 Good morning. I'm happy to speak a bit about our familial implications sub workgroup which is a subgroup of both the return of results LC workgroup and emerge as well as the outcomes workgroup and emerge and so we sort of bridge those two groups yep I did sorry about that okay so this the familial implications subgroup came about as we were all talking about the fact that we were feeling challenged about how to best approach family members of the individuals for whom we return positive pathogenic likely pathogenic variants through the emerge sequencing work and so out of this came a the subgroup with some specific aims that I'll go through here first aim was to explore the attitudes of participants by convening focus groups and or qualitative interviews and as Kathy just described they're doing some qualitative interviews at University of Washington Kaiser group health but we also are doing patient perspective interviews at Geisinger as well as some deliberative engagement types of focus groups and what we are aimed at looking at in this in the familial excuse me familial implications group is to assess how our patients or our participants see the importance of sharing information what kinds of targeted information they feel would be useful in helping them to educate family members what do they find to be barriers to effective communication and what are their preferences or even suggestions on new ways or methods strategies to contact relatives the second specific aim for our workgroup is to conduct surveys involving some standardized validated components that will be used across all sites as well as surveys that perhaps are a little more in-depth that at some of the sites and this is a to assess again fairy family sharing or communication activities and so some sites have started with baseline pre-results disclosure surveys all sites will be doing us include a small number of consistent items about family sharing in the post-results surveys that we're doing at about six months some sites are actually going to do an immediate post-results disclosure survey where they will also look at the intent to share with family members and begin to evaluate that in terms of factors that can encourage them to follow through on that intent and then some sites will actually be utilizing a more in-depth survey to understand better the sharing that's that's happening the specific aim three for our workgroup is to collect and collate points of information at us at the system level hoping to provide some guidance for policymaking or best practice development about family communication we're hoping to collect site specific activities that are planned to assess those activities and the factors that have led to both the variation among sites but also consistency in communication and look at the materials approaches and measures of success and then we may potentially be able to then compare and contrast those methods of contact so one of the things I wanted to be able to relate is that we've been doing qualitative interviews of patients to whom we have returned genomic sequencing results these aren't e-merge project results yet but they are a population who has been unselected and agreed to participate in our geisinger my code biobank health initiative and what we wanted to do was to be able to post results disclosure about and at about one month post disclosure to go back to these patients and do an in-depth semi-structured interview format survey and the domain domains that we were looking at had to do with of course their initial experience with the result what kinds of medical follow-up they did communication with family or friends what do they understand the result to mean and where did they go for resources what types of return of results procedures have they taken part in what were their psychosocial reactions to the result what have they found to be the financial implications of this result for them and what was their satisfaction and so these we've conducted 29 interviews we've not yet coded or evaluated the transcripts but we have taken a quick look at the summaries post each interview and I wanted to share with you just that subset of issues that came out of the questions regarding family sharing so what was interesting that in these 29 interviews all participants had shared with some family members there were of course some family members that participants chose not to share with and we all anticipate that that's going to be true I'm just getting my time signed so I'll go through this quickly some of the reasons were that family members are too old family members are too young and most did use the letter that our team provided them in order to communicate with family members so in terms of each of the sites in e-merge these are the a collated collection of the types of themes or domains that they are looking at in terms of the surveys that they intend to send out not surprisingly family communication is on that list as well as empowerment and information sharing Kathy already mentioned this group that is being put together by Malia and I'm happy to say Bob is definitely on board with that and then as a term in response to our outcomes portion of this familial implications we wanted to be able to measure if we could how successful have we been in reaching relatives and so we've set put together a list of outcomes that will accompany each of the reporting forms for the diseases of the and positive results that come back and as you can say we're we're trying to assess which relatives have been told and then a bit about success measures if we can get at this in terms of number of relatives with positive results number of relatives with negative results and then the reach of the cascade screening within each of the sites so thank you