Grant: Health System Impact Embedded ECR Award - Patient-Oriented Research

Psychotic disorders like schizophrenia are enduring illnesses that affect all areas of a person's life. In many areas of medicine, clinical genetic testing - a blood test that looks for differences in a person's DNA that help explain disease and guide treatment - is standard of care. Timely genetic testing and diagnosis can reduce health costs and meaningfully improve the lives of patients and their families by improving illness understanding and enabling personalized treatments. In psychiatry, guidelines have recommended physicians "consider genetic testing" for psychosis since 2017, but provide little guidance on who should be offered the test. As a result, genetic testing for psychosis is rarely offered, with marginalized groups less likely to receive access. Without clear pathways, eligibility criteria, and performance measurement, evidence-based genetic testing for psychosis cannot be implemented fairly at scale or evaluated to inform policy and funding. In partnership with the University of Toronto, my embedded research at the Centre for Addiction and Mental Health addresses this critical health system gap. First, we aim to improve fair access to genetic testing for psychosis (Aim 1), by co-designing a genomic care pathway with patients and families to ensure the service improves patient experience and advances health equity. Next, we will clarify who benefits most from genetic testing for psychosis (Aim 2) by looking at how often testing finds an underlying genetic cause across different patient groups (e.g. earlier onset) within a large existing CAMH psychosis cohort. We will use our findings to propose clearer criteria for who should be offered genetic testing for psychosis, in a way that minimizes costs and maximizes patient benefit. Finally, we will create a learning health system at CAMH - where care and research inform each other - to help continually improve and evaluate the delivery of genetic testing in routine psychosis care (Aim 3).