Precision Therapeutics and Patient-Centered Approaches in Contemporary Medicine

Abstract

Two movements are reshaping contemporary medicine. Precision therapeutics aims to match treatments to the biological characteristics of individual patients and their diseases, using genomic and other molecular information, biomarkers and data analytics. Patient-centred care aims to match treatment to the person, respecting their values, preferences, circumstances and goals. Precision approaches are most established in oncology, where tumour genomic profiling guides targeted therapies and immunotherapy, and in pharmacogenomics, where variants in genes such as CYP2C19, HLA-B and TPMT predict drug response and toxicity; a large trial showed that pre-emptive pharmacogenomic testing reduced clinically relevant adverse drug reactions by about 30%. Other applications include biomarker-guided therapy in cardiology and infectious disease, therapeutic drug monitoring, monogenic diabetes, rare disease diagnosis, and gene and cell therapies such as CAR-T cells and the first CRISPR-based therapy for sickle cell disease and β-thalassaemia. Patient-centred approaches include shared decision-making supported by decision aids, use of patient-reported outcome measures, attention to health literacy and cultural context, goal-oriented care for people with multimorbidity, and partnership with patients and families in care and research. The two approaches are complementary: precision medicine tells clinicians what is likely to work for a patient's biology, while patient-centred care determines what matters to the patient and which option fits their life. Challenges include the cost and accessibility of genomic testing and advanced therapies, under-representation of non-European populations in genomic databases, limited evidence of clinical utility for some tests, data privacy, and time and training for shared decision-making. Integrating precision and patient-centred care, supported by equitable health systems, offers the best route to truly personalised medicine.