Bridging the Gap Between Stratification and Personalization in Precision Medicine: "Invisible Labor" and Value Transformation in Japanese Cancer Genomic Medicine

Abstract

This study aims to clarify how frontline healthcare professionals transform the imbalance between clinical outcomes and patient needs—arising from the transitional implementation phase of cancer genomic medicine, a core domain of Precision Medicine (PM)—into meaningful value. Since its introduction in the United States in 2015, PM has been promoted across advanced nations as a "forward-looking promise" to create the next generation of standard care (Ackerman 2022: 197). Meanwhile, Japan entered a unique implementation phase in 2019, integrating cancer genomic medicine into its universal healthcare system. Currently, a large-scale national survey (Sunami et al. 2022) reveals a structural imbalance: the success rate of identifying therapeutic drugs (the primary objective) remains at 7.7%, whereas the detection rate of genetic risks (secondary findings, or SF), a by-product, is higher at 10.3%. Based on qualitative research at two facilities in Japan, this study utilizes Bogicevic et al.'s (2021) mode classification and Ackerman's (2022) concept of "invisible labor" for analysis. The findings indicate that the "labor of connection" performed by healthcare professionals serves to humanize and personalize the otherwise undesirable outcomes of finding no targeted treatments or disclosing SFs affecting patients' families. From a service engineering perspective, this study visualizes the value transformation process and proposes a framework for human-centered medical service design.

Keywords: Precision Medicine, Invisible Labor, Service Engineering, Genetic Counseling, Implementation Science

DOI: 10.54941/ahfe1007723