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think that's nonsense, but I know that's how some people think”. Another practitioner (P14) mentioned patient privacy concerns and insurance company access to their test information: “But they may bring that up and say, ‘Is this going to be available to insurance companies? And am I going to be rated higher because I have a certain profile?’” The need for flexible testing options was described by physicians, in order to meet the needs of diverse patients. One physician (P04) described how technical issues could be an obstacle and that some patients might not be able to navigate the technical arena of going online to watch an educational video and submit payment; he stated: “I just think some people are not technologically savvy and a simple thing, simple things become huge obstacles”. Having to mail in the test kit via FedEx was also mentioned as a barrier for some patients. A participant (P06) discussed how she might have to guide an elderly patient through the process, or that she might want to do the kit testing in the office setting, rather than have the patient do it at home. This primary care physician said: “I actually took the kit to my patient and did the testing, because she happens to be somebody I also know, and I think if I hadn't been there, she might have been a little rattled doing it. She's a little older and taking care of a variety of different medical problems at once”. One of the findings that emerged was the concept of managing results expectations with patients. A practitioner (P02) articulated the importance of this discussion with patients: “And, you know, it's again, this test doesn't encompass all drugs yet either, so you can't use it as the ace in the hole, so to speak, that it's going to get you out of trouble every time. It's just one aspect of the patient that you're analyzing that will hopefully yield some benefits for that patient. It's not going to be 100% of the time where you're going to have a successful outcome, but it's probably got limited or no downside to hurt the patient”. Another physician (P13) commented on managing patient expectations; she stated: “Not as long as you set the expectations. I think you can't bill it as, ‘We know exactly what drug to use and how much to use,’ but we can say, ‘It's a guide’. So setting those expectations, because if you don't set the expectations and they're saying, ‘How come this didn't work for me?’ It's just a guide. It's not all the answers. Also, the expectation of really what drugs we're looking at. Making sure that they're clear with that. That it's not like in a test for breast cancer risk or things like that, so it's always setting the expectations”. In addition to managing patient expectations about what kinds of information PGx testing can and cannot provide, one participant also brought up a patient's concern about potentially not being able to use a certain medication. This primary care physician (P08) described a patient who required additional reassurance after receiving her results: “I had one patient that reacted only more in panic. All the things that were red-flagged like ‘Never take Plavix, never take this’. More ‘what if I need it? What do I do then?’ You're 30, you don't need Plavix, but one day when you do, hopefully there's a drug out there that you can use instead. I only had one patient that reacted more alarmist, anxious, about the results, and was not as thrilled that she got them”. Needs going forward Participants also mentioned specific needs that they would like addressed going forward. In essence, they provided us with a wish list. This list spanned from needing more PGx education to guidance on how to address cost and insurance issues with patients. When describing PGx education needs, many different modes of training were suggested such as in-services, case studies, and online training. For example, one participant (P02) mentioned: “I think it would be nice to have more in-servicing or more education on what all those things mean and why. I know there's a clinical scenario and that's important too, but I think a little bit more of the background into it would be helpful for physicians who are ordering this, so they really feel comfortable, not only with the clinical interpretation, but really understanding a little deep analysis of what that means for that patient. So,
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