Scholars@Duke
Rebekah Ryanne Wu

Rebekah Ryanne Wu

Adjunct Associate Professor in the Department of Medicine
Medicine, General Internal Medicine
ryanne.wu@duke.edu
P.O. Box 104427, Durham, NC 27710
710 W. Main Street, P.O. Box 104427, Durham, NC 27701

Selected Publications

Viewing direct-to-consumer genetic test results for depression risk is psychologically well tolerated: Evidence from a longitudinal equivalence study.

Journal Article HGG Adv · December 8, 2025 Depression is a frequent focus of interest in genetic testing. Despite the growing availability of polygenic risk scores (PRSs) for depression, little is known about the psychological impact of receiving them in real-world settings. To quantify the impact ... Full text Link to item Cite

Trends in and predictors of patient pharmacogenomic test uptake in a national health care system.

Journal Article Genet Med · March 2025 PURPOSE: Better understanding patient uptake of pharmacogenomic (PGx) testing may inform its implementation and maximize the benefits that such testing can confer. This study examined patient and provider factors associated with PGx test ordering in a nati ... Full text Link to item Cite

Family history and cancer risk study (FOREST): A clinical trial assessing electronic patient-directed family history input for identifying patients at risk of hereditary cancer.

Journal Article Contemp Clin Trials · January 2025 BACKGROUND: Hereditary cancer syndromes cause a high lifetime risk of early, aggressive cancers. Early recognition of individuals at risk can allow risk-reducing interventions that improve morbidity and mortality. Family health history applications that ga ... Full text Link to item Cite

Rationale and design for a pragmatic randomized trial to assess gene-based prescribing for SSRIs in the treatment of depression.

Journal Article Clin Transl Sci · June 2024 Specific selective serotonin reuptake inhibitors (SSRIs) metabolism is strongly influenced by two pharmacogenes, CYP2D6 and CYP2C19. However, the effectiveness of prospectively using pharmacogenetic variants to select or dose SSRIs for depression is uncert ... Full text Link to item Cite

Pharmacogenetic testing in primary care could bolster depression treatment: A value proposition.

Journal Article Clin Transl Sci · June 2024 Pharmacogenetic testing could reduce the time to identify a safe and effective medication for depression; however, it is underutilized in practice. Major depression constitutes the most common mental disorder in the US, and while antidepressant therapy can ... Full text Link to item Cite

Workforce readiness for pharmacogenomics and key elements for sustainment within the Veterans Health Administration.

Journal Article Pharmacogenomics · February 2024 Aim: Understanding barriers and facilitators to pharmacogenomics (PGx) implementation and how to structure a clinical program with the Veterans Health Administration (VA). Materials & methods: Healthcare provider (HCP) survey at 20 VA facilities assessing ... Full text Open Access Link to item Cite

Patient Perspectives of Barriers and Facilitators for the Uptake of Pharmacogenomic Testing in Veterans Affairs' Pharmacogenomic Testing for the Veterans (PHASER) Program.

Journal Article J Pers Med · September 9, 2023 We applied implementation science frameworks to identify barriers and facilitators to veterans' acceptance of pharmacogenomic testing (PGx), which was made available as a part of clinical care at 25 VA medical centers. We conducted 30 min interviews with v ... Full text Link to item Cite

Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases.

Journal Article Singapore Med J · July 2023 INTRODUCTION: Primary care physicians face the increasing burden of managing multimorbidities in an ageing population. Implementing an integrated care team (ICT) with defined roles and accountability to share consultation tasks is an emerging care model to ... Full text Link to item Cite

A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer.

Journal Article J Gen Intern Med · May 2023 BACKGROUND: Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging. OBJECTIVE: To examine the effectiveness of a patient-facing FHH platform to identify and manage patie ... Full text Link to item Cite

The role of family history in precision medicine

Chapter · January 1, 2023 Family health history (FHH) is one of the most important tools in precision medicine and is integral to improving health outcomes through early identification of individuals at risk for both rare and chronic conditions. Additionally, FHH represents both a ... Full text Cite

Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities.

Journal Article BMC Health Serv Res · December 6, 2022 BACKGROUND: Systematically assessing disease risk can improve population health by identifying those eligible for enhanced prevention/screening strategies. This study aims to determine the clinical impact of a systematic risk assessment in diverse primary ... Full text Link to item Cite

A Mixed-Methods Protocol to Identify Best Practices for Implementing Pharmacogenetic Testing in Clinical Settings.

Journal Article J Pers Med · August 13, 2022 Using a patient's genetic information to inform medication prescriptions can be clinically effective; however, the practice has not been widely implemented. Health systems need guidance on how to engage with providers to improve pharmacogenetic test utiliz ... Full text Link to item Cite

Family health history and health risk assessment in oncology

Chapter · January 1, 2022 Health risk assessments (HRAs) have the potential to play a key role in cancer prevention and early detection both at an individual and a population level. While the idea has been around since the 1950s and HRAs are commonly performed in the workplace, the ... Full text Cite

Evaluation of the Veterans Affairs Pharmacogenomic Testing for Veterans (PHASER) clinical program at initial test sites.

Journal Article Pharmacogenomics · November 2021 Aim: The first Plan-Do-Study-Act cycle for the Veterans Affairs Pharmacogenomic Testing for Veterans pharmacogenomic clinical testing program is described. Materials & methods: Surveys evaluating implementation resources and processes were distributed to i ... Full text Link to item Cite

Experience and Perceptions of a Family Health History Risk Assessment Tool among Multi-Ethnic Asian Breast Cancer Patients.

Journal Article J Pers Med · October 19, 2021 A family health history-based risk assessment is particularly valuable for guiding cancer screening and treatment strategies, yet an optimal implementation depends upon end-users' values and needs. This is not only true prior to disease development, but al ... Full text Open Access Link to item Cite

Establishing the value of genomics in medicine: the IGNITE Pragmatic Trials Network.

Journal Article Genet Med · July 2021 PURPOSE: A critical gap in the adoption of genomic medicine into medical practice is the need for the rigorous evaluation of the utility of genomic medicine interventions. METHODS: The Implementing Genomics in Practice Pragmatic Trials Network (IGNITE PTN) ... Full text Open Access Link to item Cite

Clinical implementation of an oncology-specific family health history risk assessment tool.

Journal Article Hered Cancer Clin Pract · March 20, 2021 BACKGROUND: The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routin ... Full text Open Access Link to item Cite

Family history assessment significantly enhances delivery of precision medicine in the genomics era.

Journal Article Genome Med · January 7, 2021 BACKGROUND: Family history has traditionally been an essential part of clinical care to assess health risks. However, declining sequencing costs have precipitated a shift towards genomics-first approaches in population screening programs rendering the valu ... Full text Link to item Cite

At the intersection of precision medicine and population health: an implementation-effectiveness study of family health history based systematic risk assessment in primary care.

Journal Article BMC Health Serv Res · November 7, 2020 BACKGROUND: Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential imp ... Full text Link to item Cite

Evaluation of family health history collection methods impact on data and risk assessment outcomes.

Journal Article Prev Med Rep · June 2020 Information technology applications for patient-collection of family health history (FHH) increase identification of elevated-risk individuals compared to usual care. It is unknown if the method of collection impacts data collected or if simply going direc ... Full text Link to item Cite

Family History Assessment Significantly Enhances Delivery of Precision Medicine in the Genomics Era

Journal Article · January 30, 2020 AbstractBackgroundFamily history has traditionally been an essential part of clinical care to assess health risks. However, declining sequencing costs have precipitated a shift towards gen ... Full text Cite

Implementation of genomics in medical practice to deliver precision medicine for an Asian population

Journal Article Npj Genomic Medicine · December 1, 2019 Whilst the underlying principles of precision medicine are comparable across the globe, genomic references, health practices, costs and discrimination policies differ in Asian settings compared to the reported initiatives involving European-derived populat ... Full text Cite

An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial.

Journal Article Trials · October 7, 2019 BACKGROUND: Colorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3-10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, ... Full text Link to item Cite

A stepwise approach to implementing pharmacogenetic testing in the primary care setting.

Journal Article Pharmacogenomics · October 2019 Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharm ... Full text Link to item Cite

Family health history: underused for actionable risk assessment.

Journal Article Lancet · August 17, 2019 Family health history (FHH) is the most useful means of assessing risk for common chronic diseases. The odds ratio for risk of developing disease with a positive FHH is frequently greater than 2, and actions can be taken to mitigate risk by adhering to scr ... Full text Link to item Cite

Correction: Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network.

Journal Article Genet Med · July 2019 The original version of this Article contained an error in the spelling of the author Geoffrey S. Ginsburg, which was incorrectly given as Geoffrey Ginsburg. This has now been corrected in both the PDF and HTML versions of the Article. ... Full text Link to item Cite

Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network.

Journal Article Genet Med · March 2019 PURPOSE: While there is growing scientific evidence for and significant advances in the use of genomic technologies in medicine, there is a significant lag in the clinical adoption and sustainability of genomic medicine. Here we describe the findings from ... Full text Link to item Cite

Effect of Sociodemographic Factors on Uptake of a Patient-Facing Information Technology Family Health History Risk Assessment Platform.

Journal Article Appl Clin Inform · March 2019 OBJECTIVE: Investigate sociodemographic differences in the use of a patient-facing family health history (FHH)-based risk assessment platform. METHODS: In this large multisite trial with a diverse patient population, we evaluated the relationship between s ... Full text Link to item Cite

Implementation, adoption, and utility of family health history risk assessment in diverse care settings: evaluating implementation processes and impact with an implementation framework.

Journal Article Genet Med · February 2019 PURPOSE: This paper describes the implementation outcomes associated with integrating a family health history-based risk assessment and clinical decision support platform within primary care clinics at four diverse healthcare systems. METHODS: A type III h ... Full text Link to item Cite

Developing a common framework for evaluating the implementation of genomic medicine interventions in clinical care: the IGNITE Network's Common Measures Working Group.

Journal Article Genet Med · June 2018 PurposeImplementation research provides a structure for evaluating the clinical integration of genomic medicine interventions. This paper describes the Implementing Genomics in Practice (IGNITE) Network's efforts to promote (i) a broader understanding of g ... Full text Link to item Cite

Family Health History and Health Risk Assessment For Cardiovascular Disease in Health Care

Chapter · January 1, 2018 Health risk assessments (HRAs) have the potential to play a key role in health promotion and disease prevention both at an individual and a population level. While the idea has been around since the 1950s and HRAs are commonly performed in the workplace, t ... Full text Cite

Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network.

Journal Article BMC Med Genomics · May 22, 2017 BACKGROUND: To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified b ... Full text Open Access Link to item Cite

Implementation of Lung Cancer Screening in the Veterans Health Administration.

Journal Article JAMA Intern Med · March 1, 2017 IMPORTANCE: The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is little published experience regarding implementing this rec ... Full text Link to item Cite

Impact of Genetic Testing and Family Health History Based Risk Counseling on Behavior Change and Cognitive Precursors for Type 2 Diabetes.

Journal Article J Genet Couns · February 2017 Family health history (FHH) in the context of risk assessment has been shown to positively impact risk perception and behavior change. The added value of genetic risk testing is less certain. The aim of this study was to determine the impact of Type 2 Diab ... Full text Open Access Link to item Cite

Family Health History and Health Risk Assessment in Health Care

Chapter · January 1, 2017 Health risk assessments have the potential to play a key role in health promotion and disease prevention both at an individual and a population level. While the idea has been around since the 1950s and health risk assessments are commonly performed in the ... Full text Cite

Clinical utility of a Web-enabled risk-assessment and clinical decision support program.

Journal Article Genet Med · October 2016 PURPOSE: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate upt ... Full text Open Access Link to item Cite

The IGNITE network: a model for genomic medicine implementation and research.

Journal Article BMC Med Genomics · January 5, 2016 BACKGROUND: Patients, clinicians, researchers and payers are seeking to understand the value of using genomic information (as reflected by genotyping, sequencing, family history or other data) to inform clinical decision-making. However, challenges exist t ... Full text Open Access Link to item Cite

Protocol for the "Implementation, adoption, and utility of family history in diverse care settings" study.

Journal Article Implement Sci · November 24, 2015 BACKGROUND: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers ... Full text Open Access Link to item Cite

Implementation of health risk assessments with family health history: barriers and benefits.

Journal Article Postgrad Med J · September 2015 Health risk assessments provide an opportunity to emphasise health promotion and disease prevention for individuals and populations at large. A key component of health risk assessments is the detailed collection of family health history information. This i ... Full text Link to item Cite

Effects of provision of type 2 diabetes genetic risk feedback on patient perceptions of diabetes control and diet and physical activity self-efficacy.

Journal Article Patient Educ Couns · June 30, 2015 OBJECTIVE: We examined effects of providing type 2 diabetes genetic risk feedback on controllability perceptions. METHODS: This is a secondary analysis of a randomized controlled trial in which overweight/obese Veterans Affairs patients without diabetes re ... Full text Link to item Cite

Implementation of new clinical programs in the VHA healthcare system: the importance of early collaboration between clinical leadership and research.

Journal Article J Gen Intern Med · December 2014 Collaboration between policy, research, and clinical partners is crucial to achieving proven quality care. The Veterans Health Administration has expended great efforts towards fostering such collaborations. Through this, we have learned that an ideal coll ... Full text Link to item Cite

Providing patient education: impact on quantity and quality of family health history collection.

Journal Article Fam Cancer · June 2014 BACKGROUND: Family health history (FHH) is an underutilized tool in primary care to identify and risk-stratify individuals with increased cancer risk. OBJECTIVE: Evaluate the influence of patient education on quantity and quality of FHH entered into a prim ... Full text Link to item Cite

Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand.

Journal Article Am J Med Genet C Semin Med Genet · March 2014 UNLABELLED: The Genomic Medicine Model aims to facilitate patient engagement, patient/provider education of genomics/personalized medicine, and uptake of risk-stratified evidence-based prevention guidelines using MeTree, a patient-facing family health hist ... Full text Link to item Cite

Quality of family history collection with use of a patient facing family history assessment tool.

Journal Article BMC Fam Pract · February 13, 2014 BACKGROUND: Studies have shown that the quality of family health history (FHH) collection in primary care is inadequate to assess disease risk. To use FHH for risk assessment, collected data must have adequate detail. To address this issue, we developed a ... Full text Link to item Cite

Quality of family history collection with use of a patient facing family history assessment tool

Journal Article BMC Family Practice · 2014 Background: Studies have shown that the quality of family health history (FHH) collection in primary care is inadequate to assess disease risk. To use FHH for risk assessment, collected data must have adequate detail. To address this issue, we developed a ... Full text Cite

Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial.

Journal Article BMC Fam Pract · August 6, 2013 BACKGROUND: Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical ... Full text Link to item Cite

Safety of chronic low-dose capecitabine as maintenance therapy in gastrointestinal cancers

Journal Article Gastrointestinal Cancer Research · July 1, 2010 Background: Maintenance chemotherapy is not routinely used in gastrointestinal (GI) cancers. Capecitabine is an oral formulation that is enzymatically converted to 5-fluorouracil preferentially in tumor tissue. We hypothesize that capecitabine could be use ... Cite

Evaluation of hypertension as a marker of bevacizumab efficacy.

Journal Article J Gastrointest Cancer · 2009 BACKGROUND: Predictive factors for efficacy of vascular endothelial growth factor pathway-targeted therapies have not been identified or confirmed. Hypertension has been observed as a side effect to anti-vascular endothelial growth factor therapy. The goal ... Full text Link to item Cite