The MilSeq Project

Enabling Personalized Medicine Through Exome Sequencing in the U.S. Air Force

Robert C. Green, MD, MPH; Jacqueline Killian, RN, PhD, Lt Col, USAF; Cubby L. Gardner, FNP-C, PhD, Maj, USAF; Mauricio de Castro, MD, Maj, USAF

Sequencing in the military healthcare setting comes with a unique set of considerations as it has the potential to return information that may impact a service member’s perceived mission-readiness, duty assignments, and career. Although scholars have commented on this issue, little is known about the perspectives of those serving in the military.

The MilSeq Project is a pilot study, funded by the Department of Defense through the Air Force Medical Support Agency, examining the process of incorporating whole exome sequencing (WES) into the United States Air Force (USAF) military health system. In this study, active-duty service members of the USAF (Airmen) are enrolled into the study to undergo clinical WES. Reports are then returned directly to Airmen by military healthcare providers (who are also study participants), and are placed in their electronic health records by the study genetic counselor. Healthcare providers participate in an education session about genomic medicine prior to disclosing results and are supported by the study genetic counselor.

Through pre- and post-disclosure surveys, we ask Airmen about their motivations and barriers to undergoing WES, the impact of receiving their sequencing results, and their thoughts on integrating this type of information into the USAF military health system. Healthcare providers complete surveys about the genomic education session, their genetic knowledge and feelings of preparedness to communicate this information, and their perceived utility of the information. We are also assessing how the information is used to inform the management of the Airmen’s health.

We are interested in gaining knowledge about the barriers to and medical, behavioral, and economic implications of implementing genomic sequencing information into clinical care in the military health system through the perspectives of USAF Airmen and healthcare providers.

As technologies and our ability to understand complex traits improve, our results suggest that military members would generally be receptive to learning genetic information that could inform their risk for developing conditions that may affect their duty-related performance. Moreover, Airmen showed favorable attitudes about the use of sequencing when not used for deployment or assignment decisions.

For more detailed information about the MilSeq Project, including recruitment and eligibility details, study design and outcome measures, visit our clinical trial page:

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This material is based on research sponsored by Air Force Medical Support Agency, Research and Acquisition Directorate AFMSA/SG5 under cooperative agreement number FA8650-17-2-6704. The U.S. Government is authorized to reproduce and distribute reprints for Governmental purposes notwithstanding any copyright notation thereon. The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of Air Force Medical Support Agency, Research and Acquisition Directorate AFMSA/SG5 or the U.S. Government. The voluntary, fully informed consent of the subjects used in this research was obtained as required by 32 CFR 219 and AFI 40-402, Protection of Human Subjects in Biomedical and Behavioral Research.

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