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Fahy N, Rice C, Lahiri N, Desai R, Stott J. Genetic risk for Huntington Disease and reproductive decision-making: A systematic review. Clin Genet 2023. [PMID: 37095632 DOI: 10.1111/cge.14345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
Huntington Disease (HD) is an incurable autosomal dominant single gene neurodegenerative disorder. Typical onset is between 30 and 40 years and characterised by motor difficulties, cognitive impairment, and behavioural and personality changes. The availability of reproductive testing means that affected and at-risk individuals can make reproductive decisions with genetic risk in mind. We aimed to summarise the literature on reproductive decision-making in the context of HD risk in terms of outcomes and the subjective experiences of at-risk individuals. Five databases were searched. Findings were synthesised using Framework analysis to identify common factors across results of quantitative and qualitative studies. Twenty five studies met inclusion criteria. Framework analysis identified the following key areas: 'The relationship between reproductive intentions and HD genetic risk', 'Views on assistive options', 'Complexity and challenges in reproductive decision-making', 'Actual reproductive outcomes', and 'Other factors influencing reproductive decision-making'. Quality of included studies was mixed. Reproductive decision making in the context of HD risk was found to be a complex and emotionally challenging process. Further research is required into reproductive decision-making and outcomes among those not utilising assistive options, and in developing a model of reproductive decision-making in HD.
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Affiliation(s)
- Neil Fahy
- ADAPT Lab, Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Charlotte Rice
- ADAPT Lab, Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Nayana Lahiri
- St George's University Hospitals NHS Foundation Trust & St Georges, University of London, IMBE, London, UK
| | - Roopal Desai
- ADAPT Lab, Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical Educational and Health Psychology, University College London, London, UK
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2
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Mahmood S, Law S, Bombard Y. "I have to start learning how to live with becoming sick": A scoping review of the lived experiences of people with Huntington's disease. Clin Genet 2021; 101:3-19. [PMID: 34216010 DOI: 10.1111/cge.14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023]
Abstract
Person-centered care (PCC) is recognized as a key component of the delivery of quality healthcare and a model for healthcare systems worldwide. The experience of illness through a person's perspective is one domain defining PCC contributing to a growing interest in examining the lived experiences of illness. This scoping review sought to examine what is known from the existing literature about the lived experiences of persons gene-positive for or living with Huntington's disease (HD) as described in their own voices and to outline prominent psychosocial themes of those experiences. Five databases were systematically searched and analyzed resulting in 19 publications for inclusion. Using a thematic analysis, five prominent psychosocial themes were identified: grappling with control, avoidance as an escape from realities, adaptation to new realities, managing emotions, and appreciation for life. Variation in themes existed across HD life stage of being undiagnosed or diagnosed with HD. The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC.
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Affiliation(s)
- Saadia Mahmood
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Yvonne Bombard
- Genomics Health Service Research Group, St. Michael's Hospital - Unity Health Toronto, Toronto, Ontario, Canada
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3
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Davies G, Butow P, Napier CE, Bartley N, Juraskova I, Meiser B, Ballinger ML, Thomas DM, Schlub TE, Best MC. Advanced Cancer Patient Knowledge of and Attitudes towards Tumor Molecular Profiling. Transl Oncol 2020; 13:100799. [PMID: 32450551 PMCID: PMC7256320 DOI: 10.1016/j.tranon.2020.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/24/2023] Open
Abstract
Limited research has indicated that despite their overwhelming interest in tumor molecular profiling (MP),1 cancer patients have poor knowledge about MP. The current study aimed to investigate demographic and psychological predictors of knowledge and perceived importance of MP in an advanced cancer patient cohort. Eligible participants had advanced solid cancers of any histological type with sufficient accessible tissue for MP and were enrolled in the Molecular Screening and Therapeutics (MoST) Program. A questionnaire was completed by 1074 participants (91% response rate) after consent, prior to undergoing MP. Overall, participants had poor to moderate knowledge of MP, yet perceived MP to have high importance. Higher education, speaking English at home, and greater satisfaction with the decision to undergo MP were associated with higher knowledge scores. More negative attitudes towards uncertainty, greater self-efficacy to cope with results, and lower perceived likelihood of cancer progression were associated with greater perceived importance of MP. Less educated participants and those who do not speak English at home will need clear explanations, visual aids and ample opportunity to ask questions about MP at the time of their decision-making. Clinicians also need to consider psychological factors relevant to patients' decision to pursue MP. Given the increased awareness of and demand for cancer genomic information and the rapidly changing nature of the actionability of MP, these findings will help inform an important ongoing debate on how to facilitate ethical and informed consent and manage patient expectations about personalized treatments.
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Affiliation(s)
- Grace Davies
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
| | - Nicci Bartley
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, NSW 2032, Australia.
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, University of NSW, Sydney, NSW 2010, Australia.
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, University of NSW, Sydney, NSW 2010, Australia.
| | - Timothy E Schlub
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney, NSW 2006, Australia.
| | - Megan C Best
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
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Mandich P, Lamp M, Gotta F, Gulli R, Iacometti A, Marchese R, Bellone E, Abbruzzese G, Ferrandes G. 1993-2014: two decades of predictive testing for Huntington's disease at the Medical Genetics Unit of the University of Genoa. Mol Genet Genomic Med 2017; 5:473-480. [PMID: 28944231 PMCID: PMC5606876 DOI: 10.1002/mgg3.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Predictive testing for Huntington's disease has been available at the Medical Genetics Unit of the University of Genoa from 1987. In 1989, an integrated counseling protocol (geneticist, psychologist, and neurologist) was developed following International Guidelines. Methods This is a retrospective analysis of the clinical charts and motivation questionnaires of persons seeking predictive testing through direct DNA analysis from 1993 until 2014, with the aim to evaluate their individual characteristics, motivations, and the outcomes of the counseling protocol. Results A total of 299 persons (164 women, 135 men) applied for predictive testing. Most applicants’ features and motivations were similar to those previously described, but surprisingly the percentage of completed protocols was higher among men, 68.5% versus 53.5% (P = 0.011). Likewise, persons over 25 years of age were more likely to take the test than younger applicants (18–25 years): 63.4% versus 48.1% (P = 0.043). In addition, relationship status, having children, and the gender of the affected parent showed different effects on the decision about testing in males and females. No catastrophic reactions were reported during the study period. Conclusions We observed that factors influencing the decision‐making process might differ between males and females, and that predictive testing appears a safe procedure if framed within an integrated counseling protocol.
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Affiliation(s)
- Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Merit Lamp
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Fabio Gotta
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Rossella Gulli
- Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Ariela Iacometti
- Unit of Clinical Psychology and PsychotherapyIRCCS AOU San Martino-ISTGenoaItaly
| | | | - Emilia Bellone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Clinical Neurology UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Giovanna Ferrandes
- Unit of Clinical Psychology and PsychotherapyIRCCS AOU San Martino-ISTGenoaItaly
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Abstract
This article presents a tentative grounded theory, which can provide some explanation of variation in behaviour around predictive genetic testing (PGT) for Hereditary Non-Polyposis Colorectal Cancer (HNPCC), based on interviews with individuals ( n = 55) from families with a clinical diagnosis of HNPCC, 12 of whom were followed through the PGT protocol. The theory is built around a core category of engagement, a newly constructed concept reflecting the degree of cognitive and emotional involvement with cancer risk in individuals from these families, and models the psychosocial process of engaging with cancer risk. The degree of engagement at the time of testing can explain variations in approaches and reactions to PGT. A series of social factors, many related to the experiences of family life, emerged as either facilitating or blocking the process of engaging with cancer risk; a series of psychological factors emerged as interacting in a recursive, dynamic manner with each other and with engagement status. The degree of engagement can change with the unfolding of time and events in family life. The theory of engagement (TE) provides an explanatory framework for understanding behaviour related to PGT for HNPCC, and can potentially be applied to research on risk perception in the social sciences more generally. In addition, the theory may have potential uses in the genetics clinic, in identifying individuals at risk of adverse reactions to PGT for cancer, thus enabling better targeting of genetic counselling resources.
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Abstract
The field of genetics and the process of testing for genetic disorders have advanced considerably over the past half century, ushering in significant improvements in certain areas of medical diagnosis and disease prediction. However, genetic discoveries are accompanied by many social, emotional, and psychological implications, and counseling psychologists may be uniquely equipped to help clients deal with these issues. The present overview is intended to raise awareness of the multidimensional issues inherent in situations where clients seek genetic testing to diagnose or predict various medical conditions. Initially, the author presents a framework to help counseling psychologists identify and organize information within a genetic-testing context, followed by suggestions for addressing the various psychological, social, and multicultural issues potentially affecting client decision making, mental health, and behavior. Finally, the author raises considerations for training, continuing education, and professional practice to foster continued discussion among counseling psychologists preparing for, or presently working in, research and applied settings involving clients with genetic concerns.
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Reininghaus E, Lackner N. Relationship satisfaction and sexuality in Huntington's disease. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:325-34. [PMID: 26003252 DOI: 10.1016/b978-0-444-63247-0.00018-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Huntington's disease (HD) is a chronic disabling disease that inflicts a considerable burden on patients and their families for a variety of reasons. These reasons include cognitive impairment and motor dysfunction, personality changes, and knowledge of possible genetic transmission of the disease to their children. Thus, the decision to take a genetic test for individuals at risk for HD is often associated with family planning and relationship stress. However, for most individuals, a positive genetic test does not alter family planning with regard to their decision to have children. HD has also been associated with abnormal sexual behaviors, although only a few studies have explored sexuality and sexual dysfunction in HD. Up to 85% of men and 75% of women experience sexual problems, including hypoactive sexual disorder in some cases and increased sexual interest and paraphilia in others. Psychologic support should involve the communication of realistic expectations about the progression of the disorder and potential consequences on the children.
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Affiliation(s)
- Eva Reininghaus
- Department of Psychiatry, Medical University of Graz, Graz, Austria.
| | - Nina Lackner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
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Wessels MMS, Vriezinga SL, Koletzko S, Werkstetter K, Castillejo-De Villasante G, Shamir R, Hartman C, Putter H, van der Pal SM, Wijmenga C, Bravi E, Mearin ML. Impact on parents of HLA-DQ2/DQ8 genotyping in healthy children from coeliac families. Eur J Hum Genet 2014; 23:405-8. [PMID: 24916643 DOI: 10.1038/ejhg.2014.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 05/11/2014] [Accepted: 05/15/2014] [Indexed: 12/19/2022] Open
Abstract
Due to the association of coeliac disease and HLA-specificities DQ2 and DQ8, HLA-typing can be used for risk determination of the disease. This study was designed to evaluate the knowledge of parents from coeliac families regarding HLA-typing and the impact of HLA-typing on the perception of the health of their children. A structured questionnaire was sent to the Dutch, Spanish and German parents participating with their child in the European PreventCD study on disease prevention in high-risk families, addressing parents' understanding of and attitude towards HLA-typing, distress related to HLA-typing and perceived health and health-related quality of life of their children. Sixty-eight percent of parents of 515 children returned the questionnaires, with 85% of children being DQ2/DQ8 positive. The majority of all parents answered the questions on knowledge correctly. Forty-eight percent of parents of DQ2/DQ8-negative children thought their child could develop coeliac disease. More distress was reported by parents of DQ2/DQ8-positive children (P<0.001). All parents showed few regrets and would repeat HLA-typing in future children. Perceived health and health-related quality of life were similar. In conclusion, we can say that misinterpretation of DQ2/DQ8-negative results by parents is frequent. DQ2/DQ8-positive results do not affect perceived health and health-related quality of life of children but may cause temporary negative feelings among parents. Parents of coeliac families seem to support HLA-typing.
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Affiliation(s)
- Margreet M S Wessels
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sabine L Vriezinga
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sybille Koletzko
- Department of Pediatrics, Hauner Children's Hospital, Munich, Germany
| | | | | | - Raanan Shamir
- Department of Pediatrics, Schneider Children's Medical Center, Tel Aviv, Israel
| | - Corina Hartman
- Department of Pediatrics, Schneider Children's Medical Center, Tel Aviv, Israel
| | - Hein Putter
- Department of Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cisca Wijmenga
- Department of Genetics, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Enzo Bravi
- Department of Diagnostics, Eurospital S.p.A, Trieste, Italy
| | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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9
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Paulsen JS, Nance M, Kim JI, Carlozzi NE, Panegyres PK, Erwin C, Goh A, McCusker E, Williams JK. A review of quality of life after predictive testing for and earlier identification of neurodegenerative diseases. Prog Neurobiol 2013; 110:2-28. [PMID: 24036231 PMCID: PMC3833259 DOI: 10.1016/j.pneurobio.2013.08.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/12/2022]
Abstract
The past decade has witnessed an explosion of evidence suggesting that many neurodegenerative diseases can be detected years, if not decades, earlier than previously thought. To date, these scientific advances have not provoked any parallel translational or clinical improvements. There is an urgency to capitalize on this momentum so earlier detection of disease can be more readily translated into improved health-related quality of life for families at risk for, or suffering with, neurodegenerative diseases. In this review, we discuss health-related quality of life (HRQOL) measurement in neurodegenerative diseases and the importance of these "patient reported outcomes" for all clinical research. Next, we address HRQOL following early identification or predictive genetic testing in some neurodegenerative diseases: Huntington disease, Alzheimer's disease, Parkinson's disease, Dementia with Lewy bodies, frontotemporal dementia, amyotrophic lateral sclerosis, prion diseases, hereditary ataxias, Dentatorubral-pallidoluysian atrophy and Wilson's disease. After a brief report of available direct-to-consumer genetic tests, we address the juxtaposition of earlier disease identification with assumed reluctance toward predictive genetic testing. Forty-one studies examining health-related outcomes following predictive genetic testing for neurodegenerative disease suggested that (a) extreme or catastrophic outcomes are rare; (b) consequences commonly include transiently increased anxiety and/or depression; (c) most participants report no regret; (d) many persons report extensive benefits to receiving genetic information; and (e) stigmatization and discrimination for genetic diseases are poorly understood and policy and laws are needed. Caution is appropriate for earlier identification of neurodegenerative diseases but findings suggest further progress is safe, feasible and likely to advance clinical care.
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Affiliation(s)
- Jane S Paulsen
- Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychology, University of Iowa, Iowa City, IA, USA.
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10
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van Rij MC, de Koning Gans PAM, van Belzen MJ, Roos RAC, Geraedts JPM, De Rademaeker M, Bijlsma EK, de Die-Smulders CEM. The uptake and outcome of prenatal and pre-implantation genetic diagnosis for Huntington's disease in the Netherlands (1998-2008). Clin Genet 2013; 85:87-95. [DOI: 10.1111/cge.12089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/31/2012] [Accepted: 12/31/2012] [Indexed: 11/30/2022]
Affiliation(s)
- MC van Rij
- Department of Clinical Genetics; Maastricht University Medical Centre (MUMC); Maastricht The Netherlands
| | - PAM de Koning Gans
- Department of Clinical Genetics; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | - MJ van Belzen
- Department of Clinical Genetics; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | | | - JPM Geraedts
- Department of Clinical Genetics; Maastricht University Medical Centre (MUMC); Maastricht The Netherlands
- GROW, Research School for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| | - M De Rademaeker
- Centre for Medical Genetics; University Hospital Brussels; Brussels Belgium
| | - EK Bijlsma
- Department of Clinical Genetics; Leiden University Medical Centre (LUMC); Leiden The Netherlands
| | - CEM de Die-Smulders
- Department of Clinical Genetics; Maastricht University Medical Centre (MUMC); Maastricht The Netherlands
- GROW, Research School for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
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Forrest Keenan K, Simpson SA, Miedzybrodzka Z, Alexander DA, Semper J. How do partners find out about the risk of Huntington's disease in couple relationships? J Genet Couns 2013; 22:336-44. [PMID: 23297124 DOI: 10.1007/s10897-012-9562-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
Whilst a growing body of work has explored family communication about Huntington's disease and how at-risk individuals learn about their risk, the experience of telling a partner and partners' experiences of finding out about this potentially devastating hereditary illness have received little attention. This study describes the experiences of partners in finding out about Huntington's disease and any impact on couple's relationships/marriages. We undertook a thematic analysis of qualitative interviews which explored the dynamics of partners' marriages after predictive testing and partners' views of genetic counseling. A main theme from partners' accounts was how they found out about their spouse's risk of Huntington's disease and the impact this had on marital relations. The analysis revealed four types of disclosure experiences: (1) marital secrets; (2) alerting, but not telling; (3) knowing and seeing; (4) marital ignorance. Our findings demonstrate that partners' experiences of (non)disclosure about the risk of HD within marriages is an important factor which contributes to couples' coping or marital problems. Exploring how spouses found out about their partner's risk of HD will illuminate issues about a couple's past and future patterns of communication and their coping strategies. A practical and ethical implication is the extent to which genetic counselors should inform partners about the course and nature of Huntington's disease when a partner is the support person for the individual being tested.
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Affiliation(s)
- Karen Forrest Keenan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK.
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12
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Smith JA, Michie S, Stephenson M, Quarrell O. Risk Perception and Decision-making Processes in Candidates for Genetic Testing for Huntington's Disease: An Interpretative Phenomenological Analysis. J Health Psychol 2012; 7:131-44. [PMID: 22114233 DOI: 10.1177/1359105302007002398] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study is concerned with how candidates for pre-symptomatic genetic testing for Huntington's disease represent their risk status and how they describe the process involved in their deciding whether or not to take the test. Transcripts of semi-structured interviews with five women offered testing were analysed by interpretative phenomenological analysis (IPA). The women find it difficult to conceptualize their current risk, and express reasons for a perceived enhanced or diminished risk based on, for example, number of previous family members affected or pre-selection of a likely recipient of the genetic mutation. The article then illustrates the contextual factors, such as family discussion or a key triggering event, which can influence the decision process of whether or not to take the genetic test. The study has implications both for psychological models of decision making and for the practice of genetic counselling.
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13
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Chisholm LZ, Flavin KT, Paulsen JS, Ready R. Psychological well-being in persons affected by Huntington's disease: a comparison of at-risk, prodromal, and symptomatic groups. J Health Psychol 2012; 18:408-18. [PMID: 22569809 DOI: 10.1177/1359105312444646] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In order to broaden knowledge of psychological functioning in Huntington's disease (HD), participants at-risk, prodromal, and symptomatic for HD reported on stress, negative affect, and depressive symptoms as well as life satisfaction, positive affect, and quality of life. Persons with symptomatic HD reported fewer psychological assets and greater stress, depressive symptoms, and negative affect than other groups. Positive affect in symptomatic persons did not significantly differ from other groups, and was higher in persons at-risk for HD than in controls. Greater attention to psychological assets in HD is warranted, particularly positive affect which may not decline early in the disease.
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More Appreciation of Life or Regretting the Test? Experiences of Living as a Mutation Carrier of Huntington’s Disease. J Genet Couns 2010; 20:70-9. [DOI: 10.1007/s10897-010-9329-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
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15
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Richards FH. Predictive genetic testing of adolescents for Huntington disease: a question of autonomy and harm. Am J Med Genet A 2008; 146A:2443-6; author reply 2447-8. [PMID: 18698623 DOI: 10.1002/ajmg.a.32477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Duncan RE, Gillam L, Savulescu J, Williamson R, Rogers JG, Delatycki MB. "You're one of us now": young people describe their experiences of predictive genetic testing for Huntington disease (HD) and familial adenomatous polyposis (FAP). AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2008; 148C:47-55. [PMID: 18189288 DOI: 10.1002/ajmg.c.30158] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There has been much debate about the psychosocial effects of predictive genetic testing in minors. The majority of this debate has been theoretical, with little empirical evidence published. We conducted in-depth interviews with 18 young people who had undergone testing, to explore the range of harms and benefits that they perceived were associated with their tests. Participants were eight individuals who were tested for Huntington disease (two gene-positive, six gene-negative) and ten who were tested for familial adenomatous polyposis (five gene-positive, five gene-negative). At the time of their test they ranged from 10 to 25 years of age. When interviewed they ranged from 14 to 26 years of age. Harms described included knowledge of future illness, witnessing distress in parents, negative effects on family relationships and friendships, effects upon employment and school, experiencing regret, feeling guilty and having to confront difficult issues. Benefits included knowledge of gene-negative status, relief from uncertainty, witnessing relief in parents, feeling able to plan for the future, positive effects on family relationships and friendships, feeling empowered and experiencing a sense of clarity about what is important in life. Harms were described in relation to gene-negative test results, as were benefits in relation to gene-positive test results. The testing process itself had several positive and negative effects for young people, distinct from the actual test result. Future research concerning the effects of predictive genetic testing in young people must remain broad and should aim to measure the beneficial as well as the harmful effects that resonate for young people themselves.
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Affiliation(s)
- Rony E Duncan
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Australia.
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McAllister M, Davies L, Payne K, Nicholls S, Donnai D, MacLeod R. The emotional effects of genetic diseases: implications for clinical genetics. Am J Med Genet A 2008; 143A:2651-61. [PMID: 17937446 DOI: 10.1002/ajmg.a.32013] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this qualitative study was to explore the emotional effects that may be common to many genetic conditions, or risk of genetic conditions, that could be appropriately targeted by clinical genetics services. The study sample comprised 52 individuals. Seven focus groups with patients of clinical genetics services, their representatives from patient support organizations and genetics healthcare providers were conducted. Focus groups were supplemented by 19 face-to-face interviews with patients and patient group representatives. Focus groups and interviews were audio taped, transcribed in full, and analyzed using the constant comparative method. Eight emotional effects of genetic diseases were identified: anxiety, worry about risks to children, guilt, anger, uncertainty, sadness and grief, depression, and redemptive adjustment. Two factors were identified that could modify the emotional effects; these were variability of genetic diseases, and lack of diagnosis/inappropriate care. Despite many negative effects of genetic disease being identified, results also suggest that redemptive adjustment is possible where a genetic condition is present in a family. Interventions designed to (1) adjust the modifying conditions and (2) help manage the emotional effects may facilitate adjustment and improve patient outcomes.
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18
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Duncan RE, Gillam L, Savulescu J, Williamson R, Rogers JG, Delatycki MB. "Holding your breath": interviews with young people who have undergone predictive genetic testing for Huntington disease. Am J Med Genet A 2007; 143A:1984-9. [PMID: 17663467 DOI: 10.1002/ajmg.a.31720] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Guidelines recommend that predictive genetic testing for Huntington disease (HD) should be deferred until the age of majority (18 years in most countries). However, opposition to these guidelines exists, with some professionals arguing that testing may be beneficial for young people, and should be considered much earlier. Empirical evidence is unable to substantiate either position. We aimed to (1) explore the experience of predictive genetic testing for HD from the young person's perspective and to (2) document the impact that testing has upon various aspects of young people's lives. Eight young people who had undergone predictive genetic testing for HD were interviewed. They ranged in age from 17 to 25 years at the time of their test. Four were female and two had received a gene-positive test result. Interviews were taped, transcribed and analyzed thematically. Three themes emerged related to the time before the test was performed: "Living as though gene-positive," "Risk behaviors," and "Complex pasts." Two themes emerged related to the time after testing: "Identity difficulties" and "Living again." When the young people spoke about their experiences of predictive testing, they placed these within a broader context of growing up in a family affected by HD. For some of the young people, uncertainty about their genetic status constituted a barrier in their lives and prevented them from moving forward. Testing alleviated these barriers in some cases and helped them to move forward and make significant behavioral changes. Not one of the young people interviewed regretted undergoing predictive testing.
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Affiliation(s)
- Rony E Duncan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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19
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van Oostrom I, Meijers-Heijboer H, Duivenvoorden HJ, Bröcker-Vriends AHJT, van Asperen CJ, Sijmons RH, Seynaeve C, Van Gool AR, Klijn JGM, Riedijk SR, van Dooren S, Tibben A. A prospective study of the impact of genetic susceptibility testing for BRCA1/2 or HNPCC on family relationships. Psychooncology 2007; 16:320-8. [PMID: 16909428 DOI: 10.1002/pon.1062] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study assessed the impact of genetic testing for cancer susceptibility on family relationships and determinants of adverse consequences for family relationships. Applicants for genetic testing of a known familial pathogenic mutation in BRCA1/2 or a HNPCC related gene (N=271) rated the prevalence and nature of changes in family relationships, familial difficulties and conflicts due to genetic testing 6 months after receiving the test result. The level of family functioning, differentiation from parents, support and familial communication style regarding hereditary cancer were assessed before receiving the test result. Genetic testing affected some family relationships in a positive way (37%), i.e. by feeling closer, improved communication and support, more appreciation of the relative and relief of negative test result. A minority reported unwanted changes in relationships (19%), problematic situations (13%) or conflicts (4%). Adverse effects comprised feelings of guilt towards children and carrier siblings, imposed secrecy and communication problems. Predictors of adverse consequences on family relationships were reluctance to communicate about hereditary cancer with relatives and disengaged-rigid or enmeshed-chaotic family functioning. Open communication between relatives should be stimulated because a lack of open communication may be an important determinant of familial adverse effects.
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Affiliation(s)
- Iris van Oostrom
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Westzeedijk 114, 3016 AH Rotterdam, The Netherlands.
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20
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Paneque HM, Prieto AL, Reynaldo RR, Cruz MT, Santos FN, Almaguer ML, Velázquez PL, Heredero BL. Psychological Aspects of Presymptomatic Diagnosis of Spinocerebellar Ataxia Type 2 in Cuba. Public Health Genomics 2007; 10:132-9. [PMID: 17575457 DOI: 10.1159/000101754] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this paper, we present a descriptive study of the first year of implementation of the predictive genetic testing program for spinocerebellar ataxia type 2 (SCA2) in Cuba, which has been structured along the international guidelines for Huntington disease. SUBJECTS AND METHODS Medical records were retrospectively reviewed from 100 individuals who requested presymptomatic diagnosis. They had been seen between February 2001 and May 2002 at the Ataxia Clinic in the province of Holguín and had completed the protocol. The participants had psychological evaluations before testing and 1 week after being informed of the result. RESULTS The average age of the participants in the presymptomatic testing for SCA2 was 39.3 years, 62% were female. The main reasons for taking the test were family planning and risk assessment in their children. Family participation in the process was high and there were several additional sources of social support. Before the test, the subjects did not present high levels of anxiety or depression. On informing the patients of the test results indicators for anxiety and depression significantly decreased, and there were no significant differences according to whether the test result had been positive or negative. Catastrophic events were rare during the first week after the test. CONCLUSIONS The results indicate a strong interest in presymptomatic diagnosis among individuals at risk for SCA2 in Holguín and a lack of significant psychological drawbacks up to 1 week after information of results.
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Affiliation(s)
- H M Paneque
- Clinic for Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.
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21
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O'Neill SC, DeMarco T, Peshkin BN, Rogers S, Rispoli J, Brown K, Valdimarsdottir H, Schwartz MD. Tolerance for uncertainty and perceived risk among women receiving uninformative BRCA1/2 test results. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2007; 142C:251-9. [PMID: 17024668 DOI: 10.1002/ajmg.c.30104] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Women who receive uninformative BRCA1/2 genetic test results face ongoing uncertainty about their future cancer risks. This article prospectively examined the influence of intolerance for uncertainty and perceived breast cancer risk on psychological distress following the receipt of uninformative BRCA1/2 test results. Sixty-four women who received uninformative BRCA1/2 mutation test results completed measures of Intolerance for Uncertainty, perceived breast cancer risk, and measures of cancer-related, genetic testing, and general distress. Cancer-related (DeltaR(2) = 0.18, P < or = 0.001), general (DeltaR(2) = 0.04, P < or = 0.05), and genetic testing distress (DeltaR(2) = 0.12, P < or = 0.01) were associated with intolerance for uncertainty at 1 month post-disclosure. The interaction of intolerance for uncertainty and breast cancer perceived risk predicted cancer-related (DeltaR(2) = 0.10, P < or = 0.001) and genetic testing distress (DeltaR(2) = 0.09, P < or = 0.01) at 6 months post-disclosure. Distress was highest among patients with highest perceived risk and intolerance for uncertainty, suggesting that those who have difficulty coping with their ambiguous risk are at risk for long-term distress. The clinical and research implications of these results are discussed.
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Affiliation(s)
- Suzanne C O'Neill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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22
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Decruyenaere M, Evers-Kiebooms G, Boogaerts A, Philippe K, Demyttenaere K, Dom R, Vandenberghe W, Fryns JP. The complexity of reproductive decision-making in asymptomatic carriers of the Huntington mutation. Eur J Hum Genet 2007; 15:453-62. [PMID: 17245406 DOI: 10.1038/sj.ejhg.5201774] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to describe reproductive decisions in mutation carriers after predictive testing for Huntington's disease (HD) and to identify factors that play a role in decision-making. In 1987-2004, 245 individuals received a predictive test result; 89 of them were carriers and seven received an equivocal result. Quantitative data on reproductive behaviour have been collected during all follow-up contacts. The follow-up time in this study was 1-16 years (mean: 7.1 years). Qualitative data on reproductive decision-making have been collected by the means of semistructured interviews during the 5-year follow-up study. For 46 carriers and two persons with an equivocal result, family planning was one of the motives for predictive testing. In this group, slightly more than half of the carriers (58%) had chosen to have children with prenatal diagnosis or preimplantation genetic diagnosis and about one in three (35%) decided to have no children anymore after the test. A minority (7%) was undecided or had no children for other reasons. Factors playing a role in the decision-making process were the carrier's sex, ethical issues about PD and PGD, the strength of the desire to have children, illness representations including personal experiences with HD in the family and the technological imperative. Some of these elements were in conflict and induced ambivalence towards reproductive choices. The results illustrate the complexity of the decision-making process and the necessity of in-depth counselling. Counselling should pay special attention to conflicting values and beliefs and to all kinds of pressure.
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23
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Baty BJ, Dudley WN, Musters A, Kinney AY. Uncertainty inBRCA1 cancer susceptibility testing. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2006; 142C:241-50. [PMID: 17068806 DOI: 10.1002/ajmg.c.30112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigated uncertainty in individuals undergoing genetic counseling/testing for breast/ovarian cancer susceptibility. Sixty-three individuals from a single kindred with a known BRCA1 mutation rated uncertainty about 12 items on a five-point Likert scale before and 1 month after genetic counseling/testing. Factor analysis identified a five-item total uncertainty scale that was sensitive to changes before and after testing. The items in the scale were related to uncertainty about obtaining health care, positive changes after testing, and coping well with results. The majority of participants (76%) rated reducing uncertainty as an important reason for genetic testing. The importance of reducing uncertainty was stable across time and unrelated to anxiety or demographics. Yet, at baseline, total uncertainty was low and decreased after genetic counseling/testing (P = 0.004). Analysis of individual items showed that after genetic counseling/testing, there was less uncertainty about the participant detecting cancer early (P = 0.005) and coping well with their result (P < 0.001). Our findings support the importance to clients of genetic counseling/testing as a means of reducing uncertainty. Testing may help clients to reduce the uncertainty about items they can control, and it may be important to differentiate the sources of uncertainty that are more or less controllable. Genetic counselors can help clients by providing anticipatory guidance about the role of uncertainty in genetic testing.
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Affiliation(s)
- Bonnie J Baty
- Graduate Program in Genetic Counseling, Division of Medical Genetics, University of Utah Health Science Center, Salt Lake City, UT 84132, USA.
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24
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Peterson SK. The role of the family in genetic testing: theoretical perspectives, current knowledge, and future directions. HEALTH EDUCATION & BEHAVIOR 2005; 32:627-39. [PMID: 16148209 DOI: 10.1177/1090198105278751] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article addresses conceptual challenges and theoretical approaches for examining the role of the family in responding and adapting to genetic testing for inherited conditions. Using a family systems perspective, family-based constructs that are relevant to genetic testing may be organized into three domains: family communication, organization and structure of family relationships, and health-related cognitions and beliefs shared within families. Empirical findings are presented from key content areas in family-based genetics research, including family communication, how genetic testing affects family relationships, psychological responses to genetic testing in the family context, and family-based influences on health decisions. Future research should explore decision making about genetic testing or behavior change specifically within the context of the family system and should identify family-based determinants of genetic testing outcomes.
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Affiliation(s)
- Susan K Peterson
- Department of Behavioral Science-Unit1330, University of Texas, M. D. AndersonCancer Center, Houston, TX 77230-1439, USA.
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25
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Decruyenaere M, Evers-Kiebooms G, Boogaerts A, Demyttenaere K, Dom R, Fryns JP. Partners of mutation-carriers for Huntington's disease: forgotten persons? Eur J Hum Genet 2005; 13:1077-85. [PMID: 15999117 DOI: 10.1038/sj.ejhg.5201462] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study focuses on psychological distress and coping strategies in partners of tested persons 5 years after predictive testing for Huntington's disease. A total of 16 carrier-couples and 17 noncarrier-couples participated in the study. Self-report questionnaires were used, assessing depression level, anxiety, intrusive and avoidance thoughts and coping strategies. Partners of carriers have as much distress as carriers, and for some distress variables even more (P<0.05-0.001). They clearly experience more psychological distress than noncarriers' partners, as expected (P<0.05-0.001). Regarding coping strategies, carriers' partners adopt more passive strategies (passive-regressive and avoiding reactions; P<0.05) and less active strategies (social support seeking and problem solving; P<0.05-0.001), compared to carriers. For both carriers and partners, the adoption of more passive strategies for coping was associated with more distress and the use of more active strategies with less distress (for carriers: P<0.05-0.001; for carriers' partners: P<0.05). The presence of children before predictive testing was an additional result-specific distress factor in carriers and their partners. In conclusion, carriers' partners have at least as much psychological distress as carriers, but partners have the tendency to draw back. The results suggest that the grief of carriers' partners may be 'disenfranchised', or not socially recognised, as if they have no right to mourn. We moreover interpreted the results referring to concepts such as anticipatory grief, psychological defences, dissonance processes and imbalanced partner relationship. Finally, we formulated some implications for genetic counselling.
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Affiliation(s)
- Marleen Decruyenaere
- Psychosocial Genetics Unit, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
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26
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Liljeström B, Aktan-Collan K, Isomaa B, Sarelin L, Uutela A, Groop L, Kääriäinen H, Tuomi T. Genetic testing for maturity onset diabetes of the young: uptake, attitudes and comparison with hereditary non-polyposis colorectal cancer. Diabetologia 2005; 48:242-50. [PMID: 15660263 DOI: 10.1007/s00125-004-1629-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 08/31/2004] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS Mutations in hepatic nuclear factor 1alpha cause a monogenic form of diabetes, maturity onset diabetes of the young type 3 (MODY3). Our aim was (1) to assess the uptake of genetic testing for MODY3 and to determine factors affecting it, and (2) to compare attitudes to predictive genetic testing between families with MODY3 and a previously studied group at risk of hereditary non-polyposis colorectal cancer (HNPCC). METHODS Adult members of two extended MODY3 pedigrees, either with diabetes or a 50% risk of having inherited the mutation (n=144, age 18-60 years), were invited to an educational counselling session followed by a possibility to obtain the gene test result. Data were collected through questionnaires before counselling and 1 month after the test disclosure. RESULTS Eighty-nine out of 144 (62%) participated in counselling, and all but one wanted the test result disclosed. No significant sociodemographic differences were observed between the participants and non-participants. The counselling uptake was similar among diabetic and non-diabetic subjects. Uncertainty about the future and the risk for the children were the most common reasons to take the gene test. At follow-up, most subjects in both MODY3 (100%) and HNPCC (99%) families were satisfied with their decision to take the test and trusted the result. The majority of both diabetic and non-diabetic subjects considered that the MODY3 gene test should be offered either in childhood (50 and 37%) or as a teenager (30 and 37%). CONCLUSIONS Genetic testing for MODY3 was well accepted among both diabetic and non-diabetic participants. The subjects found the gene test reliable and they were satisfied with their decision regarding the predictive test.
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Affiliation(s)
- B Liljeström
- Department of Medicine, Helsinki University Hospital, Helsinki, Finland.
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27
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Sanderson SC, Wardle J, Jarvis MJ, Humphries SE. Public interest in genetic testing for susceptibility to heart disease and cancer: a population-based survey in the UK. Prev Med 2004; 39:458-64. [PMID: 15313084 DOI: 10.1016/j.ypmed.2004.04.051] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Given the current concerns about the clinical validity of commercially marketed genetic tests for multifactorial diseases, there is a surprising dearth of information about what public demand might be for genetic tests for any complex diseases other than cancer. The aim of this study was to examine interest in genetic testing for the most common multifactorial disease, heart disease, and to compare it with interest in testing for cancer in a general population sample that had not received detailed information about genetic tests. METHODS Interest in genetic testing for heart disease susceptibility was surveyed and compared to interest in genetic testing for cancer susceptibility among a nationally representative sample of 1,960 British adults as part of the Office for National Statistics Omnibus survey. RESULTS Sixty-nine percent of respondents expressed interest in being tested for genetic susceptibility to heart disease. Men, people aged 45-60 years, those with less education, and those with a family history were most interested in genetic testing for heart disease. Sixty-four percent of respondents expressed interest in genetic testing for susceptibility to cancer, and gender, age, and education, but not family history, were associated with interest. CONCLUSIONS Interest in genetic testing for susceptibility to both heart disease and cancer was high, with the most educated individuals being the least interested in testing. Although the shift toward the 'expert patient' is actively encouraged and consistent with today's health policies, there is considerable and justifiable concern about some of the genetic tests for multifactorial diseases that are currently being marketed directly to the public. The high level of initial interest in the general public found in this study supports the need for a public education program around genetic testing for multifactorial diseases.
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Affiliation(s)
- Saskia C Sanderson
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
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28
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Richards F. Couples' experiences of predictive testing and living with the risk or reality of Huntington disease: a qualitative study. Am J Med Genet A 2004; 126A:170-82. [PMID: 15057982 DOI: 10.1002/ajmg.a.20583] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A qualitative study, based on family systems theory, was undertaken in order to gain a better understanding of the impact of predictive testing and of living with the risk or reality of Huntington disease (HD), on couple relationships. Semi-structured interviews were conducted with 14 couples; in 9 couples the at-risk partner had undergone testing, and of these, 4 were already affected with HD. At-risk partners in the remaining five couples had not been tested. Interview transcripts were analyzed to obtain a range of themes, which reflect the salient experiences of these couples in relation to HD. Most couples reported that receiving a predictive test result had little or no adverse effect on their relationship. However for two couples who separated after the at-risk partner received a non-carrier result, emotional factors associated with years of living with the HD risk, rather than the result itself, were regarded as having caused irreparable damage to the relationship. For two couples who have remained together since the diagnosis of one partner, loyalty was identified as the main factor contributing to the continuance of the relationship. The separations of the other two couples in which one partner was diagnosed were attributed to emotional distancing, and to the obsessive behavior of the affected partner. The findings of this study highlight both the individuality and the complexity of psychological effects on the intimate relationships of couples who live with the risk or reality of HD, and provide important insights for professionals offering support to these couples.
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Affiliation(s)
- Fiona Richards
- Department of Clinical Genetics, The Children's Hospital at Westmead, LB 4001, Westmead NSW 2145, Sydney, Australia.
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29
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Richards F, Williams K. Impact on couple relationships of predictive testing for Huntington disease: a longitudinal study. Am J Med Genet A 2004; 126A:161-9. [PMID: 15057981 DOI: 10.1002/ajmg.a.20582] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since predictive testing has been available for Huntington disease (HD) and similar adult-onset neurodegenerative disorders, research into the psychosocial impact of test results has focussed on those receiving results, and to a lesser extent, on their partners. Few studies have examined the impact of predictive testing on the couple relationship, particularly from the perspective of family systems theory. This longitudinal study compared the level of marital adjustment of 23 couples in which the at-risk partner is undergoing predictive testing for HD (the testing group) with that of 20 couples in which the at-risk partner is not undergoing testing (the non-testing group). Participating couples completed a relationship measure, the Dyadic Adjustment Scale, at baseline and on two subsequent occasions. Using non-parametric tests, comparisons were made at each phase between the couple scores of the testing and non-testing groups but no significant differences were found in the levels of marital adjustment. Within the testing group the same comparisons were made for the carrier and non-carrier subgroups, and a significant difference was found at the final phase. There was an increase in the level of marital adjustment for the carrier group and a decrease for the non-carrier group. Together with trends observed in the data, this finding suggests a need for greater attention to be given to the potential impact of predictive testing on the couple relationship. Offering couples pre-result relationship assessment and referral for couple therapy, if warranted, may enhance the quality of professional support during the predictive testing process.
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Affiliation(s)
- Fiona Richards
- Department of Clinical Genetics, The Children's Hospital at Westmead, LB 4001, Westmead NSW 2145, Sydney, Australia.
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30
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Decruyenaere M, Evers-Kiebooms G, Cloostermans T, Boogaerts A, Demyttenaere K, Dom R, Fryns JP. Predictive testing for Huntington's disease: relationship with partners after testing. Clin Genet 2003; 65:24-31. [PMID: 15032971 DOI: 10.1111/j..2004.00168.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study focuses on the partner relationship of tested persons, 5 years after their predictive test result for Huntington's disease (HD). We describe changes in marital status, quality of the relationship, and perceived changes in the relationship. Twenty-six carriers, 14 of their partners, 33 non-carriers, and 17 of their partners participated in the study. Qualitative and quantitative methods were used. For the majority of tested persons (about 70%), the marital status was unchanged 5 years post test. Overall, carriers rated the quality of the relationship higher than their partners did and they perceived more positive changes. Qualitative data show that a test result leading to changed roles may induce significant marital distress. Another consequence of the test may be the changes in dynamics in asymptomatic carrier couples. A pre-test discussion of the possible impact of the test result on the relationship should result in a better preparation for and more understanding of the reactions after testing. Counselling after testing should stimulate an open communication between partners with consideration of needs and anxieties of both partners.
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Affiliation(s)
- M Decruyenaere
- Psychosocial Genetics Unit, University of Leuven-Herestraat, Leuven, Belgium.
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31
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Doukas DJ. Genetics Providers and the Family Covenant: Connecting Individuals with Their Families. ACTA ACUST UNITED AC 2003; 7:315-21. [PMID: 15000808 DOI: 10.1089/109065703322783671] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As genetic testing becomes more commonplace, medicine will likely face both family and individual demands for access to, and control of, test result information. Past research has emphasized confidentiality concerns of the individual and contrasted these claims with the "need to know" by others to avoid harm. These confidentiality concerns, based on individual self-interest, are challenged by a singularly important aspect of genetic testing-familial responsibility. As patients are often motivated to obtain genetic testing by an array of "other-directed" considerations toward their own family (such as love, fiduciary responsibility, gratitude, etc.), an accounting of these concerns is warranted. Understanding the relevance of family relationships and obligations facilitates a fuller informed consent for genetic testing. Genetic counselors and geneticists engaging in genetic counseling can account for the concerns of both individuals and their families using the family covenant-a helpful, innovative model to address proactively boundaries of privacy and information sharing within the family. This model focuses on two areas of discussion: (1) the demarcation of the boundaries of confidentiality; and (2) the definition of "family." The family covenant helps genetics providers consider what information "should" be confidential, and with respect to whom.
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Affiliation(s)
- David J Doukas
- Department of Family Practice and Community Medicine, Center for Bioethics, University of Pennsylvania, Philadelphia, PA 19104, USA.
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32
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Binedell J, Soldan JR. Nonparticipation in Huntington's Disease Predictive Testing: Reasons for Caution in Interpreting Findings. J Genet Couns 2003; 6:419-32. [DOI: 10.1023/a:1025601010891] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Julia Binedell
- ; Institute of Medical Genetics; University of Wales College of Medicine; Heath Park, Cardiff CF4 4XN United Kingdom
| | - Jo R. Soldan
- Cardiff Community Health Care Trust; Whitchurch, Cardiff CF4 7XB United Kingdom
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McAllister M. Personal theories of inheritance, coping strategies, risk perception and engagement in hereditary non-polyposis colon cancer families offered genetic testing. Clin Genet 2003; 64:179-89. [PMID: 12919131 DOI: 10.1034/j.1399-0004.2003.00133.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
From the geneticist's (or 'genetic counsellor's') perspective, lay models of inheritance can be perceived as problematic because they might interfere with understanding and acceptance of the explanation of inheritance provided in genetic counselling. The work presented here forms part of a larger qualitative grounded-theory study where the aim was to develop theory that could explain variations in adjustment to genetic testing for hereditary non-polyposis colon cancer (HNPCC). Ten of the 29 individuals interviewed who were at 50% or 25% risk used a 'personal theory of inheritance' to justify or explain a belief that they did, or did not, carry the family mutation. Two others indicated that, as a coping strategy, they chose to believe themselves to be carriers. This article presents part of the theory of engagement that was constructed using this data, relating to the process of development of risk perception. The theory suggests that for some individuals, these beliefs can form part of a process of coping and coming to terms with risk. An exploration of these processes may help practitioners to better understand the complexity of risk perception in individuals at genetic risk for cancer, particularly those preparing for predictive test results. Further development and testing of the theory is discussed.
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Affiliation(s)
- M McAllister
- Center for Family Research, Faculty of Social and Political Sciences, University of Cambridge, Cambridge, UK.
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34
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Bluman LG, Rimer BK, Regan Sterba K, Lancaster J, Clark S, Borstelmann N, Iglehart JD, Winer EP. Attitudes, knowledge, risk perceptions and decision-making among women with breast and/or ovarian cancer considering testing for BRCA1 and BRCA2 and their spouses. Psychooncology 2003; 12:410-27. [PMID: 12833555 DOI: 10.1002/pon.653] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A limited number of studies have examined the involvement of spouses in the decision-making process for genetic testing as well as impact of the actual testing. This report presents data from 40 women with a personal history of breast and/or ovarian cancer who were considering genetic testing for BRCA1 and BRCA2 and their spouses. We examined knowledge and attitudes regarding genetic testing for breast cancer susceptibility, perceptions of the likelihood that their wives (the women) had a BRCA1 or BRCA2 mutation, pros and cons of genetic testing, spouses' satisfaction with their involvement in the decision-making process and additional resources they would find helpful. Knowledge about cancer genetics and genetic testing for BRCA1 and BCA2 was limited among both women and their spouses. Up to one-third of spouses indicated that they would like to avail themselves of additional sources of information about BRCA1 and BRCA2 testing. Most spouses indicated that they thought their wives had a mutation in BRCA1 or BRCA2 and that their wives' breast cancers would recur. Pros of genetic testing were emphasized more than cons among both parties. Overall, spouses were satisfied with their role in the decision-making process. Future interventions to improve the decision-making process regarding genetic testing for breast cancer susceptibility should be undertaken.
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Affiliation(s)
- Marion McAllister
- ; Centre for Family Research; University of Cambridge; Cambridge United Kingdom
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36
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Furr LA. Perceptions of genetics research as harmful to society: differences among samples of African-Americans and European-Americans. GENETIC TESTING 2002; 6:25-30. [PMID: 12180073 DOI: 10.1089/109065702760093889] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Genetics has the potential not only to find cures for diseases, but to possess the mechanisms to change the bio-social make-up of populations. A specific question that has arisen on this issue is how developments in genetic technology may intersect with existing race and ethnic relations. Evidence of the racialization of some genetic disorders has been demonstrated elsewhere. The purpose of this study is to compare and contrast African-American and European-American attitudes on the benefits of genetics research for society. Findings show that African-Americans were more likely to say genetics research is harmful for society. This relationship remained statistically significant after controls were introduced in a regression model. Demographic characteristics and self-rated knowledge of genetics had no effect on attitudes among African-Americans. A willingness to use genetic services correlated with favorable attitudes. Differences in social position may lead some groups to opposing interpretations and symbolic meanings of genetics. This may be true in the context of this study because the social meanings of genetics may be tainted by racialization, historical attempts at eugenics, and the potential abuse of genetics targeting groups partially defined by superficial genetic characteristics.
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Affiliation(s)
- L Allen Furr
- Department of Sociology and Clinical Research, Epidemiology and Statistics Training Program, University of Louisville, Louisville, KY 40292, USA.
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Frost S, Myers LB, Newman SP. Genetic screening for Alzheimer's disease: what factors predict intentions to take a test? Behav Med 2002; 27:101-9. [PMID: 11985183 DOI: 10.1080/08964280109595776] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors investigated factors that predict intention to take a genetic test for Alzheimer's disease (AD). The 449 men and women were surveyed in two groups: (a) those told that a positive result meant a 90% chance of developing AD (increased certainty) and (b) those told that a positive result meant a 50% chance of developing AD (decreased certainty). Participants completed measures of the Theory of Planned Behavior (TPB), anticipated regret, risk perception, likelihood of taking a genetic test for cancer, and AD risk factors. Just over 50% of the variance in intentions was related to TPB variables, likelihood of taking a genetic test for cancer, number of people the participants knew who had AD, experimental condition, and anticipated regret. The subjective norm was the strongest predictor of intention in the increased certainty group, whereas positive belief was the strongest predictor in the decreased certainty group.
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Affiliation(s)
- S Frost
- Department of Psychiatry and Behavioral Sciences, Royal Free University College Medical School in London, United Kingdom
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Braithwaite D, Sutton S, Steggles N. Intention to Participate in Predictive Genetic Testing for Hereditary Cancer: The Role of Attitude toward Uncertainty. Psychol Health 2002. [DOI: 10.1080/0887044021000054764] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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39
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Burson CM, Markey KR. Genetic counseling issues in predictive genetic testing for familial adult-onset neurologic diseases. Semin Pediatr Neurol 2001; 8:177-86. [PMID: 11575847 DOI: 10.1053/spen.2001.26451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Genetic counseling is important in any genetic testing situation in order to address the various issues related to obtaining a genetic diagnosis. Presymptomatic testing for adult-onset neurodegenerative disease, in particular, presents a complex counseling scenario. It is imperative to discuss the potential impact of test results on patients' family dynamics, insurability and employability, family planning, and future health in addition to ascertaining a complete understanding of recurrence, inheritance, and testing parameters. The Huntington disease presymptomatic testing protocol is well-defined and has been used for more than 10 years. These guidelines, which protect both patient and provider, can now be applied to other diseases as further presymptomatic testing capabilities are realized.
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Affiliation(s)
- C M Burson
- Hattie B. Munroe Center for Human Genetics, University of Nebraska Medical Center, Omaha 68198-5440, USA
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40
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Grosfeld FJ, Beemer FA, Lips CJ, Hendriks KS, ten Kroode HF. Parents' responses to disclosure of genetic test results of their children. AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 94:316-23. [PMID: 11038446 DOI: 10.1002/1096-8628(20001002)94:4<316::aid-ajmg10>3.0.co;2-n] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The psychological reactions of 22 parental couples and 3 single parents were investigated after disclosure of genetic test results of their children. The children were tested for the early-onset, monogenetic cancer disorder multiple endocrine neoplasia type 2. Participants came from 13 different families and were aged between 28 and 47 years. Parents who were informed that their child was a gene carrier reacted with resignation, showed moderate to high levels of test-related and general anxiety, but few psychological complaints. Daily activities were disturbed in 43% of the parents with carrier-children. There was little disruption of the parents' future perspective, apart from some socioeconomic disadvantages and increased parental concern for the carrier-children. Most parents with carrier-children showed restraint with respect to short-term prophylactic treatment. Parents with favorable test results showed significantly less anxiety and no disturbance in their daily activities. They did not, however, seem to be reassured by the DNA test result. These parents questioned the reliability of the DNA test, wanted confirmation of the test results, and were eager to continue screening of their noncarrier children. Parents, especially those with a lower level of education and/or a pessimistic view of the future, were distressed by unfavorable test results. Additional counseling is advised to prevent parents of carrier-children worrying unnecessarily, or parents with children in whom the disease gene was not found being not reassured. Am. J. Med. Genet. 94:316-323, 2000.
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Affiliation(s)
- F J Grosfeld
- University Medical Center, Utrecht, The Netherlands.
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41
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Aktan-Collan K, Mecklin JP, de la Chapelle A, Peltomäki P, Uutela A, Kääriäinen H. Evaluation of a counselling protocol for predictive genetic testing for hereditary non-polyposis colorectal cancer. J Med Genet 2000; 37:108-13. [PMID: 10662810 PMCID: PMC1734517 DOI: 10.1136/jmg.37.2.108] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the feasibility of a reduced counselling programme for predictive genetic testing for hereditary non-polyposis colorectal cancer (HNPCC) in terms of counsellees' opinions on the extent and significance of genetic counselling and need for psychological support at different phases of the testing procedure. DESIGN Prospective follow up study with pre-test questionnaire assessment of background sociodemographic variables. The protocol comprised a pre-test counselling session, a period for reflection, and a test disclosure session. The outcome variables were studied by post-test questionnaires at one month and one year follow up. SUBJECTS Two hundred and seventy one high risk members of 36 families with HNPCC who attended both counselling sessions and completed the questionnaires. RESULTS The pre-test counselling was considered fairly or very useful by 89% of respondents and one post-test session was considered sufficient by over 80% of respondents at follow up. Fifty three percent would have used extra psychological support had it been offered with the counselling. On enquiry one year after receiving the test result, only 2% stated that the need for support was at its greatest at that time, while the majority (46%) reported that the need for support had been greatest at the moment of test disclosure. CONCLUSIONS A protocol that includes one comprehensive pre-test counselling session and a test disclosure session, supplemented with the option of professional psychological support, seems to be sufficient for both the educational and supportive needs of counsellees. Only a minority expressed a need for post-test follow up sessions, which suggests that, in this disorder, resources can be directed to the beneficial surveillance programmes rather than to extensive psychological support.
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Affiliation(s)
- K Aktan-Collan
- Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland
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42
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Aktan-Collan K, Mecklin JP, Järvinen H, Nyström-Lahti M, Peltomäki P, Söderling I, Uutela A, de la Chapelle A, Kääriäinen H. Predictive genetic testing for hereditary non-polyposis colorectal cancer: Uptake and long-term satisfaction. Int J Cancer 2000. [DOI: 10.1002/(sici)1097-0215(20000120)89:1<44::aid-ijc8>3.0.co;2-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lodder L, Frets PG, Trijsburg RW, Meijers-Heijboer EJ, Klijn JG, Duivenvoorden HJ, Tibben A, Wagner A, van der Meer CA, van den Ouweland AM, Niermeijer MF. Psychological impact of receiving aBRCA1/BRCA2 test result. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1096-8628(20010101)98:1<15::aid-ajmg1014>3.0.co;2-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Shaw C, Abrams K, Marteau TM. Psychological impact of predicting individuals' risks of illness: a systematic review. Soc Sci Med 1999; 49:1571-98. [PMID: 10574231 DOI: 10.1016/s0277-9536(99)00244-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this review is to determine the frequency and circumstances under which predicting individuals' risk of illness has adverse psychological effects. Using systematic review methodology, the literature was searched for studies that had assessed the adverse psychological outcomes of risk assessment programmes. The outcomes investigated are emotional (anxiety, depression, distress) cognitive (intrusive thoughts, perceptions of health) and behaviour (work absenteeism). The impact of both positive and negative test results are summarised in terms of the number of studies showing significant effects between and within groups in the short (one month or less) and longer term (more than one month). Where sufficient data were available, a meta-analysis was conducted to assess effect size. Fifty-four studies met the criteria for inclusion. The studies assessed the impact of informing individuals about cardiovascular risk (21), risk of AIDS (eight), risk of cancer (10), risk of Huntington's disease (10), risk of diabetes (two), risk of spinocerebellar ataxia (one) and risk of osteoporosis (two). Overall, the quality of studies assessed was limited, with only two using a randomised design to determine the psychological impact of risk assessment. Receiving a positive test result was associated in the short term in the great majority of studies with depression, anxiety, poorer perceptions of health and psychological distress. Data were available for a quantitative synthesis of results on three outcomes, anxiety, depression and distress. Anxiety and depression were significantly higher in those tested positive compared with those tested negative in the short term but not the longer term. Distress could only be assessed in the longer term: there was no evidence of an increase for those receiving positive test results. The five experimental studies that reported interventions aimed at preventing some of these adverse effects all reported favourable results. There was little evidence of any adverse psychological effects of receiving an unfavourable test result. Adverse psychological effects are a common immediate consequence of positive test results following risk assessment. Results from the few experimental studies reviewed suggest that these adverse outcomes should not be seen as inevitable.
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Affiliation(s)
- C Shaw
- Department of Epidemiology and Public Health, University of Leicester, UK
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45
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Maat-Kievit A, Vegter-van der Vlis M, Zoeteweij M, Losekoot M, van Haeringen A, Kanhai H, Roos R. Experience in prenatal testing for Huntington's disease in The Netherlands: procedures, results and guidelines (1987-1997). Prenat Diagn 1999. [DOI: 10.1002/(sici)1097-0223(199905)19:5<450::aid-pd568>3.0.co;2-l] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cho MK, Sankar P, Wolpe PR, Godmilow L. Commercialization of BRCA1/2 testing: practitioner awareness and use of a new genetic test. AMERICAN JOURNAL OF MEDICAL GENETICS 1999; 83:157-63. [PMID: 10096590 PMCID: PMC2225442 DOI: 10.1002/(sici)1096-8628(19990319)83:3<157::aid-ajmg4>3.0.co;2-g] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It was our purpose to determine the characteristics of practitioners in the United States who were among the first to inquire about and use the BRCA1 and BRCA2 (BRCA1/2) genetic tests outside of a research protocol. Questionnaires were mailed to all practitioners who requested information on or ordered a BRCA1/2 test from the University of Pennsylvania (UPenn) Genetic Diagnostics Laboratory (GDL) between October 1, 1995 and January 1, 1997 (the first 15 months the test was available for clinical use). The response rate was 67% of practitioners; 54% (121/225) were genetic counselors, 39% (87/225) were physicians or lab directors. Most physicians were oncologists, pathologists, or obstetrician/gynecologists, but 20% practiced surgery or internal or general medicine. Fifty-six percent (125/225) had ordered a BRCA1/2 test for a patient; most of the rest had offered or were willing to offer testing. Of those who had offered testing, 70% had a patient decline BRCA1/2 testing when offered. Practitioners perceived that patients' fear of loss of confidentiality was a major reason for declining. Nearly 60% of practitioners reported that their patients had access to a genetic counselor, but 28% of physicians who ordered a BRCA1/2 test reported having no such access, despite the GDL's counseling requirement. The proportion of physicians reporting no access to genetic counselors for their patients increased from 22.4% in the first half of the study to 50% in the last half. Many practitioners have an interest in BRCA1/2 testing, despite policy statements that discourage its use outside of research protocols. Practitioner responses suggest that patient interest in testing seems to be tempered by knowledge of potential risks. An apparent increase in patient concern about confidentiality and inability to pay for testing could indicate growing barriers to testing. Although most practitioners reported having access to counseling facilities, perceived lack of such access among an increasing proportion of practitioners indicates that lab requirements for counseling are difficult to enforce and suggests that an increasing proportion of patients may not be getting access to counseling.
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Affiliation(s)
- M K Cho
- Center for Biomedical Ethics, Stanford University School of Medicine, California, USA
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47
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Evers-Kiebooms G, Decruyenaere M. Predictive testing for Huntington's disease: a challenge for persons at risk and for professionals. PATIENT EDUCATION AND COUNSELING 1998; 35:15-26. [PMID: 9832893 DOI: 10.1016/s0738-3991(98)00086-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
About a decade ago the introduction of predictive testing for Huntington's disease (HD) was an important milestone in medical history. The aim of the present paper concerning predictive DNA-testing for HD is fourfold. First of all it describes the professional challenge of elaborating an adequate test protocol and of permanently using a multidisciplinary approach to deal with predictive test requests. Secondly the paper is aimed at unraveling the factors that play a part in uptake and decision making regarding predictive testing. Hereby the Health Belief Model is used as a framework for understanding differences between tested and untested persons. Thirdly the impact of the test result on psychological well-being is reviewed. Finally this paper assesses the utilisation of prenatal diagnosis after predictive testing for HD and reflects on the psychological and ethical implications of different types of prenatal tests, including preimplantation genetic diagnosis.
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Affiliation(s)
- G Evers-Kiebooms
- Psychosocial Genetics Unit, Center for Human Genetics, University Hospital Gasthuisberg, Leuven, Belgium.
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Dudok deWit AC, Duivenvoorden HJ, Passchier J, Niermeijer MF, Tibben A. Course of distress experienced by persons at risk for an autosomal dominant inheritable disorder participating in a predictive testing program: an explorative study. Rotterdam/Leiden Genetics Workgroup. Psychosom Med 1998; 60:543-9. [PMID: 9773756 DOI: 10.1097/00006842-199809000-00005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the effects of predictive DNA testing on participants at risk for either Huntington disease (HD), or familial adenomatous polyposis (FAP), or hereditary breast and ovarian cancer (HBOC). METHOD Psychological distress was measured with the Impact of Event Scale before testing and at 1 week and 6 months after the test result, in individuals at 50% risk for either HD (N = 25), FAP (N = 23), or HBOC (N = 10). RESULTS A marginally significant trend was found indicating that carriers of the disease genes tended to show unchanged levels of distress during the study period whereas noncarriers showed the expected decrease. Men reported significantly less distress than women, and 1 week after the test result male noncarriers showed a sharp significant increase in the reported distress followed by a steady decline up to 6 months later. CONCLUSIONS The course of distress over time reported by carriers and noncarriers of the three disease genes was similar, which leads one to conclude that the previous experience with predictive testing for Huntington Disease may be a useful paradigm. However, those formerly at risk for HD reported more distress than those at risk for FAP and HBOC. From our clinical experience we learned that individuals at risk for FAP and HBOC are more inclined to ward off the emotions involved. Additional qualitative studies should be undertaken to investigate this.
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Affiliation(s)
- A C Dudok deWit
- Department of Medical Psychology, Erasmus University Rotterdam, The Netherlands.
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DudokdeWit AC, Tibben A, Duivenvoorden HJ, Niermeijer MF, Passchier J. Predicting adaptation to presymptomatic DNA testing for late onset disorders: who will experience distress? Rotterdam Leiden Genetics Workgroup. J Med Genet 1998; 35:745-54. [PMID: 9733033 PMCID: PMC1051427 DOI: 10.1136/jmg.35.9.745] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The first comparative study on predicting post-test distress (conceptualised by intrusion and avoidance, measured with the Impact of Event Scale) after presymptomatic genetic testing for Huntington's disease (HD, n=25), cancer syndromes (familial adenomatous polyposis (FAP, n=23)), and hereditary breast and ovarian cancer (HBOC, n=10) is reported. The variables with the highest predictive potential of post-test distress are presented. Participants who were depressed before the test were more distressed after testing, but we found that those who were anxious before the test were less distressed, that is, had less intrusive thoughts post-test. Other factors associated with a higher level of post-test intrusion were gender (being a woman), having children, and pre-test intrusion. Religion and being at risk for HBOC were associated with less post-test intrusion. Participants who showed avoidance behaviour before the test and those who had many people available for support showed more avoidance behaviour post-test. The test result did not additionally contribute to post-test distress. The prima facie simple notion that the test result, as such, determines the distress experienced seems to be a misrepresentation of the complex reality.
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Affiliation(s)
- A C DudokdeWit
- Department of Medical Psychology and Psychotherapy, Erasmus University Rotterdam, The Netherlands
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50
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Marteau TM, Croyle RT. The new genetics. Psychological responses to genetic testing. BMJ (CLINICAL RESEARCH ED.) 1998; 316:693-6. [PMID: 9522800 PMCID: PMC1112686 DOI: 10.1136/bmj.316.7132.693] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- T M Marteau
- Psychology and Genetics Research Group, United Medical School, Guy's Hospital, London
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