How should physicians handle incidental findings in genomics?

• A. Always disclose all incidental findings to the patient, regardless of consent or preferences
• B. Never disclose incidental findings unless the patient explicitly requests
• C. They should have a plan for disclosure, consider patient preferences, clinical actionability, privacy, and obtain consent pre-testing
• D. Disclose only after family counseling

Answer: (C)

Handling incidental findings in genomics requires a plan that respects patient autonomy while balancing potential benefit and privacy. Physicians should obtain consent before testing that covers which incidental findings might be disclosed and the patient’s preferences for learning about them. The disclosure process should be clearly defined: who will disclose the results, how they will be communicated, and under what circumstances, with genetic counseling available to help the patient understand implications.

Key considerations include clinical actionability—findings that have meaningful steps to prevent or treat disease are more likely to be disclosed if the patient has agreed to receive such information. Privacy and confidentiality are also central; reporting to relatives may be discussed, but it generally depends on the patient’s consent, and should respect the patient’s wishes and applicable laws.

Choosing this approach ensures that information is provided in a way that benefits the patient, aligns with their values, and protects their rights. The other approaches lack respect for autonomy, impose disclosure without consent, or inappropriately default to family counseling, which can undermine patient preferences and privacy.