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Kleiderman E, Boardman F, Newson AJ, Laberge AM, Knoppers BM, Ravitsky V. Unpacking the notion of "serious" genetic conditions: towards implementation in reproductive decision-making? Eur J Hum Genet 2024:10.1038/s41431-024-01681-0. [PMID: 39127803 DOI: 10.1038/s41431-024-01681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
The notion of a "serious" genetic condition is commonly used in clinical contexts, laws, and policies to define and delineate both the permissibility of and, access to, reproductive genomic technologies. Yet, the notion lacks conceptual and operational clarity, which can lead to its inconsistent appraisal and application. A common understanding of the relevant considerations of "serious" is lacking. This article addresses this conceptual gap. We begin by outlining existing distinctions around the notion of "serious" that will factor into its appraisal and need to be navigated, in the context of prenatal testing and the use of reproductive genomic technologies. These include tensions between clinical care and population health; the impact of categorizing a condition as "serious"; and the role of perception of quality of life. We then propose a set of four core dimensions and four procedural elements that can serve as a conceptual tool to prompt a mapping of the features of seriousness in any given context. Ultimately, consideration of these core dimensions and procedural elements may lead to improvements in the quality and consistency of decision-making where the seriousness of a genetic condition is a pivotal component at both a policy and practice level.
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Affiliation(s)
- Erika Kleiderman
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
| | - Felicity Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Anne-Marie Laberge
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal, QC, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- The Hastings Center, Garrison, NY, USA
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To-Mai XH, Nguyen HT, Nguyen-Thi TT, Nguyen TV, Nguyen-Thi MN, Thai KQ, Lai MT, Nguyen TA. Prevalence of common autosomal recessive mutation carriers in women in the Southern Vietnam following the application of expanded carrier screening. Sci Rep 2024; 14:7461. [PMID: 38553482 PMCID: PMC10980709 DOI: 10.1038/s41598-024-57513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
The common autosomal recessive (AR) mutation carrier is still unknown in Vietnam. This study aims to identify the most common AR gene mutation carriers in women of reproductive age to build a Vietnamese-specific carrier screening panel for AR and X-linked disorders in the preconception and prenatal healthcare program. A cross-sectional study was conducted at University Medical Center-Branch 2 in Ho Chi Minh City from December 1st, 2020, to June 30th, 2023. 338 women have consented to take a 5 mL blood test to identify 540 recessive genes. The carrier screening panel was designed based on the American College of Medical Genetics and Genomics (ACMG)-recommended genes and suggestions from 104 clinical experts in Vietnam. Obstetricians and genetic experts counseled all positive testing results to discuss the possibility of recessive diseases in their offspring. The most common recessive disorders were defined at a prevalence of 1 in 60 or greater, and those were added to a Vietnamese-specific carrier screening panel. 338 non-pregnant and pregnant women underwent the expanded carrier screening (ECS). The carrier frequency was 63.6%, in which 215 women carried at least one AR gene mutation. GJB2 hearing impairment was identified as the most common chronic condition (1 in 5). The second most common AR disorder was beta-thalassemia (1 in 16), followed by cystic fibrosis (1 in 23), G6PD deficiency (1 in 28), Wilson's disease (1 in 31), Usher's syndrome (1 in 31), and glycogen storage disease (1 in 56). Seven common recessive genes were added in ethnic-based carrier screening. Women in the South of Vietnam have been carried for many recessive conditions at high frequency, such as hearing impairment, genetic anemia, and cystic fibrosis. It is necessary to implement a preconception and prenatal screening program by using seven widely popular AR genes in a Vietnamese-specific carrier screening panel to reduce the burden related to AR and X-linked disorders.
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Affiliation(s)
- Xuan-Hong To-Mai
- University of Alberta, Edmonton, Canada
- University of Nam Can Tho, Can Tho, Vietnam
| | - Huu-Trung Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center-Branch 2, Ho Chi Minh City, Vietnam
| | | | - Thuy-Vy Nguyen
- University of Science, Vietnam National University Ho Chi Minh, Ho Chi Minh City, Vietnam
- Ktest Company, Ho Chi Minh City, Vietnam
| | - My-Nuong Nguyen-Thi
- University of Science, Vietnam National University Ho Chi Minh, Ho Chi Minh City, Vietnam
- Ktest Company, Ho Chi Minh City, Vietnam
| | | | | | - Tuan-Anh Nguyen
- University Medical Center-Branch 2, Ho Chi Minh City, Vietnam.
- Molecular Biomedical Center, University Medical Center, Ho Chí Minh City, Vietnam.
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Freeman L, Delatycki MB, Leach Scully J, Kirk EP. Views of reproductive genetic carrier screening participants regarding screening for genes associated with non-syndromic hearing loss. Prenat Diagn 2022; 42:1658-1666. [PMID: 36289583 PMCID: PMC10100309 DOI: 10.1002/pd.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Reproductive genetic carrier screening (RGCS) panels often include genes associated with non-syndromic hearing loss (NSHL) despite a lack of evidence of acceptability. Although some couples take steps to avoid having a child who is deaf, there are effective interventions for children who are deaf. There is no consensus whether deafness is considered a disabling condition. METHOD This study explored views of people who had RGCS, without genes for NSHL, about this topic. Online surveys were sent to 2186 people who had a low chance RGCS result and 655 completed the survey (participation rate 30%). RESULTS Sixty-three percent (N = 412) think deafness is a serious health condition. The majority agreed (60%, N = 391) that with support (i.e. hearing aids/cochlear implants) deafness is a minor condition in children. Most (84%, N = 545) agreed genes for NSHL should be included in RGCS. Thirty-five percent (N = 231) indicated they would make different reproductive decisions if they had an increased chance of having a child born deaf; 31% would not change their reproductive plans and 34% were unsure what they would do. CONCLUSION While the majority support inclusion of genes associated with NSHL in RGCS, there was uncertainty about the severity of deafness as a health condition and there was no consensus on whether it is a health condition that warrants changing reproductive decisions.
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Affiliation(s)
- Lucinda Freeman
- School of Women's and Children's HealthUNSWRandwickNew South WalesAustralia
- Graduate School of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Martin B. Delatycki
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Victorian Clinical Genetics ServicesParkvilleVictoriaAustralia
| | | | - Edwin P. Kirk
- School of Women's and Children's HealthUNSWRandwickNew South WalesAustralia
- Centre for Clinical GeneticsSydney Children's Hospitals NetworkRandwickNew South WalesAustralia
- NSW Health Pathology East GenomicsRandwickNew South WalesAustralia
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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Newson AJ, Dive L. Taking seriousness seriously in genomic health. Eur J Hum Genet 2022; 30:140-141. [PMID: 34782753 PMCID: PMC8821609 DOI: 10.1038/s41431-021-01002-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Ainsley J. Newson
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, 2006 NSW Australia
| | - Lisa Dive
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, 2006 NSW Australia
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Development and use of the Australian reproductive genetic carrier screening decision aid. Eur J Hum Genet 2022; 30:194-202. [PMID: 34725472 PMCID: PMC8821595 DOI: 10.1038/s41431-021-00991-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 02/03/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) may be offered to all individuals and couples, regardless of family history or ethnicity. "Mackenzie's Mission" (MM) is an Australian RGCS pilot study, evaluating the offer of couple-based screening for ~1300 genes associated with around 750 autosomal and X-linked recessive childhood-onset conditions. Each member of the couple makes an individual decision about RGCS and provides consent. We developed a decision aid (RGCS-DA) to support informed decision-making in MM, suitable for couples who were either non-pregnant or in early pregnancy. A Delphi approach invited experts to review values statements related to various concepts of RGCS. Three review rounds were completed, seeking consensus for relevance and clarity of statements, incorporating recommended modifications in subsequent iterations. The final RGCS-DA contains 14 statements that achieved Delphi consensus plus the attitude scale of the measure of informed choice. This was then evaluated in cognitive talk aloud interviews with potential users to assess face and content validity. Minimal wording changes were required at this stage. After this process, the RGCS-DA was piloted with 15 couples participating in MM who were then interviewed about their decision-making. The RGCS-DA prompted discussion within couples and facilitated in depth consideration of screening. There was reassurance when values aligned and a sense of shared decision-making within the couple. This RGCS-DA may become a very useful tool in supporting couples' decision making and contribute to RGCS being feasible for scaled-up implementation.
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What is a 'serious' genetic condition? The perceptions of people living with genetic conditions. Eur J Hum Genet 2021; 30:160-169. [PMID: 34565797 PMCID: PMC8821585 DOI: 10.1038/s41431-021-00962-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
Despite no consensus on the definition of ‘seriousness’, the concept is regularly used in policy and practice contexts to categorise conditions, determine access to genetic technologies and uses of selective pregnancy termination. Whilst attempts have been made to create taxonomies of genetic condition seriousness to inform clinical and policy decision-making, these have often relied on condition appraisals made by health and genetics professionals. The views of people with genetic conditions have been largely under-represented. This study explores the concept of seriousness through the perspectives of people with a range of ‘clinically serious’ conditions (fragile X conditions, spinal muscular atrophy, cystic fibrosis, haemophilia, thalassaemia). Attitudes towards suffering, quality of life (QoL) and selective pregnancy termination were elucidated from 45 in-depth qualitative interviews and 469 postal/online surveys. The majority of participants reported good health/wellbeing, and the capacity for good QoL, despite experiencing suffering with their condition. Notably, participants with later-onset conditions held more negative views of their health and QoL, and were more likely to view their condition as an illness, than those with early-onset conditions. These participants were more likely to see their condition as part of their identity. Whilst most participants supported prenatal screening, there was little support for selective termination. Moreover, social environment emerged as a critical mediator of the experience of the condition. The complex and rich insights of people living with genetic conditions might usefully be incorporated into future genetic taxonomies of ‘seriousness’ to ensure they more accurately reflect the lived reality of those with genetic conditions.
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Thomas GM, Rothman BK, Strange H, Latimer JE. Testing Times: The Social Life of Non-invasive Prenatal Testing. SCIENCE TECHNOLOGY AND SOCIETY 2021. [DOI: 10.1177/0971721820960262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-invasive prenatal testing (NIPT) is a genomic technology used to predict the chance of a foetus having a genetic condition. Despite the immediacy of this technology’s integration into clinical practice, there is a dearth of evidence outlining how both patients and professionals experience NIPT on the ground. In this article, we draw upon our collective empirical research—specifically on earlier screening technologies (BKR), Down syndrome screening (GT), genetic screening/testing (JL) and NIPT (HS)—to outline the most pressing and often controversial issues which, we argue, remain unresolved and vital to consider regarding NIPT. We begin with a brief introduction to NIPT as a prenatal technology and the bodies of literature which unpack its ‘social life’. In what follows, BKR discusses NIPT within the context of her research on ‘the tentative pregnancy’ and diagnostic testing in the USA. In the following sections, GT, HS and JL identify different, but related, concerns with respect to NIPT, particularly around routinisation, commercialisation, choice, abortion, and configurations of disability and ‘normalcy’.
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Affiliation(s)
- Gareth M. Thomas
- Gareth Thomas (corresponding author), School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, UK
| | - Barbara Katz Rothman
- Barbara Katz Rothman, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016, USA
| | - Heather Strange
- Heather Strange, School of Medicine, Cardiff University, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK
| | - Joanna E. Latimer
- Joanna Latimer, Department of Sociology, University of York, Heslington, York, North Yorkshire, YO10 5DD, UK
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Thomas LA, Lewis S, Massie J, Kirk EP, Archibald AD, Barlow-Stewart K, Boardman FK, Halliday J, McClaren B, Delatycki MB. Which types of conditions should be included in reproductive genetic carrier screening? Views of parents of children with a genetic condition. Eur J Med Genet 2020; 63:104075. [PMID: 33007447 DOI: 10.1016/j.ejmg.2020.104075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/21/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
Reproductive genetic carrier screening identifies couples with an increased chance of having children with autosomal and X-linked recessive conditions. Initially only offered for single conditions to people with a high priori risk, carrier screening is becoming increasingly offered to individuals/couples in the general population for a wider range of genetic conditions. Despite advances in genomic testing technology and greater availability of carrier screening panels, there is no consensus around which types of conditions to include in carrier screening panels. This study sought to identify which types of conditions parents of children with a genetic condition believe should be included in carrier screening. Participants (n = 150) were recruited through Royal Children's Hospital (RCH) Melbourne outpatient clinics, the Genetic Support Network of Victoria (GSNV) and a databank of children with hearing loss (VicCHILD). This study found that the majority of participants support offering carrier screening for: neuromuscular conditions (n = 128/134, 95.5%), early fatal neurodegenerative conditions (n = 130/141, 92.2%), chronic multi-system disorders (n = 124/135, 91.9%), conditions which cause intellectual disability (n = 128/139, 92.1%) and treatable metabolic conditions (n = 120/138, 87.0%). Views towards the inclusion of non-syndromic hearing loss (n = 88/135, 65.2%) and preventable adult-onset conditions (n = 75/135, 55.6%) were more mixed. Most participants indicated that they would use reproductive options to avoid having a child with the more clinically severe conditions, but most would not do so for clinically milder conditions. A recurring association was observed between participants' views towards carrier screening and their lived experience of having a child with a genetic condition.
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Affiliation(s)
- Lauren A Thomas
- Department of Paediatrics, University of Melbourne, Australia; Victorian Clinical Genetics Services, Australia
| | - Sharon Lewis
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia
| | - John Massie
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Royal Children's Hospital Melbourne, Australia
| | - Edwin P Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital, Australia; Randwick Genomics Laboratory, New South Wales Health Pathology, Australia; School of Women's and Children's Health, University of New South Wales, Australia
| | - Alison D Archibald
- Department of Paediatrics, University of Melbourne, Australia; Victorian Clinical Genetics Services, Australia; Murdoch Children's Research Institute, Australia
| | - Kristine Barlow-Stewart
- School of Women's and Children's Health, University of New South Wales, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | | | - Jane Halliday
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia
| | - Belinda McClaren
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia
| | - Martin B Delatycki
- Department of Paediatrics, University of Melbourne, Australia; Victorian Clinical Genetics Services, Australia; Murdoch Children's Research Institute, Australia.
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Rowe CA, Wright CF. Expanded universal carrier screening and its implementation within a publicly funded healthcare service. J Community Genet 2019; 11:21-38. [PMID: 31828606 PMCID: PMC6962405 DOI: 10.1007/s12687-019-00443-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Carrier screening, a well-established clinical initiative, has been slow to take advantage of the new possibilities offered by high-throughput next generation sequencing technologies. There is evidence of significant benefit in expanding carrier screening to include multiple autosomal recessive conditions and offering a ‘universal’ carrier screen that could be used for a pan-ethnic population. However, the challenges of implementing such a programme and the difficulties of demonstrating efficacy worthy of public health investment are significant barriers. In order for such a programme to be successful, it would need to be applicable and acceptable to the population, which may be ethnically and culturally diverse. There are significant practical and ethical implications associated with determining which variants, genes and conditions to include whilst maintaining adequate sensitivity and accuracy. Although preconception screening would maximise the potential benefits from universal carrier screening, the resource implications of different modes of delivery need to be carefully evaluated and balanced against maximising reproductive autonomy and ensuring equity of access. Currently, although a number of existing initiatives are increasing access to carrier screening, there is insufficient evidence to inform the development of a publicly funded, expanded, universal carrier screening programme that would justify investment over other healthcare interventions.
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Affiliation(s)
- Charlotte A Rowe
- University of Exeter, St Luke's Campus, 79 Heavitree Rd, Exeter, EX1 1TX, UK. .,Post Graduate Centre, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, TR1 3LQ, UK.
| | - Caroline F Wright
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, RILD Building, RD&E, Barrack Road, Exeter, EX2 5DW, UK.
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Fisher CF, Birkeland LE, Reiser CA, Zhao Q, Palmer CGS, Zikmund-Fisher BJ, Petty EM. Alternative option labeling impacts decision-making in noninvasive prenatal screening. J Genet Couns 2019; 29:910-918. [PMID: 31793699 DOI: 10.1002/jgc4.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 11/08/2022]
Abstract
Prenatal genetic screening should be an informed, autonomous patient choice. Extrinsic factors which influence patient decision-making threaten the ethical basis of prenatal genetic screening. Prior research in the area of medical decision-making has identified that labeling may have unanticipated effects on patient perceptions and decision-making processes. This Internet-administered study explored the impact of option labeling on the noninvasive prenatal screening (NIPS) selections of US adults. A total of 1,062 participants were recruited through Amazon Mechanical Turk (MTurk) and randomly assigned to one of three possible label sets reflecting provider-derived and industry-derived option labels used in prenatal screening. Multinomial logistic regression analysis showed option labeling had a statistically significant impact on the NIPS selections of study participants (p = .0288). Outcomes of the Satisfaction with Decision Scale (SWD) indicated option labels did not play a role in participant satisfaction with screening selection. The results of this study indicate a need for further evaluation of the impact NIPS option labeling has on patient screening decisions in real-world clinical interactions. Clinical providers and testing laboratories offering NIPS should give careful consideration to the option labels used with prenatal screening so as to minimize influence on patient screening selection and decision-making processes.
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Affiliation(s)
- Camille F Fisher
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Section of Clinical and Metabolic Genetics, Dell Children's Medical Group, Austin, TX, USA
| | - Laura E Birkeland
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Center for Perinatal Care, UnityPoint Health Meriter Hospital, Madison, WI, USA
| | - Catherine A Reiser
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christina G S Palmer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Division of General Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth M Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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12
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Boardman FK, Hale R, Gohel R, Young PJ. Preventing lives affected by hemophilia: A mixed methods study of the views of adults with hemophilia and their families toward genetic screening. Mol Genet Genomic Med 2019; 7:e618. [PMID: 30838796 PMCID: PMC6503017 DOI: 10.1002/mgg3.618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/11/2019] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Genomic sequencing technologies have made the possibility of population screening for whole panels of genetic disorders more feasible than ever before. As one of the most common single gene disorders affecting the UK population, hemophilia is an attractive candidate to include on such screening panels. However, very little is known about views toward genetic screening amongst people with hemophilia or their family members, despite the potential for a wide range of impacts on them. Methods Twenty‐two in‐depth qualitative interviews were undertaken to explore the views of adults with hemophilia and their family members, recruited through the Haemophilia Society UK. These interviews were used to develop a survey, the Haemophilia Screening Survey (UK), which was distributed in paper and online format through the support group, receiving 327 returns between January and June 2018. Results Fifty‐seven per cent of the sample supported preconception carrier screening of the population for hemophilia, and 59% supported prenatal carrier screening. Key reasons for support included a desire to reduce pregnancy terminations and increase awareness of hemophilia. Despite support for screening however, 90% of the sample disagreed with pregnancy terminations for hemophilia. Conclusions Families and adults living with hemophilia are more supportive of screening for information and preparation purposes than to prevent boys with hemophilia from being born. A distinction was made between preventing the disease and preventing the lives of people with it, with support shown for the use of screening to achieve the former, but not at the expense of the latter.
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Affiliation(s)
| | - Rachel Hale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Raksha Gohel
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
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13
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Boardman F, Hale R. Responsibility, identity, and genomic sequencing: A comparison of published recommendations and patient perspectives on accepting or declining incidental findings. Mol Genet Genomic Med 2018; 6:1079-1096. [PMID: 30370638 PMCID: PMC6305652 DOI: 10.1002/mgg3.485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of genomic sequencing techniques is increasingly being incorporated into mainstream health care. However, there is a lack of agreement on how "incidental findings" (IFs) should be managed and a dearth of research on patient perspectives. METHODS In-depth qualitative interviews were carried out with 31 patients undergoing genomic sequencing at a regional genetics service in England. Interviews explored decisions around IFs and were comparatively analyzed with published recommendations from the literature. RESULTS Thirteen participants opted to receive all IFs from their sequence, 12 accepted some and rejected others, while six participants refused all IFs. The key areas from the literature, (a) genotype/phenotype correlation, (b) seriousness of the condition, and (c) implications for biological relatives, were all significant; however, patients drew on a broader range of social and cultural information to make their decisions. CONCLUSION This study highlights the range of costs and benefits for patients of receiving IFs from a genomic sequence. While largely positive views toward the dissemination of genomic data were reported, ambivalence surrounding genetic responsibility and its associated behaviors (e.g., duty to inform relatives) was reported by both IF decliners and accepters, suggesting a need to further explore patient perspectives on this highly complex topic area.
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Kraft SA, Duenas D, Wilfond BS, Goddard KAB. The evolving landscape of expanded carrier screening: challenges and opportunities. Genet Med 2018; 21:790-797. [PMID: 30245516 PMCID: PMC6752283 DOI: 10.1038/s41436-018-0273-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
Carrier screening allows individuals to learn their chance of passing on an autosomal or X-linked condition to their offspring. Initially introduced as single-disease, ancestry-based screening, technological advances now allow for the possibility of multi-disease, pan-ethnic carrier screening, which we refer to as “expanded carrier screening.” There are numerous potential benefits to expanded carrier screening, including maximizing the opportunity for couples to make autonomous reproductive decisions, and efficiency and marginal additional costs of including more conditions if the test is already being offered. While numerous laboratories currently offer expanded carrier screening services, it is not yet commonly used in clinical practice, and there is a lack of consensus among experts about the service, including whether this should be offered to individuals and couples, whether this should be offered preconception or prenatally, and what conditions to include in screening programs. Challenges for expanded carrier screening programs include a lack of demand from the public, low prioritization by health systems, the potential for pressure to undergo screening, the possibility of disability-based discrimination, needed adaptations to pre- and post-test counseling, technical limitations, and the evolving technological and socio-political landscape.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Devan Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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15
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Boardman FK, Hale R. How do genetically disabled adults view selective reproduction? Impairment, identity, and genetic screening. Mol Genet Genomic Med 2018; 6:941-956. [PMID: 30196552 PMCID: PMC6305648 DOI: 10.1002/mgg3.463] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/19/2018] [Accepted: 07/20/2018] [Indexed: 11/11/2022] Open
Abstract
Background Genomic medicine is rapidly evolving, particularly in the domain of reproduction. Population carrier screening for a range of disorders is becoming possible using whole genome/exome sequencing. However, very little is known about the views of genetically disabled adults toward selective reproduction. Methods Forty‐three in‐depth qualitative interviews were carried out with adults living with different types of genetic condition, recruited through support groups and clinics. Interviews covered participants’ experiences of their condition and their views toward genetic intervention in reproduction. Thematic analysis of the data using NVivo 11 was undertaken, and participants were assigned categories as either supporting, not‐supporting, or having ambivalent views toward selective reproduction. Results The majority of participants (65%) expressed either disapproval of, or held ambivalent views toward, selective reproduction. Key reasons for non‐support included regarding genetic impairment as part of personal identity and the prioritization of social and environmental barrier removal. Key reasons for support of selective reproduction included negative and externalizing attitudes toward genetic impairment and a belief in the importance of informed reproductive decision‐making. Conclusion The degree to which participants identified with their impairment, more so than how they valued it, was significant in determining attitudes toward selective reproduction. Those who supported genetic screening viewed their impairment as separate to themselves, while participants who considered their impairment as integral to their identity were most likely to report ambivalent or negative attitudes. Policymakers and stakeholders considering the role of genetic carrier screening panels might usefully engage with adults affected by heritable disease as well as disability identity politics when considering the acceptability and social impact of genetic screening programs.
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16
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Porter KM, Kauffman TL, Koenig BA, Lewis KL, Rehm HL, Richards CS, Strande NT, Tabor HK, Wolf SM, Yang Y, Amendola LM, Azzariti DR, Berg JS, Bergstrom K, Biesecker LG, Biswas S, Bowling KM, Chung WK, Clayton EW, Conlin LK, Cooper GM, Dulik MC, Garraway LA, Ghazani AA, Green RC, Hiatt SM, Jamal SM, Jarvik GP, Goddard KAB, Wilfond BS. Approaches to carrier testing and results disclosure in translational genomics research: The clinical sequencing exploratory research consortium experience. Mol Genet Genomic Med 2018; 6:898-909. [PMID: 30133189 PMCID: PMC6305639 DOI: 10.1002/mgg3.453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/23/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background Clinical genome and exome sequencing (CGES) is primarily used to address specific clinical concerns by detecting risk of future disease, clarifying diagnosis, or directing treatment. Additionally, CGES makes possible the disclosure of autosomal recessive and X‐linked carrier results as additional secondary findings, and research about the impact of carrier results disclosure in this context is needed. Methods Representatives from 11 projects in the clinical sequencing exploratory research (CSER) consortium collected data from their projects using a structured survey. The survey focused on project characteristics, which variants were offered and/or disclosed to participants as carrier results, methods for carrier results disclosure, and project‐specific outcomes. We recorded quantitative responses and report descriptive statistics with the aim of describing the variability in approaches to disclosing carrier results in translational genomics research projects. Results The proportion of participants with carrier results was related to the number of genes included, ranging from 3% (three genes) to 92% (4,600 genes). Between one and seven results were disclosed to those participants who received any positive result. Most projects offered participants choices about whether to receive some or all of the carrier results. There were a range of approaches to communicate results, and many projects used separate approaches for disclosing positive and negative results. Conclusion Future translational genomics research projects will need to make decisions regarding whether and how to disclose carrier results. The CSER consortium experience identifies approaches that balance potential participant interest while limiting impact on project resources.
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Affiliation(s)
- Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Barbara A Koenig
- Institute for Health and Aging, University of California, San Francisco, California
| | - Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch of the National Human Genome Research Institute, Bethesda, Maryland
| | - Heidi L Rehm
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Partners Personalized Medicine, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts
| | - Carolyn Sue Richards
- Knight Diagnostic Laboratories and Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon
| | - Natasha T Strande
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics, Palo Alto, California
| | - Susan M Wolf
- University of Minnesota Law School, Medical School and Consortium on Law and Values in Health, Environment & the Life Sciences, Minneapolis, Minnesota
| | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington
| | - Danielle R Azzariti
- Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts
| | - Jonathan S Berg
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katie Bergstrom
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch of the National Human Genome Research Institute, Bethesda, Maryland
| | - Sawona Biswas
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin M Bowling
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama
| | - Wendy K Chung
- Department of Pediatrics, Columbia University, New York, New York.,Department of Medicine, Columbia University Medical Center, New York, New York
| | - Ellen W Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura K Conlin
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Matthew C Dulik
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Arezou A Ghazani
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology and Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Partners Personalized Medicine, Boston, Massachusetts.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan M Hiatt
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama
| | - Seema M Jamal
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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17
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Wilfond BS, Kauffman TL, Jarvik GP, Reiss JA, Richards CS, McMullen C, Gilmore M, Himes P, Kraft SA, Porter KM, Schneider JL, Punj S, Leo MC, Dickerson JF, Lynch FL, Clarke E, Rope AF, Lutz K, Goddard KAB. Lessons Learned From A Study Of Genomics-Based Carrier Screening For Reproductive Decision Making. Health Aff (Millwood) 2018; 37:809-816. [PMID: 29733724 DOI: 10.1377/hlthaff.2017.1578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Genomics-based carrier screening is one of many opportunities to use genomic information to inform medical decision making, but clinicians, health care delivery systems, and payers need to determine whether to offer screening and how to do so in an efficient, ethical way. To shed light on this issue, we conducted a study in the period 2014-17 to inform the design of clinical screening programs and guide further health services research. Many of our results have been published elsewhere; this article summarizes the lessons we learned from that study and offers policy insights. Our experience can inform understanding of the potential impact of expanded carrier screening services on health system workflows and workforces-impacts that depend on the details of the screening approach. We found limited patient or health system harms from expanded screening. We also found that some patients valued the information they learned from the process. Future policy discussions should consider the value of offering such expanded carrier screening in health delivery systems with limited resources.
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Affiliation(s)
- Benjamin S Wilfond
- Benjamin S. Wilfond ( ) is director of the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and of the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, all in Seattle, Washington
| | - Tia L Kauffman
- Tia L. Kauffman is a project director at the Center for Health Research, Kaiser Permanente Northwest, in Portland, Oregon
| | - Gail P Jarvik
- Gail P. Jarvik is a professor in the Division of Medical Genetics, Department of Medicine, and in the Department of Genome Sciences, both at the University of Washington
| | - Jacob A Reiss
- Jacob A. Reiss is a medical geneticist at the Center for Health Research, Kaiser Permanente Northwest
| | - C Sue Richards
- C. Sue Richards is a professor in the Knight Diagnostic Laboratories, Oregon Health & Science University, in Portland
| | - Carmit McMullen
- Carmit McMullen is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Marian Gilmore
- Marian Gilmore is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Patricia Himes
- Patricia Himes is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Stephanie A Kraft
- Stephanie A. Kraft is an acting assistant professor in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and in the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine
| | - Kathryn M Porter
- Kathryn M. Porter is a research scientist in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute
| | - Jennifer L Schneider
- Jennifer L. Schneider is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Sumit Punj
- Sumit Punj is a senior clinical scientist in the Clinical Genomics Program, GeneDx, in Gaithersburg, Maryland
| | - Michael C Leo
- Michael C. Leo is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - John F Dickerson
- John F. Dickerson is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Frances L Lynch
- Frances L. Lynch is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Elizabeth Clarke
- Elizabeth Clarke is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Alan F Rope
- Alan F. Rope is a staff physician at Northwest Permanente, Kaiser Permanente Northwest
| | - Kevin Lutz
- Kevin Lutz is publications manager at the Center for Health Research, Kaiser Permanente Northwest
| | - Katrina A B Goddard
- Katrina A. B. Goddard is associate director, research programs, at the Center for Health Research, Kaiser Permanente Northwest
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18
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Kraft SA, McMullen CK, Porter KM, Kauffman TL, Davis JV, Schneider JL, Goddard KAB, Wilfond BS. Patient perspectives on the use of categories of conditions for decision making about genomic carrier screening results. Am J Med Genet A 2017; 176:376-385. [DOI: 10.1002/ajmg.a.38583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/05/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie A. Kraft
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
- Division of BioethicsDepartment of PediatricsUniversity of Washington School of MedicineSeattleWashington
| | | | - Kathryn M. Porter
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
| | - Tia L. Kauffman
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregon
| | - James V. Davis
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregon
| | | | | | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Hospital and Research InstituteSeattleWashington
- Division of BioethicsDepartment of PediatricsUniversity of Washington School of MedicineSeattleWashington
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19
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Clinician-Stakeholders' Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results. J Genet Couns 2017; 27:349-357. [PMID: 29159545 DOI: 10.1007/s10897-017-0179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.
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20
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Chokoshvili D, Vears D, Borry P. Expanded carrier screening for monogenic disorders: where are we now? Prenat Diagn 2017; 38:59-66. [DOI: 10.1002/pd.5109] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Davit Chokoshvili
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care; University of Leuven; Leuven Belgium
| | - Danya Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care; University of Leuven; Leuven Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care; University of Leuven; Leuven Belgium
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21
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Himes P, Kauffman TL, Muessig KR, Amendola LM, Berg JS, Dorschner MO, Gilmore M, Nickerson DA, Reiss JA, Richards CS, Rope AF, Simpson DK, Wilfond BS, Jarvik GP, Goddard KA. Genome sequencing and carrier testing: decisions on categorization and whether to disclose results of carrier testing. Genet Med 2017; 19:803-808. [PMID: 28079899 PMCID: PMC5509491 DOI: 10.1038/gim.2016.198] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We investigated the use of genome sequencing for preconception carrier testing. Genome sequencing could identify one or more of thousands of X-linked or autosomal recessive conditions that could be disclosed during preconception or prenatal counseling. Therefore, a framework that helps both clinicians and patients understand the possible range of findings is needed to respect patient preferences by ensuring that information about only the desired types of genetic conditions are provided to a given patient. METHODS We categorized gene-condition pairs into groups using a previously developed taxonomy of genetic conditions. Patients could elect to receive results from these categories. A Return of Results Committee (RORC) developed inclusion and exclusion criteria for each category. RESULTS To date, the RORC has categorized 728 gene-condition pairs: 177 are categorized as life span-limiting, 406 are categorized as serious, 93 are categorized as mild, 41 are categorized as unpredictable, and 11 are categorized as adult-onset. An additional 64 gene-condition pairs were excluded from reporting to patients or put on a watch list, generally because evidence that a gene and condition were associated was limited. CONCLUSION Categorization of gene-condition pairs using our taxonomy simplifies communication regarding patient preferences for carrier information from a genomic test.Genet Med advance online publication 12 January 2017.
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Affiliation(s)
- Patricia Himes
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Tia L. Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Kristin R. Muessig
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Laura M. Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Marian Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Jacob A. Reiss
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - C. Sue Richards
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA
| | - Alan F. Rope
- Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Dana K. Simpson
- Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Benjamin S. Wilfond
- Seattle Children’s Research Institute, Treuman Katz Center for Pediatric Bioethics, Seattle, Washington, USA
| | - Gail P. Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
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22
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Molster CM, Lister K, Metternick-Jones S, Baynam G, Clarke AJ, Straub V, Dawkins HJS, Laing N. Outcomes of an International Workshop on Preconception Expanded Carrier Screening: Some Considerations for Governments. Front Public Health 2017; 5:25. [PMID: 28286745 PMCID: PMC5323409 DOI: 10.3389/fpubh.2017.00025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/09/2017] [Indexed: 01/08/2023] Open
Abstract
Background Consideration of expanded carrier screening has become an emerging issue for governments. However, traditional criteria for decision-making regarding screening programs do not incorporate all the issues relevant to expanded carrier screening. Further, there is a lack of consistent guidance in the literature regarding the development of appropriate criteria for government assessment of expanded carrier screening. Given this, a workshop was held to identify key public policy issues related to preconception expanded carrier screening, which governments should consider when deciding whether to publicly fund such programs. Methods In June 2015, a satellite workshop was held at the European Society of Human Genetics Conference. It was structured around two design features: (1) the provision of information from a range of perspectives and (2) small group deliberations on the key issues that governments need to consider and the benefits, risks, and challenges of implementing publicly funded whole-population preconception carrier screening. Results Forty-one international experts attended the workshop. The deliberations centered primarily on the conditions to be tested and the elements of the screening program itself. Participants expected only severe conditions to be screened but were concerned about the lack of a consensus definition of “severe.” Issues raised regarding the screening program included the purpose, benefits, harms, target population, program acceptability, components of a program, and economic evaluation. Participants also made arguments for consideration of the accuracy of screening tests. Conclusion A wide range of issues require careful consideration by governments that want to assess expanded carrier screening. Traditional criteria for government decision-making regarding screening programs are not a “best fit” for expanded carrier screening and new models of decision-making with appropriate criteria are required. There is a need to define what a “severe” condition is, to build evidence regarding the reliability and accuracy of screening tests, to consider the equitable availability and downstream effects on and costs of follow-up interventions for those identified as carriers, and to explore the ways in which the components of a screening program would be impacted by unique features of expanded carrier screening.
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Affiliation(s)
- Caron M Molster
- Office of Population Health Genomics, Public Health Division, Department of Health Western Australia , Perth, WA , Australia
| | - Karla Lister
- Office of Population Health Genomics, Public Health Division, Department of Health Western Australia , Perth, WA , Australia
| | | | - Gareth Baynam
- Office of Population Health Genomics, Public Health Division, Department of Health Western Australia, Perth, WA, Australia; Genetic Services WA, Perth, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Western Australian Register of Developmental Anomalies, Perth, WA, Australia; Spatial Sciences, Department of Science and Engineering, Curtin University, Perth, WA, Australia
| | - Angus John Clarke
- Division of Cancer and Genetics, School of Medicine, Cardiff University , Cardiff , UK
| | - Volker Straub
- Institute of Human Genetics, University of Newcastle upon Tyne , Newcastle upon Tyne , UK
| | - Hugh J S Dawkins
- Office of Population Health Genomics, Public Health Division, Department of Health Western Australia, Perth, WA, Australia; Centre for Comparative Genomics, Murdoch University, Perth, WA, Australia; Centre for Population Health Research, Curtin University, Perth, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Nigel Laing
- Centre for Medical Research, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia; Neurogenetics Unit, Department of Diagnostic Genomics, PathWest Laboratory Medicine, Department of Health Western Australia, Perth, WA, Australia
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23
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Wilfond BS. Breaking the Sounds of Silence: Respecting People With Disabilities and Reproductive Decision Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:37-39. [PMID: 27996901 PMCID: PMC7656958 DOI: 10.1080/15265161.2016.1251664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Benjamin S. Wilfond
- University of Washington School of Medicine, Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital, Seattle, WA 98101, USA.
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24
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Leo MC, McMullen C, Wilfond BS, Lynch FL, Reiss JA, Gilmore MJ, Himes P, Kauffman TL, Davis JV, Jarvik GP, Berg JS, Harding C, Kennedy KA, Simpson DK, Quigley DI, Richards CS, Rope AF, Goddard KAB. Patients' ratings of genetic conditions validate a taxonomy to simplify decisions about preconception carrier screening via genome sequencing. Am J Med Genet A 2016; 170:574-82. [PMID: 26792268 DOI: 10.1002/ajmg.a.37477] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/28/2015] [Indexed: 12/27/2022]
Abstract
Advances in genome sequencing and gene discovery have created opportunities to efficiently assess more genetic conditions than ever before. Given the large number of conditions that can be screened, the implementation of expanded carrier screening using genome sequencing will require practical methods of simplifying decisions about the conditions for which patients want to be screened. One method to simplify decision making is to generate a taxonomy based on expert judgment. However, expert perceptions of condition attributes used to classify these conditions may differ from those used by patients. To understand whether expert and patient perceptions differ, we asked women who had received preconception genetic carrier screening in the last 3 years to fill out a survey to rate the attributes (predictability, controllability, visibility, and severity) of several autosomal recessive or X-linked genetic conditions. These conditions were classified into one of five taxonomy categories developed by subject experts (significantly shortened lifespan, serious medical problems, mild medical problems, unpredictable medical outcomes, and adult-onset conditions). A total of 193 women provided 739 usable ratings across 20 conditions. The mean ratings and correlations demonstrated that participants made distinctions across both attributes and categories. Aggregated mean attribute ratings across categories demonstrated logical consistency between the key features of each attribute and category, although participants perceived little difference between the mild and serious categories. This study provides empirical evidence for the validity of our proposed taxonomy, which will simplify patient decisions for results they would like to receive from preconception carrier screening via genome sequencing.
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Affiliation(s)
- Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Jacob A Reiss
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Marian J Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | - Patricia Himes
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - James V Davis
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Jonathan S Berg
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cary Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Kathleen A Kennedy
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Denise I Quigley
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | - C Sue Richards
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Alan F Rope
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
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