Published: January 2021

Abstract
Background
Increasingly, genomics is informing clinical practice, but challenges remain for medical professionals lacking genetics expertise, and in access to and clinical utility of genomic testing for minority and underrepresented populations. The latter is a particularly pernicious problem due to the historical lack of inclusion of racially and ethnically diverse populations in genomic research and genomic medicine. A further challenge is the rapidly changing landscape of genetic tests and considerations of cost, interpretation, and diagnostic yield for emerging modalities like whole-genome sequencing.

Methods
The NYCKidSeq project is a randomized controlled trial recruiting 1130 children and young adults predominantly from Harlem and the Bronx with suspected genetic disorders in three disease categories: neurologic, cardiovascular, and immunologic. Two clinical genetic tests will be performed for each participant, either proband, duo, or trio whole-genome sequencing (depending on sample availability) and proband targeted gene panels. Clinical utility, cost, and diagnostic yield of both testing modalities will be assessed. This study will evaluate the use of a novel, digital platform (GUÍA) to digitize the return of genomic results experience and improve participant understanding for English- and Spanish-speaking families. Surveys will collect data at three study visits: baseline (0 months), result disclosure visit (ROR1, + 3 months), and follow-up visit (ROR2, + 9 months). Outcomes will assess parental understanding of and attitudes toward receiving genomic results for their child and behavioral, psychological, and social impact of results. We will also conduct a pilot study to assess a digital tool called GenomeDiver designed to enhance communication between clinicians and genetic testing labs. We will evaluate GenomeDiver’s ability to increase the diagnostic yield compared to standard practices, improve clinician’s ability to perform targeted reverse phenotyping, and increase the efficiency of genetic testing lab personnel.

Discussion
The NYCKidSeq project will contribute to the innovations and best practices in communicating genomic test results to diverse populations. This work will inform strategies for implementing genomic medicine in health systems serving diverse populations using methods that are clinically useful, technologically savvy, culturally sensitive, and ethically sound.

Trial registration
ClinicalTrials.govNCT03738098. Registered on November 13, 2018
Trial Sponsor: Icahn School of Medicine at Mount Sinai
Contact Name: Eimear Kenny, PhD (Principal Investigator)
Address: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1003, New York, NY 10029
Email: eimear.kenny@mssm.edu