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Kay AC, Wells J, Hallowell N, Goriely A. Providing recurrence risk counselling for parents after diagnosis of a serious genetic condition caused by an apparently de novo mutation in their child: a qualitative investigation of the PREGCARE strategy with UK clinical genetics practitioners. J Med Genet 2023; 60:925-931. [PMID: 36931705 PMCID: PMC10447403 DOI: 10.1136/jmg-2023-109183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Diagnosis of a child with a genetic condition leads to parents asking whether there is a risk the condition could occur again with future pregnancies. If the cause is identified as an apparent de novo mutation (DNM), couples are currently given a generic, population average, recurrence risk of ~1%-2%, depending on the condition. Although DNMs usually arise as one-off events, they can also originate through the process of mosaicism in either parent; in this instance, the DNM is present in multiple germ cells and the actual recurrence risk could theoretically be as high as 50%. METHODS Our qualitative interview study examined the views and reflections on current practice provided by UK practitioners working in clinical genetics (n=20) regarding the potential impact of PREcision Genetic Counselling And REproduction (PREGCARE)-a new preconception personalised recurrence risk assessment strategy. RESULTS Those interviewed regarded PREGCARE as a very useful addition to risk management, especially for cases where it revised the risk downwards or clarified that a couple's personalised recurrence risk meets National Health Service thresholds for non-invasive prenatal testing, otherwise inaccessible based on the generic DNM recurrence risk. CONCLUSION Participants said it could release some couples requiring reassurance from undergoing unnecessary invasive testing in future pregnancies. However, they regarded mosaicism and PREGCARE as complex concepts to communicate, requiring further training and additional appointment time for pre-test genetic counselling to prepare couples for all the possible outcomes of a personalised risk assessment, including potentially identifying the parental origin of the DNM, and to ensure informed consent.
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Affiliation(s)
- Alison C Kay
- MRC-Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jonathan Wells
- MRC-Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nina Hallowell
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Goriely
- MRC-Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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2
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Saelaert M, Mertes H, Moerenhout T, Van Cauwenbergh C, Leroy BP, Devisch I, De Baere E. A qualitative study among patients with an inherited retinal disease on the meaning of genomic unsolicited findings. Sci Rep 2021; 11:15834. [PMID: 34349199 PMCID: PMC8339116 DOI: 10.1038/s41598-021-95258-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/05/2021] [Indexed: 12/30/2022] Open
Abstract
Exome-based testing for genetic diseases can reveal unsolicited findings (UFs), i.e. predispositions for diseases that exceed the diagnostic question. Knowledge of patients’ interpretation of possible UFs and of motives for (not) wanting to know UFs is still limited. This lacking knowledge may impede effective counselling that meets patients’ needs. Therefore, this article examines the meaning of UFs from a patient perspective. A qualitative study was conducted and an interpretative phenomenological analysis was made of 14 interviews with patients with an inherited retinal disease. Patients assign a complex meaning to UFs, including three main components. The first component focuses on result-specific qualities, i.e. the characteristics of an UF (inclusive of actionability, penetrance, severity and age of onset) and the consequences of disclosure; the second component applies to a patient’s lived illness experiences and to the way these contrast with reflections on presymptomatic UFs; the third component addresses a patient’s family embedding and its effect on concerns about disease prognosis and genetic information’s family relevance. The complex meaning structure of UFs suggests the need for counselling procedures that transcend a strictly clinical approach. Counselling should be personalised and consider patients’ lived illness experiences and family context.
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Affiliation(s)
- Marlies Saelaert
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium.
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Tania Moerenhout
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium.,Bioethics Centre, University of Otago, Dunedin, New Zealand.,Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Caroline Van Cauwenbergh
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Bart P Leroy
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium.,Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium.,Division of Ophthalmology & Center for Cellular & Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
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Beck AT, Sutton EJ, Chow CPY, Curtis SH, Kullo IJ, Sharp RR. "Who Doesn't Like Receiving Good News?" Perspectives of Individuals Who Received Genomic Screening Results by Mail. J Pers Med 2021; 11:jpm11050322. [PMID: 33919001 PMCID: PMC8142970 DOI: 10.3390/jpm11050322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
As genomic sequencing expands to screen larger numbers of individuals, offering genetic counseling to everyone may not be possible. One approach to managing this limitation is for a genetic counselor to communicate clinically actionable results in person or by telephone, but report other results by mail. We employed this approach in a large genomic implementation study. In this paper, we describe participants' experiences receiving genomic screening results by mail. We conducted 50 semi-structured telephone interviews with individuals who received neutral genomic screening results by mail. Most participants were satisfied receiving neutral results by mail. Participants generally had a good understanding of results; however, a few participants had misunderstandings about their genomic screening results, including mistaken beliefs about their disease risk and the comprehensiveness of the test. No one reported plans to alter health behaviors, defer medical evaluations, or take other actions that might be considered medically problematic. Reporting neutral results by mail is unlikely to cause recipients distress or generate misunderstandings that may result in reduced vigilance in following recommended preventive health strategies. Nonetheless, some individuals may benefit from additional genetic counseling support to help situate their results in the context of personal concerns and illness experiences.
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Affiliation(s)
- Annika T. Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Erica J. Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Carolyn P. Y. Chow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Susan H. Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Iftikhar J. Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA;
| | - Richard R. Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55901, USA
- Correspondence:
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4
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Kollmann J, Nussbeck FW, Lages NC, Debbeler LJ, Schupp HT, Renner B. Lack of reassurance after unexpected positive health risk feedback - an analysis of temporal dynamics. Health Psychol Behav Med 2021; 9:322-337. [PMID: 34104563 PMCID: PMC8159202 DOI: 10.1080/21642850.2021.1913168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION How do people receive unexpected positive health risk information? While common motivational accounts predict acceptance, consistency accounts such as the cue-adaptive reasoning account (CARA) predict a 'lack of reassurance'. OBJECTIVES We therefore tested (1) whether people prefer striving for positivity or retaining a sense of self-consistency ('lack of reassurance'), and (2) if there are systematic differences in short- and long-term reception, which would indicate temporal dynamics in processing. METHODS As part of a longitudinal cohort study, participants of a community health screening (N = 1,055) received their actual cholesterol readings. Feedback reception was assessed immediately, at one month and six months. RESULTS Processing trajectories for unexpected positive feedback showed a significant 'lack of reassurance' effect over time compared with expected positive feedback, while unexpected negative feedback was less threatening than expected negative feedback. CONCLUSIONS The perseverance of this 'lack of reassurance' over time indicates that striving for consistency in self-views is a robust phenomenon, even if it means forfeiting a better view of one's own health.
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Affiliation(s)
- Josianne Kollmann
- Department of Psychology, Psychological Assessment & Health Psychology, University of KonstanzKonstanz, Germany
| | - Fridtjof W. Nussbeck
- Department of Psychology, Methods for Intensive Data in Psychology, University of Konstanz, Konstanz, Germany
| | - Nadine C. Lages
- Department of Psychology, Psychological Assessment & Health Psychology, University of KonstanzKonstanz, Germany
| | - Luka J. Debbeler
- Department of Psychology, Psychological Assessment & Health Psychology, University of KonstanzKonstanz, Germany
| | - Harald T. Schupp
- Department of Psychology, General & Biological Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Department of Psychology, Psychological Assessment & Health Psychology, University of KonstanzKonstanz, Germany
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5
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Development and validation of a measure of comprehension of genomic screening-negative results (CoG-NR). Eur J Hum Genet 2020; 28:1394-1402. [PMID: 32457518 PMCID: PMC7608237 DOI: 10.1038/s41431-020-0657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 11/18/2022] Open
Abstract
To realize the promise of population genomic screening for rare medically actionable conditions, critical challenges in the return of normal/negative results must be understood and overcome. Our study objective was to assess the functioning of a new 13-item measure (CoG-NR) of understanding of and knowledge about normal/negative genomic screening results for three highly actionable conditions: Lynch Syndrome, Hereditary Breast and Ovarian Cancer, and Familial Hypercholesterolemia. Based on our prior research and expert review, we developed CoG-NR and tested how well it functioned using hypothetical scenarios in three Qualtrics surveys. We report on its psychometric properties and performance across the three different conditions. The measure performed similarly for the three conditions. Examinations of item difficulty, internal reliability, and differential item functioning indicate that the items perform well, with statistically significant positive correlations with genomic knowledge, health literacy, and objective numeracy. CoG-NR assesses understanding of normal/negative results for each of the conditions. The next step is to examine its performance among individuals who have actually undergone such tests, and subsequent use in clinical or research situations. The CoG-NR measure holds great promise as a tool to enhance benefits of population genomic screening by bringing to light the prevalence of incorrect interpretation of negative results.
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6
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McBride CM, Guan Y, Hay JL. Regarding the Yin and Yang of Precision Cancer- Screening and Treatment: Are We Creating a Neglected Majority? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4168. [PMID: 31671746 PMCID: PMC6862105 DOI: 10.3390/ijerph16214168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022]
Abstract
In this commentary, we submit that the current emphasis of precision cancer screening and treatment (PCST) has been to provide and interpret the implications of "positive" screening results for those deemed to be at greatest risk for cancer or most likely to benefit from targeted treatments. This is an important, but proportionately small target group, regardless of the cancer context. Overlooked by this focus is the larger majority of those screened who receive "negative" results. We contend that for optimal dissemination of PCST, the complement of positive and negative results be viewed as an inseparable yin-yang duality with the needs of those who receive negative screening results viewed as important as those deemed to be at highest risk or derive targeted treatment benefit. We describe three areas where communication of negative PCST results warrant particular attention and research consideration: population-based family history screening, germline testing for hereditary cancer syndromes, and tumor testing for targeted cancer treatment decision-making. Without thoughtful consideration of the potential for negative results to have psychological and behavioral influences, there is a potential to create a "neglected majority". This majority may be inclined to misinterpret results, disseminate inaccurate information to family, dismiss the credibility of results, or become disillusioned with existing medical treatments.
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Affiliation(s)
- Colleen M McBride
- Behavioral Science and Health Education Department, Rollins School of Public Health Emory University, Atlanta, GA 30322, USA.
| | - Yue Guan
- Behavioral Science and Health Education Department, Rollins School of Public Health Emory University, Atlanta, GA 30322, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, NY 10022, USA.
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Geraldi Gauci M. WASP (Write a Scientific Paper): Interpretative phenomenological analysis: Its attraction and relevance to the medical field. Early Hum Dev 2019; 133:52-56. [PMID: 30975485 DOI: 10.1016/j.earlhumdev.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper describes the use of Interpretative Phenomenological Analysis (IPA) in qualitative research and its adaptability to medical research. Whilst presenting the main tenets of the approach, it also highlights its' strengths in helping medical professionals gain rich information about their service users' needs, symptoms and experiences, via research. It discusses the application of IPA on various levels such as by contextualising quantitative data or gaining insight into patients' understanding of clinical guidelines. The paper also describes methodological choices of the approach and the reasoning behind them. It outlines the sample, data collection tools and method of analysis utilised in IPA. To help researchers locate the particular use of this approach on the qualitative research landscape, this paper also compares its' use to that of other qualitative approaches. Finally, it discusses ways of evaluating IPA studies and hence, to ensure that such studies respect the philosophical roots of qualitative research in general, and those of IPA in particular.
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8
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Antoine P, Smith J. Saisir l’expérience : présentation de l’analyse phénoménologique interprétative comme méthodologie qualitative en psychologie. PSYCHOLOGIE FRANCAISE 2017. [DOI: 10.1016/j.psfr.2016.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Michie S, Lester K, Pinto J, Marteau TM. Communicating Risk Information in Genetic Counseling: An Observational Study. HEALTH EDUCATION & BEHAVIOR 2016; 32:589-98. [PMID: 16148206 DOI: 10.1177/1090198105278562] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study investigates risk communication within genetic counselling. Transcripts of 115 U.K. genetic consultations were reliably coded into form of risk expression used, whether the patient responded with understanding and agreement or showed signs of misunderstanding or disagreement, or did not respond at all, and whether clinicians assessed patient comprehension. Of the 492 risk expressions used, 53% were words and 47% were numbers (32% probabilities and 15% percentages). There was no association between form of risk expression and response. Clinicians assessed comprehension on only 25% of occasions, less often following the use of words than numbers, and on only 9% of occasions when there was no response to their risk communication. Because patients did not respond to 43% of risk communications, there is a concern that patients may make decisions without understanding the risks involved.
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Affiliation(s)
- Susan Michie
- Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, London.
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10
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Abstract
Identification of a potential genetic susceptibility to cancer and confirmation of a pathogenic gene mutation raises a number of challenging issues for the patient with cancer, their relatives and the health professionals caring for them. The specific risks and management issues associated with rare cancer types have been addressed in the earlier chapters. This chapter considers the wider issues involved in genetic counselling and genetic testing for a genetic susceptibility to cancer for patients, families and health professionals. The first part of the chapter will present the issues raised by the current practice in genetic counselling and genetic testing for cancer susceptibility. The second part of the chapter will address some of the issues raised by the advances in genetic testing technology and the future opportunities provided by personalised medicine and targeted cancer therapy. Facilitating these developments requires closer integration of genomics into mainstream cancer care, challenging the existing paradigm of genetic medicine, adding additional layers of complexity to the risk assessment and management of cancer and presenting wider issues for patients, families, health professionals and clinical services.
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Affiliation(s)
- Chris Jacobs
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- University College London, London, UK.
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11
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Fay V, Thomas S, Slade P. Maternal-fetal medicine specialists' experiences of conducting feticide as part of termination of pregnancy: a qualitative study. Prenat Diagn 2015; 36:92-9. [DOI: 10.1002/pd.4720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/16/2015] [Accepted: 10/29/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Vanessa Fay
- Department of Clinical Psychology (Complex Cases, Central); Gaskell House; Manchester UK
| | - Sophie Thomas
- Department of Clinical Psychology and Neuropsychology; Queens Medical Centre; Nottingham UK
| | - Pauline Slade
- Department of Clinical Psychology - Ground Floor Whelan Building; University of Liverpool; Liverpool UK
- Department of Psychological Sciences, Institute of Psychology, Health and Society; University of Liverpool; Liverpool UK
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12
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Albada A, van Dulmen S, Dijkstra H, Wieffer I, Witkamp A, Ausems MGEM. Counselees' Expressed Level of Understanding of the Risk Estimate and Surveillance Recommendation are Not Associated with Breast Cancer Surveillance Adherence. J Genet Couns 2015; 25:279-89. [PMID: 26321750 PMCID: PMC4799246 DOI: 10.1007/s10897-015-9869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
We studied counselees’ expressed understanding of the risk estimate and surveillance recommendation in the final consultation for breast cancer genetic counseling in relation with their risk perception, worry and cancer surveillance adherence 1 year post-counseling. Consecutive counselees were included from 2008 to 2010. Counselees with an indication for diagnostic DNA-testing for themselves or a breast cancer affected relative were requested to complete online questionnaires before and after counseling and one year after counseling (N = 152–124). Self-reported surveillance was compared to surveillance recommendations. Consultations were videotaped. Counselees’ reactions to the risks and recommendations were coded. Statements about the risk perception and surveillance intentions of breast cancer unaffected counselees were transcribed. Associations with outcomes were explored. Almost all breast cancer unaffected counselees (>90 %) reacted to their risk estimate with an utterance indicating understanding and this reaction was not significantly associated with their post-visit risk perception alignment. Over one-third (38.6 %) overestimated their risk post-counseling. Few counselees (5.8 %) expressed surveillance intentions. One year after counseling, about three-quarters (74.0 %) of the breast cancer unaffected counselees had adhered to the surveillance recommendation. Almost one-quarter (23.3 %) had performed more mammograms/MRI scans than recommended, which was associated with prior mammography uptake (n = 47; X2 = 5.2; p = .02). Counselees’ post-counseling overestimation of their risk, high levels of worry and high surveillance uptake were not reflected in their reactions to the counselor’s information during the final visit.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Henrietta Dijkstra
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ivette Wieffer
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arjen Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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13
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Knight SJ, Mohamed AF, Marshall DA, Ladabaum U, Phillips KA, Walsh JME. Value of Genetic Testing for Hereditary Colorectal Cancer in a Probability-Based US Online Sample. Med Decis Making 2015; 35:734-744. [PMID: 25589525 PMCID: PMC4501912 DOI: 10.1177/0272989x14565820] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND . While choices about genetic testing are increasingly common for patients and families, and public opinion surveys suggest public interest in genomics, it is not known how adults from the general population value genetic testing for heritable conditions. We sought to understand in a US sample the relative value of the characteristics of genetic tests to identify risk of hereditary colorectal cancer, among the first genomic applications with evidence to support its translation to clinical settings. METHODS . A Web-enabled choice-format conjoint survey was conducted with adults age 50 years and older from a probability-based US panel. Participants were asked to make a series of choices between 2 hypothetical blood tests that differed in risk of false-negative test, privacy, and cost. Random parameters logit models were used to estimate preferences, the dollar value of genetic information, and intent to have genetic testing. RESULTS . A total of 355 individuals completed choice-format questions. Cost and privacy were more highly valued than reducing the chance of a false-negative result. Most (97% [95% confidence interval (CI)], 95%-99%) would have genetic testing to reduce the risk of dying of colorectal cancer in the best scenario (no false negatives, results disclosed to primary care physician). Only 41% (95% CI, 25%-57%) would have genetic testing in the worst case (20% false negatives, results disclosed to insurance company). CONCLUSIONS . Given the characteristics and levels included in the choice, if false-negative test results are unlikely and results are shared with a primary care physician, the majority would have genetic testing. As genomic services become widely available, primary care professionals will need to be increasingly knowledgeable about genetic testing decisions.
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Affiliation(s)
- Sara J. Knight
- Health Services Research and Development Program, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ateesha F. Mohamed
- CHEOR, Specialty Medicine, Bayer Healthcare Pharmaceuticals Inc., Whippany, New Jersey, United States
| | - Deborah A. Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Uri Ladabaum
- Department of Medicine, Stanford University, Palo Alto, California, United States
| | - Kathryn A. Phillips
- Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States
| | - Judith M. E. Walsh
- Departments of Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States
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14
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Esplen MJ, Wong J, Aronson M, Butler K, Rothenmund H, Semotiuk K, Madlensky L, Way C, Dicks E, Green J, Gallinger S. Long-term psychosocial and behavioral adjustment in individuals receiving genetic test results in Lynch syndrome. Clin Genet 2015; 87:525-32. [PMID: 25297893 PMCID: PMC4391982 DOI: 10.1111/cge.12509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/19/2014] [Accepted: 09/23/2014] [Indexed: 11/29/2022]
Abstract
A cross-sectional study of 155 participants who underwent genetic testing for Lynch syndrome (LS) examined long-term psychosocial and behavioral outcomes. Participants completed standardized measures of perceived risk, psychosocial functioning, knowledge, and a questionnaire of screening activities. Participants were on average 47.3 years and had undergone testing a mean of 5.5 years prior. Eighty four (54%) tested positive for a LS mutation and 71 (46%) negative. For unaffected carriers, perceived lifetime risk of colorectal cancer was 68%, and surprisingly, 40% among those testing negative. Most individuals demonstrated normative levels of psychosocial functioning. However, 25% of those testing negative had moderate depressive symptoms, as measured by the Center for Epidemiologic Studies for Depression Scale, and 31% elevated state anxiety on the State-Trait Anxiety Inventory. Being female and a stronger escape - avoidant coping style were predictive of depressive symptoms. For state anxiety, similar patterns were observed. Quality of life and social support were significantly associated with lower anxiety. Carriers maintained higher knowledge compared to those testing negative, and were more engaged in screening. In summary, most individuals adapt to genetic test results over the long term and continue to engage in screening. A subgroup, including some non-carriers, may require added psychosocial support.
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Affiliation(s)
- M J Esplen
- University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; de Souza Institute, Toronto, Canada
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15
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Schuurman AG, van der Kolk DM, Verkerk MA, Birnie E, Ranchor AV, Plantinga M, van Langen IM. Maximising the efficiency of clinical screening programmes: balancing predictive genetic testing with a right not to know. Eur J Hum Genet 2015; 23:1124-8. [PMID: 25564039 PMCID: PMC4538217 DOI: 10.1038/ejhg.2014.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/02/2014] [Accepted: 10/31/2014] [Indexed: 01/22/2023] Open
Abstract
We explored the dilemma between patients' right not to know their genetic status and the efficient use of health-care resources in the form of clinical cancer screening programmes. Currently, in the Netherlands, 50% risk carriers of heritable cancer syndromes who choose not to know their genetic status have access to the same screening programmes as proven mutation carriers. This implies an inefficient use of health-care resources, because half of this group will not carry the familial mutation. At the moment, only a small number of patients are involved; however, the expanding possibilities for genetic risk profiling means this issue must be addressed because of potentially adverse societal and financial impact. The trade-off between patients' right not to know their genetic status and efficient use of health-care resources was discussed in six focus groups with health-care professionals and patients from three Dutch university hospitals. Professionals prefer patients to undergo a predictive DNA test as a prerequisite for entering cancer screening programmes. Professionals prioritise treating sick patients or proven mutation carriers over screening untested individuals. Participation in cancer screening programmes without prior DNA testing is, however, supported by most professionals, as testing is usually delayed and relatively few patients are involved at present. Reducing the number of 50% risk carriers undergoing screening is expected to be achieved by: offering more psychosocial support, explaining the iatrogenic risks of cancer screening, increasing out-of-pocket costs, and offering a less stringent screening programme for 50% risk carriers.
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Affiliation(s)
- Agnes G Schuurman
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dorina M van der Kolk
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marian A Verkerk
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mirjam Plantinga
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Irene M van Langen
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Cotton SC, Sharp L, Little J, Gray NM, Walker LG, Whynes DK, Cruickshank ME. A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology. Cytopathology 2014; 26:178-87. [DOI: 10.1111/cyt.12173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- S. C. Cotton
- Obstetrics & Gynaecology; University of Aberdeen; Foresterhill Aberdeen UK
| | - L. Sharp
- National Cancer Registry Ireland; Cork Ireland
| | - J. Little
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON Canada
| | - N. M. Gray
- Centre of Academic Primary Care; University of Aberdeen; Foresterhill Aberdeen UK
| | | | - D. K. Whynes
- School of Economics; University of Nottingham; Nottingham UK
| | - M. E. Cruickshank
- Obstetrics & Gynaecology; University of Aberdeen; Foresterhill Aberdeen UK
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17
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Albada A, Ausems MGEM, van Dulmen S. Counselee participation in follow-up breast cancer genetic counselling visits and associations with achievement of the preferred role, cognitive outcomes, risk perception alignment and perceived personal control. Soc Sci Med 2014; 116:178-86. [PMID: 25016325 DOI: 10.1016/j.socscimed.2014.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 06/02/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
The purpose of the study was to assess the counselee participation in the follow-up visits, compared to the first visits, for breast cancer genetic counselling and to explore associations with counselees' achievement of their preferred role in decision making, information recall, knowledge, risk perception alignment and perceived personal control. First and follow-up visits for breast cancer genetic counselling of 96 counselees of a Dutch genetics center were videotaped (2008-2010). Counselees completed questionnaires before counselling (T1), after the follow-up visit (T2) and one year after the follow-up visit (T3). Consultations were rated with the Roter Interaction Analysis System (RIAS). Counselee participation was measured as the percentage of counselee utterances, the percentage of counselee questions and the interactivity (number of turns per minute). Follow-up visits had higher levels of counselee participation than first visits as assessed by the percentage of counselee talk, the interactivity and counselee questions. More counselee talk in the follow-up visit was related to higher achievement of the preferred role (T2) and higher perceived personal control (T3). Higher interactivity in the follow-up visit was related to lower achievement of the preferred role in decision making and lower information recall (T2). There were no significant associations with the percentage of questions asked and none of the participation measures was related to knowledge, risk perception alignment and perceived personal control (T2). In line with the interviewing admonishment 'talk less and listen more', the only assessment of counselee participation associated to better outcomes is the percentage of counselee talk. High interactivity might be associated with lower recall in breast cancer genetic counselees who are generally highly educated. However, this study was limited by a small sample size and a heterogeneous group of counselees. Research is needed on the interactions causing interactivity and its relationships with involvement in decision making and recall.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, Buskerud University College, Drammen, Norway
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18
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Psychosocial consequences of predictive genetic testing for Lynch syndrome and associations to surveillance behaviour in a 7-year follow-up study. Fam Cancer 2014; 12:639-46. [PMID: 23512527 DOI: 10.1007/s10689-013-9628-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We evaluated long-term psychosocial consequences of predictive genetic testing, and surveillance behaviour in Lynch syndrome (LS). We conducted a longitudinal study of 208 participants (62 LS mutation carriers and 146 non-carriers) who provided information on general anxiety (State-Trait Anxiety Inventory), fear of cancer and dying, satisfaction with life, risk and test perceptions, and surveillance behaviour in the baseline questionnaire before testing, and 1 month, 1 year and 7 years post-test. At 7 years, most of the psychosocial variables remained unchanged, regardless of mutation status. Carriers tended to underestimate their colorectal cancer risk but were more worried about their cancer risk than their counterparts. Non-carriers reported a higher degree of satisfaction with their testing decisions (P < 0.05), but had more doubts concerning test result validity than carriers (P < 0.05). All carriers attended a post-test colonoscopy surveillance, while 16% of non-carriers reported colonoscopy examinations. Those non-carriers with doubts about test validity were more likely (P = 0.019) to report post-test colonoscopy. Of the carriers, 17% had an interval longer than 3 years between their colonoscopies. Fear of dying soon, measured at 1-month post-test follow-up was the only psychosocial variable predicting non-compliance in recommended surveillance. No adverse psychosocial consequences were detected, and respondents were satisfied with their decision to testing 7 years post-test. Among the carriers, solely fear of dying soon predicted non-compliance in recommended surveillance. Some non-carriers were still worried about their risk and had doubts about the validity of their genetic testing results predicting post-test colonoscopy.
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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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20
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Accuracy of recall of information about a cancer-predisposing BRCA1/2 gene mutation among patients and relatives. Eur J Hum Genet 2014; 23:147-51. [PMID: 24848747 DOI: 10.1038/ejhg.2014.84] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/11/2014] [Accepted: 03/18/2014] [Indexed: 11/09/2022] Open
Abstract
This observational study aimed to (i) compare the accuracy of information recalled by patients and relatives following genetic counselling about a newly identified BRCA1/2 mutation, (ii) identify differences in accuracy of information about genetics and hereditary cancer and (iii) investigate whether accuracy among relatives improved when information was provided directly by genetics health professionals. Semistructured interviews following results from consultations with 10 breast/ovarian cancer patients and 22 relatives were audio-recorded and transcribed. Information provided by the genetics health professional was tracked through the families and coded for accuracy. Accuracy was analysed using the Wilcoxon Signed-Ranks test. Sources of information were tested using Spearman's rank-order correlation coefficient. Fifty-three percent of the information recalled by patients was accurate. Accuracy of recall among relatives was significantly lower than that among patients (P=0.017). Both groups recalled a lower proportion of information about hereditary cancer than about genetics (P=0.005). Relatives who learnt the information from the patient alone recalled significantly less accurate information than those informed directly by genetics health professionals (P=0.001). Following genetic counselling about a BRCA1/2 mutation, accuracy of recall was low among patients and relatives, particularly about hereditary cancer. Multiple sources of information, including direct contact with genetics health professionals, may improve the accuracy of information among relatives.
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21
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Client Views and Attitudes to Non-Invasive Prenatal Diagnosis for Sickle Cell Disease, Thalassaemia and Cystic Fibrosis. J Genet Couns 2014; 23:1012-21. [DOI: 10.1007/s10897-014-9725-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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22
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O'Connor M, Costello L, Murphy J, Prendiville W, Martin CM, O'Leary JJ, Sharp L. 'I don't care whether it's HPV or ABC, I just want to know if I have cancer.' Factors influencing women's emotional responses to undergoing human papillomavirus testing in routine management in cervical screening: a qualitative study. BJOG 2014; 121:1421-9. [PMID: 24690225 DOI: 10.1111/1471-0528.12741] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore emotional responses, and predictors of negative reactions, among women undergoing human papillomavirus (HPV) tests in routine clinical practice. DESIGN Exploratory qualitative interview study. SETTING A large busy colposcopy clinic in a Dublin hospital. SAMPLE Twenty-seven women who had had an HPV DNA test in the previous 6 months following one or more low-grade cytology tests or treatment for cervical intraepithelial neoplasia (CIN). METHODS In-depth semi-structured interviews were conducted. Interview transcripts were analysed using a thematic approach (Framework Analysis). MAIN OUTCOME MEASURES Women's emotional responses and predictors of negative emotional reactions. RESULTS For most women, having a test for high-risk HPV types generated little negative or positive emotional impact. Adverse emotional responses related to HPV infection rather than testing. Factors that influenced whether women experienced negative emotional responses were: concerns over abnormal cytology or diagnosis of CIN; HPV knowledge; awareness of HPV being sexually transmitted; awareness of HPV prevalence; and HPV information needs. Women's concerns about abnormal cytology/CIN dominated all other issues. CONCLUSIONS These qualitative data suggest that in the context of follow up of abnormal cytology or treatment for CIN, the emotional impact of HPV testing may be modest: women's primary concerns at this time relate to abnormal cytology/CIN.
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Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
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23
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Eatough V, Santini H, Eiser C, Goller ML, Krysa W, de Nicola ‘A, Paduanello M, Petrollini M, Rakowicz M, Squitieri F, Tibben A, Lee Weille K, Landwehrmeyer B, Quarrell O, Smith JA. The personal experience of parenting a child with juvenile Huntington's disease: perceptions across Europe. Eur J Hum Genet 2013; 21:1042-8. [PMID: 23443023 PMCID: PMC3778352 DOI: 10.1038/ejhg.2013.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/30/2012] [Accepted: 01/16/2013] [Indexed: 11/09/2022] Open
Abstract
The study reported here presents a detailed description of what it is like to parent a child with juvenile Huntington's disease in families across four European countries. Its primary aim was to develop and extend findings from a previous UK study. The study recruited parents from four European countries: Holland, Italy, Poland and Sweden,. A secondary aim was to see the extent to which the findings from the UK study were repeated across Europe and the degree of commonality or divergence across the different countries. Fourteen parents who were the primary caregiver took part in a semistructured interview. These were analyzed using an established qualitative methodology, interpretative phenomenological analysis. Five analytic themes were derived from the analysis: the early signs of something wrong; parental understanding of juvenile Huntington's disease; living with the disease; other people's knowledge and understanding; and need for support. These are discussed in light of the considerable convergence between the experiences of families in the United Kingdom and elsewhere in Europe.
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Affiliation(s)
- Virginia Eatough
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | | | - Christine Eiser
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Wioletta Krysa
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Matteo Paduanello
- Department of Philosophy, Sociology, Education & Applied Psychology, University of Padova, Padova, Italy
| | | | - Maria Rakowicz
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Aad Tibben
- Centre for Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Oliver Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Jonathan A Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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24
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Theory development from studies with young women with breast cancer who are BRCA mutation negative. ANS Adv Nurs Sci 2013; 36:E41-53. [PMID: 23644270 DOI: 10.1097/ans.0b013e3182901ff1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Researchers and practitioners can use inductively derived theory to direct their research and practice. This article describes the ongoing development of a theory that can assist in explaining experiences of young women with breast cancer who have genetic testing for the BRCA mutation. Seventeen BRCA-negative women with breast cancer from a larger grounded theory study were interviewed. While receiving a negative BRCA mutation test result subsequent to a breast cancer diagnosis was described as a relief, the information was also confusing. The author's published Theory of Genetic Vulnerability is expanded to incorporate the outcomes of this analysis.
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25
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Thomassen G, Sarangi S. Evidence-based familial risk explanations in cancer genetic counselling. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2012.711813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Hilgart J, Mercer J, Thirlaway K. Individuals’ experiences of, and responses to, a negative genetic test result for familial hypercholesterolaemia. J Health Psychol 2012; 18:339-49. [DOI: 10.1177/1359105312443403] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to explore the responses of individuals who have undergone genetic testing for familial hypercholesterolaemia (FH) where no genetic mutation has been identified. Semi-structured interviews were conducted with 11 patients and interpretative phenomenological analysis (IPA) was employed. This article describes three inter-related themes: ‘feeling in limbo’, ‘exploring causes of raised cholesterol’ and ‘contradictions in talk about diet’. Although participants generally adhered to medication and engaged in healthy lifestyles, the findings have clinical implications for how genetic test results are communicated.
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27
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Cancelo Hidalgo M, López Parra M, Marcos González M, Muñoz Algar M, Cancelo Hidalgo C, Álvarez de los Heros J. Consejo genético en el cáncer de mama y ovario. ¿Y luego qué? Semergen 2011. [DOI: 10.1016/j.semerg.2011.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Distress and psychosocial needs of a heterogeneous high risk familial cancer population. J Genet Couns 2011; 20:249-69. [PMID: 21509653 DOI: 10.1007/s10897-010-9344-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 12/20/2010] [Indexed: 12/14/2022]
Abstract
In order to assess the levels of distress and psychosocial support needs of a high risk population, we undertook a study to look at both the objective and subjective levels of distress and the wants and needs of individuals from a high familial cancer risk population. Three hundred and eighteen individuals (160 affected, 158 unaffected) completed several distress and psychosocial needs questionnaires (including the Brief Symptom Inventory-18). Sixty key informants were also surveyed about their perspective on the support needs of this population. In the largely female (90%), largely HBOC syndrome group (approximately 90%), 20% had significant levels of generalized distress, with no significant differences between affected and unaffected individuals. Generalized distress was also not significantly different as a function of mutation status. Individuals who received inconclusive test results, however, were more likely to indicate somatic symptoms of distress. Those individuals who did not have social support were more likely to be those who had never had cancer and who either had a mutation, received inconclusive test results, or were not tested. Key informants were most likely to indicate that patients need more support. These results provide evidence for the importance of establishing regular psychosocial distress screening, including a focus on somatic symptoms, in such high risk populations.
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29
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Becker F, van El CG, Ibarreta D, Zika E, Hogarth S, Borry P, Cambon-Thomsen A, Cassiman JJ, Evers-Kiebooms G, Hodgson S, Janssens ACJW, Kaariainen H, Krawczak M, Kristoffersson U, Lubinski J, Patch C, Penchaszadeh VB, Read A, Rogowski W, Sequeiros J, Tranebjaerg L, van Langen IM, Wallace H, Zimmern R, Schmidtke J, Cornel MC. Genetic testing and common disorders in a public health framework: how to assess relevance and possibilities. Background Document to the ESHG recommendations on genetic testing and common disorders. Eur J Hum Genet 2011; 19 Suppl 1:S6-44. [PMID: 21412252 PMCID: PMC3327518 DOI: 10.1038/ejhg.2010.249] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Frauke Becker
- Hannover Medical School, Department of Human Genetics, Hannover, Germany
| | - Carla G van El
- Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Dolores Ibarreta
- IPTS Institute for Prospective Technological Studies, Joint Research Centre, European Commission, Seville, Spain
| | - Eleni Zika
- IPTS Institute for Prospective Technological Studies, Joint Research Centre, European Commission, Seville, Spain
| | - Stuart Hogarth
- Department of Social Sciences, Loughborough University, Loughborough, UK
| | - Pascal Borry
- Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Medical Humanities and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anne Cambon-Thomsen
- Inserm, U 558, Department of Epidemiology, Health Economics and Public Health, University Paul Sabatier, Toulouse, France
| | | | - Gerry Evers-Kiebooms
- Psychosocial Genetics Unit University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Shirley Hodgson
- Department of Clinical Genetics, St George's University of London, London, UK
| | - A Cécile J W Janssens
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Christian-Albrechts-Universität, Kiel, Germany
| | | | - Jan Lubinski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Andrew Read
- Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, UK
| | - Wolf Rogowski
- Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ludwig Maximilians University, Munich, Germany
| | - Jorge Sequeiros
- IBMC – Institute for Molecular and Cell Biology, and ICBAS, University of Porto, Porto, Portugal
| | - Lisbeth Tranebjaerg
- Department of Audiology, H:S Bispebjerg Hospital and Wilhelm Johannsen Centre of Functional Genomics, University of Copenhagen, Copenhagen, Denmark
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Helen Wallace
- GeneWatch UK, The Mill House, Tideswell, Derbyshire, UK
| | - Ron Zimmern
- PHG Foundation, Worts Causeway, Cambridge, UK
| | - Jörg Schmidtke
- Hannover Medical School, Department of Human Genetics, Hannover, Germany
| | - Martina C Cornel
- Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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30
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Hilgart J, Phelps C, Bennett P, Hood K, Brain K, Murray A. "I have always believed I was at high risk..." The role of expectation in emotional responses to the receipt of an average, moderate or high cancer genetic risk assessment result: a thematic analysis of free-text questionnaire comments. Fam Cancer 2010; 9:469-77. [PMID: 20119651 DOI: 10.1007/s10689-010-9324-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It is well-recognised that receipt of cancer genetic risk information can evoke a mix of both positive and negative emotional responses. Objective risk itself is not necessarily predictive of emotional response to receipt of risk information and the Cue Adaptive Reasoning Account (CARA; Renner, 2004) suggests that that the degree to which level of risk is consistent with expectations may influence emotional responses. This paper reports a thematic analysis of the free-text data structured around responses to the three risk labels: average, moderate or high. Data is reported from both 123 women and 15 men, including those with a past or current cancer diagnosis. Reactions to risk information appear to be dependent upon participants' pre-conceived expectations about their level of cancer risk. Many average risk respondents questioned the accuracy of their result, whereas high risk information was often expected. Findings are discussed in relation to the CARA model and clinical implications.
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Affiliation(s)
- J Hilgart
- Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, Wales, UK.
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31
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Smith JA, Dancyger C, Wallace M, Jacobs C, Michie S. The development of a methodology for examining the process of family communication of genetic test results. J Genet Couns 2010; 20:23-34. [PMID: 20835758 DOI: 10.1007/s10897-010-9317-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 07/23/2010] [Indexed: 11/26/2022]
Abstract
It is important to study communication processes in families where members are undergoing testing for genetic conditions because the information received from such testing is crucial not just to the individual concerned but also to other members of the biological family. This topic has received little research attention, in part because of the complexities of methodology required. In this paper we present the development of a method specifically designed for the examination of the content and process of communication of genetic information in families. The method aims to maximize ecological validity as far as is possible. We describe how participants and other family members are recruited and how data were collected. We outline three main data analytic strategies: a graphic to show how genetic information changes as it flows from clinic and through the family, an intensive qualitative analysis of the meaning and impact of the genetic information to different family members, and an informative genogram which plots key family dynamics. This method will be illustrated in relation to a study of ten family-groups where one individual has been found to carry a genetic mutation predisposing them to hereditary breast and ovarian cancer.
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Affiliation(s)
- Jonathan A Smith
- Department of Psychological Sciences, Birkbeck University of London, Malet St, London WC1E 7HX, UK.
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Macneela P, Gibbons A, McGuire B, Murphy A. "We need to get you focused": general practitioners' representations of chronic low back pain patients. QUALITATIVE HEALTH RESEARCH 2010; 20:977-986. [PMID: 20335499 DOI: 10.1177/1049732310364219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although subject to considerable research from perspectives including general practitioners, patients, and perspective guidelines, chronic low back pain (CLBP) continues to be a common but contentious condition in primary care. We used medical consultation records, critical incident interviews, and a think-aloud problem-solving task to examine how general practitioners applied professional knowledge of the condition, especially in relation to psychosocial care. Using qualitative content analysis and thematic analysis, we identified a pragmatic, goal-focused approach to patients, a schema based on biomedical knowledge and tacit theories of motivation. The doctors' expectations for CLBP included uncertainty over symptoms and doubts over patient credibility, which helped to explain an autonomous rather than collaborative approach to managing back pain patients. The findings are discussed in light of social representations theory, self-determination, and research on the therapeutic relationship.
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Levine FR, Coxworth JE, Stevenson DA, Tuohy T, Burt RW, Kinney AY. Parental attitudes, beliefs, and perceptions about genetic testing for FAP and colorectal cancer surveillance in minors. J Genet Couns 2010; 19:269-79. [PMID: 20195720 DOI: 10.1007/s10897-010-9285-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 02/09/2010] [Indexed: 12/12/2022]
Abstract
Familial adenomatous polyposis (FAP) is the second most common hereditary colorectal cancer syndrome and confers a nearly 100% lifetime risk of developing colorectal cancer. Understanding factors that facilitate and inhibit genetic testing and cancer surveillance in children who are members of families affected by FAP will better equip clinicians to clarify misunderstandings and facilitate appropriate care. The aims of this study were to examine parental attitudes and beliefs regarding endoscopic surveillance and genetic testing in minors at risk for developing FAP. This cross-sectional study includes analyses of qualitative and quantitative interview data collected from parents of children with or at risk for FAP. This report includes data from 28 parents with a total of 51 biological children between 10-17 years of age. The parents had a clinical and/or genetic diagnosis of FAP. Most commonly reported facilitators included provider recommendation (surveillance) and personalized medical management (genetic testing). Most commonly reported barriers included lack of provider recommendation (surveillance) and cost (genetic testing).
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Affiliation(s)
- Fallon R Levine
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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Douma KFL, Aaronson NK, Vasen HFA, Gerritsma MA, Gundy CM, Janssen EPA, Vriends AHJT, Cats A, Verhoef S, Bleiker EMA. Psychological distress and use of psychosocial support in familial adenomatous polyposis. Psychooncology 2010; 19:289-98. [DOI: 10.1002/pon.1570] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Shedlosky-Shoemaker R, Ngo TL, Ferketich AK, Porter K, Leventhal H, Kelly KM. Exploring perceptions of genetic testing: an examination of perceived accuracy over time. PATIENT EDUCATION AND COUNSELING 2010; 78:34-39. [PMID: 19553058 DOI: 10.1016/j.pec.2009.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 04/09/2009] [Accepted: 05/23/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Despite the potential impact of perceptions of genetic testing, little research has examined these perceptions. The current study examined factors associated with perceived accuracy of genetic testing to detect BRCA1/2 mutations and change in perceived accuracy. METHODS Participants were recruited through advertisements, community groups, and local oncologists and gynecologists. Ashkenazi Jewish patients (N=120) at increased risk for BRCA1/2 genetic mutations were surveyed in a repeated-measures design with assessments at three time points: pre-counseling, post-counseling, and post-testing. RESULTS Better knowledge of cancer genetics related to higher perceived accuracy before counseling. Lower perceived risk of developing ovarian cancer was associated with increased perceived accuracy, while greater distress regarding gene status was associated with decreased perceived accuracy. Genetic test results were unrelated to change in perceived accuracy. CONCLUSION The results offer an initial look at how patients form perceptions of genetic testing. Both cognitive factors and affective factors relate to how patients perceived the accuracy of testing and how their perception changes over time. PRACTICE IMPLICATIONS Understanding cognitive and affective factors which may impact patients' perceptions of genetic testing is important. Specifically, attention should be paid to educating patients regarding cancer genetics and encouraging adaptive coping strategies to deal with distress.
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Miles A, Atkin WS, Kralj-Hans I, Wardle J. The psychological impact of being offered surveillance colonoscopy following attendance at colorectal screening using flexible sigmoidoscopy. J Med Screen 2009; 16:124-30. [PMID: 19805753 DOI: 10.1258/jms.2009.009041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine the psychological impact of being assigned to colonoscopic surveillance following detection of adenomatous polyps at flexible sigmoidoscopy (FS) screening. SETTING Participants invited for screening in 12 of the 14 study centres in the UK FS Trial. METHODS A postal survey following FS screening assessed bowel cancer worry, psychological distress, generalized anxiety, bowel symptoms, general practitioner (GP) visits, positive emotional consequences of screening, and reassurance among people with no polyps (n = 26,573), lower-risk polyps removed at FS (n = 7401) and higher-risk polyps who underwent colonoscopy and were either assigned to colonoscopic surveillance (n = 1543) or discharged (n = 183). A sub-sample (n = 6389) also completed a questionnaire prior to screening attendance that measured bowel cancer worry, generalized anxiety, bowel symptoms and GP visits, making it possible to examine longitudinal changes in this group. RESULTS People offered surveillance reported lower psychological distress and anxiety than those with either no polyps or lower-risk polyps. The surveillance group also reported more positive emotional benefits of screening than the other outcome groups. Post-screening bowel cancer worry and bowel symptoms were higher in people assigned to surveillance, but both declined over time, reaching levels observed in either one or both of the other two groups found to have polyps, suggesting these results were a consequence of polyp detection rather than surveillance per se. Few differences were observed between the group assigned surveillance and the group discharged following colonoscopy. CONCLUSION The results of the current study are broadly reassuring and indicate that referral for colonoscopic surveillance is not associated with adverse psychological consequences.
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Affiliation(s)
- Anne Miles
- Psychology, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
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Abstract
Genetic testing for adult-onset diseases is now available. One such test is for the mutations present in the BRCA gene that result in a significantly higher risk for the development of breast cancer or ovarian cancer. Women who have one of these mutations face difficult choices in terms of increased surveillance or prophylactic surgeries. Examining experiences of women with BRCA mutations can serve as an exemplar for other populations at risk for genetically associated adult-onset diseases.
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Affiliation(s)
- Rebekah Hamilton
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Osborn M, Smith JA. The Fearfulness of Chronic Pain and the Centrality of the Therapeutic Relationship in Containing It: An Interpretative Phenomenological Analysis. QUALITATIVE RESEARCH IN PSYCHOLOGY 2008. [DOI: 10.1080/14780880701826143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The beliefs, and reported and intended behaviors of unaffected men in response to their family history of prostate cancer. Genet Med 2008; 10:430-8. [PMID: 18496220 DOI: 10.1097/gim.0b013e31817701c1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Genetic testing for hereditary cancer facilitates medical management and improves health outcomes. Genetic testing is not currently available for prostate cancer, but trials are underway to investigate if antiandrogens and selenium have a preventive role for at-risk individuals. To inform future genetic counseling, we sought to understand the pre-existing beliefs and behaviors of men with a family history of prostate cancer and explore their intention to adopt possible preventive behaviors in response to test results. METHODS A survey was completed by 280 men (response: 59%). RESULTS The belief that diet influenced prostate cancer risk was held by 73% of participants, whereas 37% believed in medication/natural therapies. Thirty-nine percent reported at least one change to their diet, alcohol consumption, smoking, exercise patterns, vitamin/mineral/supplement intake and/or medication/natural therapy in response to their family history. The men expressed interest in genetic testing with 92% "definitely" or "probably" interested. Definite interest was associated with number of affected relatives and prostate cancer-related anxiety. A positive genetic test would motivate 93% of men to make at least one behavioral change. CONCLUSIONS Participants commonly believed behavioral factors influenced prostate cancer risk and reported that they would alter their behavior to reduce risk after (hypothetical) genetic testing.
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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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Collins VR, Meiser B, Ukoumunne OC, Gaff C, St John DJ, Halliday JL. The impact of predictive genetic testing for hereditary nonpolyposis colorectal cancer: three years after testing. Genet Med 2008; 9:290-7. [PMID: 17505206 DOI: 10.1097/gim.0b013e31804b45db] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To fully assess predictive genetic testing programs, it is important to assess outcomes over periods of time longer than the 1-year follow-up reported in the literature. METHODS We conducted a 3-year study of individuals who received predictive genetic test results for previously identified familial mutations in Australian Familial Cancer Clinics. Questionnaires were sent before attendance at the familial cancer clinic and 2 weeks, 4 months, 1 year, and 3 years after receiving test results. Psychological measures were included each time, and preventive behaviors were assessed at baseline and 1 and 3 years. Psychological measures were adjusted for age, gender, and baseline score. RESULTS The study included 19 carriers and 54 non-carriers. We previously reported an increase in mean cancer-specific distress in carriers at 2 weeks with a return to baseline levels by 12 months. This level was maintained until 3 years. Non-carriers showed sustained decreases after testing with a significantly lower level at 3 years compared with baseline (P < 0.001). These scores tended to be lower than those for carriers at 3 years (P = 0.09). Mean depression and anxiety scores did not differ between carriers and non-carriers and, at 3 years, were similar to baseline. All carriers and 7% of non-carriers had had a colonoscopy by 3 years, and 69% of 13 female carriers had undergone gynecological screening in the previous 2 years. Prophylactic surgery was rare. CONCLUSION This report of long-term data indicates appropriate screening and improved psychological measures for non-carriers with no evidence of undue psychological distress in carriers of hereditary nonpolyposis colorectal cancer mutations.
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Affiliation(s)
- Veronica R Collins
- Public Health Genetics, Murdoch Childrens Research Institute, Victoria, Australia.
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Esplen MJ, Madlensky L, Aronson M, Rothenmund H, Gallinger S, Butler K, Toner B, Wong J, Manno M, McLaughlin J. Colorectal cancer survivors undergoing genetic testing for hereditary non-polyposis colorectal cancer: motivational factors and psychosocial functioning. Clin Genet 2007; 72:394-401. [PMID: 17892499 DOI: 10.1111/j.1399-0004.2007.00893.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC) represents about 1-3% of all cases of colorectal cancer (CRC). The objectives of the study were to examine motivational factors, expectations and psychosocial functioning in a sample of CRC survivors undergoing genetic testing for HNPCC. A cross-sectional survey of 314 colorectal cancer patients recruited through a population-based colon cancer family registry was conducted. Motivations for genetic testing for hereditary cancer were similar to those of clinic-based samples of CRC patients and included learning of the increased risk to offspring and finding out if additional screening was needed. While age at diagnosis and sex were associated with psychological functioning, significant predictors of post-counseling distress were perceived lower satisfaction with social support, an escape-avoidant coping style and the anticipation of becoming depressed if a mutation was present. Most cancer survivors anticipated disclosing test results to relatives and physicians. Cancer survivors reported several motivations for genetic testing for HNPCC that varied by sex. A subgroup of survivors with lower satisfaction with social support and an escape-avoidant coping style were worried about the potential impact of genetic test results and demonstrated more distress following counseling. Findings have implications for future research and potential support needs during the genetic counseling and testing process.
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Affiliation(s)
- M J Esplen
- Behavioral Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
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Smith JA, Osborn M. Pain as an assault on the self: An interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychol Health 2007. [DOI: 10.1080/14768320600941756] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Treloar SA, Morley KI, Taylor SD, Hall WD. Why do they do it? A pilot study towards understanding participant motivation and experience in a large genetic epidemiological study of endometriosis. Public Health Genomics 2007; 10:61-71. [PMID: 17380055 DOI: 10.1159/000099083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This exploratory, pilot study aimed to investigate motivations and reflections of participants who had provided epidemiological information, blood samples and access to clinical records and data in a large genetic epidemiological study of endometriosis, a common multifactorial disorder affecting women. We also aimed to explore understanding of complex genetic or multifactorial conditions in general. METHODS In-depth interviews were conducted with 16 endometriosis study participants with diverse characteristics. RESULTS Interviewees generally described their participation in the genetic study using altruistic frameworks of reference. Themes that emerged included unquestioning willingness and consent to participate, little concern about privacy issues, desire for more information from the researchers about the condition rather than scientific progress, the benefits of research participation to family communication, and differing ideas about genetic influences on endometriosis. Specific features of endometriosis also influenced reflections on research participation experience. CONCLUSIONS As increasing numbers of individuals and families in the community become involved in genetic epidemiological studies of common diseases, more extensive research will be needed to better understand their expectations with a view to improving researchers' communications with study participants.
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Affiliation(s)
- Susan A Treloar
- Genetic Epidemiology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia.
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Abstract
PURPOSE OF REVIEW In this article we summarize recent investigations into the influence of illness perceptions on outcomes in patients with medical conditions. RECENT FINDINGS Developments in assessment include the publishing of a new brief scale to assess illness perceptions and the examination of the relationship between patient drawings of their illness and outcomes. Recent studies in primary care highlight the importance of patients' beliefs and emotional responses to their illness as being important in influencing their satisfaction with the consultation, reassurance following negative medical testing and future healthcare use. Recent research shows illness perceptions to have associations with a number of outcomes in chronic illness including self-management behaviours and quality of life. As yet, however, few interventions have been developed designed to change illness perceptions and improve illness outcomes. Emerging areas of research include the application of illness perceptions to mental illness and genetic and risk factor testing. SUMMARY Research on illness perceptions has confirmed that patients' beliefs are associated with important outcomes in a broadening range of illnesses and risk factor testing. New interventions based on this model have the potential to improve patient outcomes but have yet to be widely developed and applied.
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Affiliation(s)
- Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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Harris PR, Smith V. When the risks are low: the impact of absolute and comparative information on disturbance and understanding in US and UK samples. Psychol Health 2007. [DOI: 10.1080/08870440512331317689] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
In this article the Self Regulatory Theory (Leventhal, 1970; Leventhan H., Benyamini, Brownlee, Diefenbach, Leventhal E.A., Patrick-Miller, & Robitaille, 1997) is presented as a framework for conceptualizing genetic counseling. Findings published in the genetic counseling literature are re-interpreted from the perspective of the theory. Clients are seen as active information processors rather than passive receivers of information. Research related to clients' representations of genetic causality of disease and specific genetic conditions is reviewed. Associations of genetic illness representations to self representations, coping and health behaviors are examined, and suggestions are made for applications of the theory in research and clinical practice.
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Affiliation(s)
- Shoshana Shiloh
- Department of Psychology, Tel Aviv University, Tel Aviv, 69978, Israel.
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Osborn M, Smith JA. Living with a body separate from the self. The experience of the body in chronic benign low back pain: an interpretative phenomenological analysis. Scand J Caring Sci 2006; 20:216-22. [PMID: 16756528 DOI: 10.1111/j.1471-6712.2006.00399.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper presents an in-depth, idiographic study exploring the personal experience of chronic benign low back pain in relation to the participant's body and sense of self. Semi-structured interviews were conducted with patients and the resultant transcripts subjected to interpretative phenomenological analysis. One theme is presented in detail: 'Living with a body separate from the self', whereby when out of pain the body has little salience to the self yet when in pain it is consciously excluded from the self. The complex and paradoxical relationship between the body, chronic pain and the self is explored and evidence is provided to argue that the embodied unpleasantness of chronic pain involves an assault upon and a defence of a preferred or desirable self. The results are considered in relation to relevant themes in the extant literature.
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Affiliation(s)
- Mike Osborn
- Pain Clinic, Royal United Hospital, Combe Park, Bath, UK. Mike.Osborn.ruh-bath.swest.nhs.uk
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Haga SB. Genomics-based labeling and attribution: a case for integrating social sciences into personalized medicine research. Per Med 2006; 3:317-323. [DOI: 10.2217/17410541.3.3.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As the field of genomics uncovers the etiology and pathophysiological mechanisms of disease, we will gain a greater understanding of the causes of disease, leading to preventive interventions, early diagnoses and new and improved treatments. Although understanding the specific roles of environment and genetics in disease onset and development will most likely improve health outcomes, the impact of this information for the individual and public remains to be seen. Understanding what factors influence individual and public perceptions and behavioral consequences related to genome-based disease labels and attributions will be critical to a successful transition for personalized medicine. To better understand the impact of genomic-based disease labeling and attribution, social scientists need to be involved in clinical genomics studies to assess the consequences of the use of and response to new personalized diagnoses and treatments.
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Affiliation(s)
- Susanne B Haga
- Duke University, Institute for Genome Sciences & Policy, 101 Science Drive, Box 3382, Durham, NC 27708, USA
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Bookman EB, Langehorne AA, Eckfeldt JH, Glass KC, Jarvik GP, Klag M, Koski G, Motulsky A, Wilfond B, Manolio TA, Fabsitz RR, Luepker RV. Reporting genetic results in research studies: summary and recommendations of an NHLBI working group. Am J Med Genet A 2006; 140:1033-40. [PMID: 16575896 PMCID: PMC2556074 DOI: 10.1002/ajmg.a.31195] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Prospective epidemiologic studies aid in identifying genetic variants associated with diseases, health risks, and physiologic traits. These genetic variants may eventually be measured clinically for purposes of diagnosis, prognosis, and treatment. As evidence of the potential clinical value of such information accrues, research studies face growing pressure to report these results to study participants or their physicians, even before sufficient evidence is available to support widespread screening of asymptomatic persons. There is thus a need to begin to develop consensus on whether and when genetic findings should be reported to participants in research studies. The National Heart, Lung, and Blood Institute (NHLBI) convened a Working Group on Reporting Genetic Results in Research Studies to discuss if, when, and how genetic information should be reported to study participants. The Working Group concluded that genetic test results should be reported to study participants when the associated risk for the disease is significant; the disease has important health implications such as premature death or substantial morbidity or has significant reproductive implications; and proven therapeutic or preventive interventions are available. Finally, the Working Group recommended procedures for reporting genetic research results and encouraged increased efforts to create uniform guidelines for this activity.
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Affiliation(s)
- Ebony B Bookman
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7934, USA.
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