DNA Sequencing in Clinical Practice, Mayo Clinic Health Tapestry Study

Study Overview
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Brief Summary
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This clinical trial collects information on how sequencing a patient's deoxyribonucleic acid (DNA) (i.e., the genetic material) could impact their health care. This study also develops and improves ways to include genomic information from DNA sequencing into the electronic health record to create a more complete Health Tapestry for each participant. Sequencing of a patient's DNA leads to the detection of genetic variants some of which determine risk for disease development. Discovery of those genetic variants in a patient could result in prevention, earlier diagnosis or better therapy of disease.

Detailed Description
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PRIMARY OBJECTIVES: I. To detect and compare the actionable genetic findings derived from whole exome sequencing (WES) testing and examine their frequency and association with family history using a large cohort of patients seen across specialties within the Mayo Clinic enterprise. II. To assess the effect of actionable genetic findings of patients on health-care utilization, and patients acceptance. III. To create a unique vertically integrated data asset (Mayo Clinic Health Tapestry) that links genomics and other omics information to traditional health parameters in the Electronic Medical Record (EMR) with the aim to elucidate disease formation and outcomes. IV. Assess the frequency of hereditary cancer predisposition genes (BRCA1, BRCA2, Lynch syndrome mismatch repair [MMR] genes) through population screening using WES and the uptake of genetic counseling. V. To study the genetic predisposition to coronavirus disease 2019 (COVID-19) disease we propose using a COVID-19 survey. VI. Assess the recruitment rate of those approached by portal and email. VII. Assess differential consent rates by combinations of mode of invitation (initial contact via email or patient portal) and content of material (standard invitation content vs. enhanced content with improved language and visual display) in one cohort. OUTLINE: Participants receive a saliva kit, register with Helix then undergo collection of saliva sample which is returned o Helix. Participants also receive an online link to complete the About Me family history. Once sequencing is completed by Helix, ancestry/trait information and genetic findings are shared with participants and their primary provider, if applicable. Participants with positive results are offered genetic counseling and are encouraged to seek clinical confirmatory testing. Following clinical confirmation, results are scanned into the electronic health record. Participants may also undergo the collection of blood, urine, and stool samples for future studies.

Official Title
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MAYO CLINIC TAPESTRY: Use of Genomic Sequencing in Clinical Practice

Conditions
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Genetic Disorder

Intervention / Treatment
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* Procedure: Biospecimen Collection
* Other: Diagnostic Laboratory Biomarker Analysis
* Other: Genetic Counseling
* Other: Questionnaire Administration
* Other: Questionnaire Administration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age >= 18 years Registered Mayo Clinic patient Able to provide informed written consent E-mail and web access (for electronic consent, video education, registering with Helix and receiving results) Ability to collect and ship saliva sample within the United States Of note: Women, who are pregnant, or planning to become pregnant, can take part in this study. However, this study does not replace prenatal genetic testing. If participants have these concerns, they will be encouraged to contact their obstetrics (OB) provider or a genetic counselor to discuss further Exclusion Criteria: Other co-morbidity which would in physician's opinion interferes with patient's ability to participate in the study (eg: reduced ability to comprehend eg: dementia, intellectual disability, fluency in consent language) Allogeneic bone marrow transplant (e.g. samples from autologous bone marrow transplant recipients are acceptable if collected at least one month after transplant) Active hematological cancer or history of a hematological cancer Resident of the state of New York The Helix lab does not currently have New York state licensure Residents without a shipping address in the United States The Helix lab is unable to ship and receive samples internationally

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Screening (biospecimen collection, genetic analysis)<br>Participants receive a saliva kit, register with Helix then undergo collection of saliva sample which is returned o Helix. Participants also receive an online link to complete the About Me family history. Once sequencing is completed by Helix, ancestry/trait information and genetic findings are shared with participants and their primary provider, if applicable. Participants with positive results are offered genetic counseling and are encouraged to seek clinical confirmatory testing. Following clinical confirmation, results are scanned into the electronic health record. Participants may also undergo the collection of blood, urine, and stool samples for future studies. | Procedure: Biospecimen Collection<br>* Undergo collection of saliva, blood, urine and stool samples<br>* Other names: Specimen Collection;Other: Diagnostic Laboratory Biomarker Analysis<br>* Correlative studies<br>Other: Genetic Counseling<br>* Receive genetic counseling<br>Other: Questionnaire Administration<br>* Complete family history<br>Other: Questionnaire Administration<br>* Ancillary studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Actionable genetic findings derived from whole exome sequencing (WES) testing | Patients will be asked to complete a family history as part of this study. The family history will be assessed to determine the percentage of participants with evidence of genetic risk for the actionable finding. Standard descriptive statistics approaches will be used for analysis. | Up to 5 years | 
| Effect of actionable genetic findings of patients on health-care utilization | Medical records will be reviewed for evidence that patients take active participation in managing genetic risks. Additionally, patients will be surveyed as to their experience with genomic based testing. Standard descriptive statistics approaches will be used for analysis. | Up to 5 years | 
| Patients' acceptance | Standard descriptive statistics approaches will be used for analysis. | Up to 5 years | 
| Creation of a unique vertically integrated data asset (Mayo Clinic Health Tapestry) | A variety of patient cohorts will be ascertained throughout this study. Data will be made available to researchers to query correlations of disease states and clinical outcomes to genomic findings. These insights will be invaluable to creating genomic informed care plans in the future. Standard descriptive statistics approaches will be used for analysis. | Up to 5 years | 
| Genetic predisposition to coronavirus disease 2019 (COVID-19) disease | Will examine the genetic variants derived from the WES data that associate with COVID-19 outcomes. Standard descriptive statistics approaches will be used for analysis. | Up to 5 years |