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about the complicated dynamics that occur when patients try medications that either do not work or cause adverse effects. Patients may or may not want to embark on another medication trial and one physician (P05) talked about how PGx testing could be used to improve patient compliance in these situations: “…like my patients who are on antidepressants, cholesterol medications-we can actually do the testing and find out which medications either work the best or produce the least side effects. And then hopefully that would lead to better compliance. That's the problem with all these medications-nobody takes them”. Participants discussed the medication odyssey that some patients embark on before they have a successful outcome and that this process can cause suffering, harm and increased costs to the patient. Physicians mentioned how PGx testing could make this process of medication decision-making for some patients much more efficient and save them from having to suffer and incur additional costs. One primary care doctor (P08) elucidated: “A lot of times we try a medicine and they're only on it for two weeks, and they paid for a whole month. They're only on it for two weeks and they had horrible side effects. Let's toss that and move onto something else. That's a lot of money, and time, and side effects that they don't necessarily need to suffer from if we knew ahead of time that they weren't going to react well to it”. Another positive outcome mentioned by some of the primary care providers was psychological benefit to patients. A few physicians discussed how findings from PGx testing can offer reassurance that the medication plan should either stay the same or be changed. Test findings were described as having important explanatory benefits for patients, who were searching for reasons of why medications worked or did not work so well. One physician (P13) brought up how PGx findings allowed the patient to have less fear and anxiety about trying a new medication: “The reassurance to me is key and there's a psychological benefit. If I knew that drug A would be better for me than drug B, there's a psychological component to saying, ‘Okay, my doctor knows that drug A is going to be effective for me or that it's not going to be harmful for me’. Both for the patient's reassurance and certainly for mine”. Pharmacogenomic results were also described as a potential benefit to family members, including children. One primary care physician (P15) remarked about a patient: “every pain medicine that I could think of - fentanyl, Dilaudid, morphine, hydrocodone, oxycodone -showed that he's unlikely to respond to the typical doses. And then that [PGx results] made sense in response to his experience. He had broken his hip when he was eight and was on the unit for days, and he remembers having to be moved into isolation because he was screaming so much, because he was constantly in pain. The morphine would wear off after like 30 minutes. So my thought, our thought, is good chance he was being dosed appropriately for a pediatric patient, but [actually] much less than what he needed. It was nice to see that there was a reason behind that, probably. I think traditionally, we think of this [PGx testing] as helpful for adults, but in this particular instance, like a kid having to deal with pain for a broken bone - because they actually need a lot more medication. Most doctors would be really cautious about not overdosing with narcotics. It's just something that would be helpful to take into account”. Although the majority of participants described value and utility of PGx testing in positive terms, a few providers mentioned that they did not think PGx testing was useful in their patient population and/or that PGx testing may not be useful now but will be more valuable in the future. For example, one practitioner (P13) commented: “For the general population, who is not going to be on pain meds or any of the antidepressants, anti-anxiety agents, I'm not sure how beneficial it's going to be”. However, one provider (P12) speculated that its future utility may increase: “But in the future, maybe every patient, it could be offered to them”. Challenges to implementation in practice
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