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his own PGx testing and results process was helpful to him in explaining patient results. He said: “I was my own test case, so I think that was a very good way to introduce physicians to this process, to actually do it. When you do it, you certainly learn a lot more. Then, you go through the report. Certainly makes it easier for me to explain a patient's report when I have seen my own”. Primary care physicians described how PGx testing could help them individualize medication treatments for their patients and, for many, how there is a context-dependent value for specific conditions or categories of patients. The most common indications for offering PGx testing that physicians mentioned were for medications used in psychiatry, cardiology, oncology and for pain management. One provider (P12) reported: “I think it will be specific to certain patient populations…patients that I see that'll benefit from it are probably patients that are on some psychiatric drugs, antidepressants, SSRIs are a big one”. Another participant (P14) described how having results from PGx testing could be beneficial in his patient population: “One of the most valuable parts of this [testing] I think is the blood thinner. That'll be very valuable if they're in the emergency room getting a stent and the decision is trying to be made as to which blood thinner they get put on. I think they are going to benefit tremendously from that bit of information”. Another general area discussed regarding the utility of PGx testing was helpfulness to patients in potentially avoiding medication side effects and guiding decision-making for patients who are starting a new medication. One participant (P04) related his thoughts about PGx testing for his patients: “I think of patients who've had difficulties with different medications, classes of medications, and potentially utilizing this information to prevent using time poorly in terms of starting patients on medicines that probably won't work or putting them on doses that probably won't work”. Another participant (P07) said: “It will help me decide what medication to give to the patient, say if it's a patient with depression that I'm having a hard time figuring out what medication I could use due to side effects or lack of response”. Some primary care physicians indicated that they had a number of patients who are highly motivated to learn more about their health in general, and that these individuals would likely be interested in testing. One physician mentioned pre-emptive testing and how PGx testing could be offered during an annual exam. Another primary care physician (P01) articulated how through PGx testing, a mutual benefit of informed decision-making can occur for both physician and patient: “I think it can help both physician and patient make informed decisions together, based on likelihood of responding poorly to medications -based on the genetic profile”. Improving patient outcomes Another value of PGx testing described was specific positive outcomes for patients. For example, some of the physicians discussed how using PGx direct access testing can foster increased patient autonomy and satisfaction. One provider (P09) stated: “…the patients, if they're interested, they can just go ahead and initiate it themselves [after physician places the order, patients do the test kit when and where convenient] and that just opens up doors and decreases the barriers”. In addition, participants cited specific examples of how PGx testing results were used to adjust patient medications to increase effectiveness and reduce side effects. A practitioner (P11) explained: “His results showed that Plavix was not likely to be beneficial to him, so it affected, actually, his treatment plan”. Another interviewed physician (P15) detailed her patient's outcome: “Yeah, he's been struggling with depression. He's been very against medication, antidepressants specifically. A lot of anxiety related to side effects. He went on Lexapro and after two days he had horrible, horrible side effects that took a week to ease off of, mostly GI-related. You hit that point where you finally get him to the threshold, and all the things he was afraid of happened…But now [after PGx test results] he's on Effexor, and a month later he's a totally different person”. A number of primary care physicians talked
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