Nursing advocacy in a postgenomic age

The Human Genome Project will change how health is defined and how disease is prevented, diagnosed, and treated. As the largest group of health care providers in contact with patients, nurses need to be competent in the science of genetics. Beyond this, nurses need to understand the complexities that arise in genomic health care. Ethical, legal, and social issues are integral to the delivery of genomic health care, and nurses must have an astute understanding of such complexities. What it means to know, to reason, and to act in this postgenomic age is explored.

Genetic education for primary care providers: improving attitudes, knowledge, and confidence

OBJECTIVE

To increase primary care providers' awareness and use of genetic services; increase their knowledge of genetic issues; increase their confidence in core genetic competencies; change their attitudes toward genetic testing for hereditary diseases; and increase their confidence as primary care genetic resources.

DESIGN

Participants completed a workshop and 3 questionnaires: a baseline questionnaire, a survey that provided immediate feedback on the workshop itself, and a follow-up questionnaire 6 months later.

SETTING

Ontario.

PARTICIPANTS

Primary care providers suggested by deans of nursing, midwifery, family medicine, and obstetric programs, as well as coordinators of nurse practitioner programs, in Ontario and by the Ontario College of Family Physicians.

INTERVENTION

A complex educational intervention was developed, including an interactive workshop and PowerPoint educational modules on genetic topics for participants' use (available at www.mtsinai.on.ca/FamMedGen/).

MAIN OUTCOME MEASURES

Awareness and use of genetic services, knowledge of genetics, confidence in core clinical genetic skills, attitudes toward genetic testing, and teaching activities related to genetics.

RESULTS

The workshop was attended by 29 participants; of those, 21 completed the baseline questionnaire and the 6-month follow-up questionnaire. There was no significant change found in awareness or reported use of genetic services. There was significant improvement in self-assessed knowledge of (P = .001) and confidence in (P = .005) skills related to adult-onset genetic disorders. There were significant increases in confidence in many core genetic competencies, including assessing risk of hereditary disorders (P = .033), deciding who should be offered referral for genetic counseling (P = .003), discussing prenatal testing options (P = .034), discussing benefits, risks, and limitations of genetic testing (P = .033), and describing what to expect at a genetic counseling session (P = .022). There was a significant increase in the number of primary care providers agreeing that genetic testing was beneficial in the management of adult-onset diseases (P = .031) and in their confidence in being primary care genetic resources for adult-onset genetic disorders (P = .006).

CONCLUSION

Educational interventions that include interactive peer resource workshops and educational modules can increase knowledge of and confidence in the core competencies needed for the delivery of genetic services in primary care.

Knowledge, beliefs and practices of African-American nurses regarding genetics/genomics

In an effort to increase the awareness of genetics among African-American nurses, a pilot study was conducted with members of the National Black Nurses Association (NBNA) in order to assess the interest, knowledge, and practice of African-American nurses regarding genetics and to identify program needs. Self-administered surveys were distributed to a convenience sample of 77 African-American nurses (N=77) attending the 2006 Annual Conference of the National Black Nurses Association (NBNA) in Hollywood, Florida. Measures of central tendency and frequencies were used to analyze the data. Over half the sample (56%) self-reported their knowledge of genetics as being only fair or poor; however, 56% were interested in genetic awareness training, and 93.5% were willing to participate in planned genomic education. An unexpected finding was that 77.9% believed that genetic tests could be used to discriminate against minorities. Although this sample reported limited genetics/genomic knowledge, their interest in genetics training and the incorporation of genetics into daily practice was high. These data can be used to support the development and implementation of culturally appropriate genetic awareness training. Challenges for the organization include identification of the type of venue to use for genetic/genomic awareness training and identification of resources and partnerships to support NBNA members in gaining genetic awareness training.

Understanding the role of genetics and genomics in health 2: implications for practice

This second article in a two part series on genetics and genomics in healthcare focuses on the implications for nursing practice. Part 1 examined the progress of research in this area and discussed the implications for healthcare. This part outlines the nurse's role in supporting the patient pathway, and some of the ethical issues and challenges facing nurses as they integrate genomic healthcare into practice.

Testing communication strategies to convey genomic concepts using virtual reality technology

Health professionals need to be able to communicate information about genomic susceptibility in understandable and usable ways, but substantial challenges are involved. We developed four learning modules that varied along two factors: (1) learning mode (active learning vs. didactic learning) and (2) metaphor (risk elevator vs. bridge) and tested them using a 2 x 2 between-subjects, repeated measures design. The study used an innovative virtual reality technology experimental platform; four virtual worlds were designed to convey the concept that genetic and behavioral factors interact to affect common disease risk. The primary outcome was comprehension (recall, transfer). Study participants were 42 undergraduates aged 19-23. The results indicated that the elevator metaphor better supported learning of the concept than the bridge metaphor. Mean transfer score was significantly higher for the elevator metaphor (p < 0.05). Mean change in recall was significantly higher for didactic learning than active learning (p < 0.05). Mean ratings for variables posited to be associated with better learning (e.g., motivation), however, were generally higher for the active learning worlds. The results suggested that active learning might not always be more effective than didactic learning in increasing comprehension of health information. The findings also indicated that less complex metaphors might convey abstract concepts more effectively.

[A study of three-combination teaching model in college medical genetics teaching]

Based on the education law and training objective at professional colleges, and by integrating Medical Genetics in accordance with the length of medical schooling, periods and the students' characteristics, the "three-combination" teaching model has been implemented completely, namely "teaching content and training objective, theory instruction and clinic application, and practice teaching and vocational ability improvement" which are clued mainly to categorized genetic diseases. Through three years' practice, the model proved reasonable and helpful in activating student interest in the study of their medical genetics and acquiring comprehensive achievements.

Teaching 'race' at medical school: social scientists on the margin

This essay examines the efforts of social scientists and humanities scholars to teach students at a major US medical school about 'race'. The objectives were to explain that race is no longer considered a biologically legitimate concept and to demonstrate that race remains an influential social classification, causing social and biological harm. That is, these educators sought to reframe the medical significance of race. An examination of the email discussions of those involved in this teaching exercise (which included the author) reveals concerns over the credibility of social scientists and humanities scholars speaking on genetics in the modern medical school. It also indicates the intellectual and curricular marginalization of critiques of racial classification in medical education. In science studies journals one can read convincing deconstructions of the new genetics of race, but it is rare to find an analysis of how ideas about race figure in the mundane practice of educating future medical doctors and researchers. Through examination of an exemplary, wide-ranging discussion of an attempt to teach on race in the medical curriculum, this essay addresses the disciplinary and institutional difficulties of translating critiques of controversial science into pedagogy.

Clinical geneticists' and genetic counselors' views on the communication of genetic risks: a qualitative study

OBJECTIVE

In genetic counseling, counselees' understanding of risk information is considered crucial for informed decision-making. The counselors' task is to convey risks in a format that is understandable. It is therefore important to know how and why counselors say they communicate risks in different formats, and to identify any perceived training needs. By investigating counselors' perspectives, training can be more tailored to their needs.

METHODS

Interviews were held with 18 counselors in 4 of the 8 clinical genetic centres in The Netherlands.

RESULTS

Counselors reported using different formats, but seemed to prefer a numerical format (e.g. percentages). Methods varied between counselors and depended on their training, their own abilities, experiences they have had with counselees, but rarely because of information they have gathered from the literature on risk communication. Counselors reported assessing comprehension most often from counselees' non-verbal responses, and reported tailoring their approaches to their clients' needs. Although some counselors are eager to know if their way of risk communication is 'right', overall the counselors did not report a need to be trained in risk communication.

CONCLUSION

Counselors appear to have clear ideas about how to present risks, although evidence for their methods is often lacking.

PRACTICE IMPLICATIONS

Training in general communication skills and evidence-based risk communication could be of benefit to counselors and, consequently, to their counselees.

Clinical genetics issues encountered by family physicians

PURPOSE

To describe the genetics-related clinical issues encountered by family physicians, and the medical problems they referred to genetics consultants.

METHODS

Questionnaires were mailed to a nationwide, random sample of 498 practicing family physicians, asking how many times in the past year they discussed genetic information about 19 familial or genetic conditions with patients and what proportion of the families with each genetic condition were referred for genetics consultation. Factor analysis was used to group the conditions.

RESULTS

The response rate was 38% (n = 190). Respondents were similar to non-respondents except that more were women. Most family physicians reported discussing the genetics of common cancers, cardiovascular disease, and Alzheimer's disease with two or more patients in the past year. Thirteen percent had referred families for genetics assessment of breast-ovarian cancer but only two made genetics referrals for cardiovascular disease or dementia. 25% to 50% of family physicians had addressed genetic issues in at least one family with hemoglobinopathy, a blood clotting disorder, hemochromatosis, mental illness, vision loss or deafness, chromosome abnormality, infertility or pregnancy loss, congenital anomalies, mental retardation, and neurofibromatosis. Most cases were not referred to geneticists. Of respondents, 23% said that genetics consultation is very difficult to obtain or unavailable and 18% listed ethical and social dilemmas related to pursuing genetic diagnosis.

CONCLUSION

Nationwide, family physicians address a variety of genetics issues with patients, most frequently consulting geneticists for perinatal conditions and familial cancers. Access to genetics consultation is more difficult in rural areas. These data may be used in organizing genetics services and in planning professional education programs for primary care clinicians.

Providers' knowledge of genetics: A survey of 5915 individuals and families with genetic conditions

PURPOSE

Individuals affected by genetic conditions are increasingly likely to seek information about inheritance and risk factors from their primary care physicians rather than a geneticist, but several studies suggest that few health care providers are capable of fulfilling that role or are comfortable doing so. Acknowledging that the adoption of new genetics knowledge and technologies is often patient-driven, we asked affected individuals and family members about their experiences in encounters with a variety of nongenetics-trained health care providers.

METHODS

Staff at the National Coalition for Health Professional Education in Genetics, the Genetic Alliance, and a University of Maryland graduate student in genetic counseling drafted a web-based survey. We recruited study participants from the Genetic Alliance, and a total of 5915 respondents completed the questionnaire between December 2004 and August 2005.

RESULTS

Overall, 64% of respondents reported receiving no genetics education materials from the provider type named most important in the management of the condition in the family. We present knowledge ratings for various provider types and themes emerging from written descriptions of positive and disappointing experiences.

CONCLUSION

We discuss the implications of these and other results for continuing genetics education and for clinical practice.

Genetic association studies in nursing practice and scholarship

PURPOSE

To explore the role of genetic association studies in risk assessment for common complex diseases.

ORGANIZING FRAMEWORK

An introduction to the types of genetic association studies is followed by a discussion of their potential use in risk assessment for age-related macular degeneration and type 2 diabetes mellitus. The benefits and limitations of this burgeoning technology are explored and related to nursing practice and scholarship.

CONCLUSIONS

Nurses in practice must be prepared to assist clients with decisions about seeking and interpreting results from genetic association studies and nurse researchers must apply current guidelines for conducting robust studies and applying the results of such studies in clinical practice.

CLINICAL RELEVANCE

Data collected from genetic association studies will increasingly be used to identify novel prevention and treatment strategies for many complex diseases. An understanding of the principles that underlie this new science is essential for nurses in all areas of clinical practice as they design, test, and implement appropriate intervention and prevention strategies based on genetic association studies.

Genetics education for health professionals: a context

Education of health professionals about genetics is essential to the integration of genetics into mainstream health care, but there are a number of associated challenges. By virtue of their training, genetic counselors are well suited to address many of those challenges and to assume a variety of roles related to genetics education for health professionals. This paper provides a brief overview of the status of genetics education for non-genetics health professionals and reviews the context in which educational efforts are likely to occur.