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Droin-Mollard M, Hervouet L, Lahlou-Laforêt K, de Montgolfier S. Narrative review on ethical and psychological issues raised by genetic and genomic testing in pediatric oncology care. J Genet Couns 2024. [PMID: 39075631 DOI: 10.1002/jgc4.1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
In pediatric oncology, genetic and genomic tests are proposed throughout the care pathway for many reasons (e.g., cancer characterization, identification of the most appropriate treatment, patient selection for clinical trials, identification of tissue/organ donors, or risk of relapse prediction). Despite the many different approaches (somatic or germline testing, targeted gene or genome sequencing), the implicated individuals are confronted with situations that may intersect and that are interesting to compare. No study has identified and analyzed the available works on these new practices in pediatric oncology. The aim of this narrative literature review was to describe the ethical and psychological perspectives of children with cancer, parents, and healthcare professionals when genetic or genomic testing is proposed as part of the cancer management. Eighteen articles met the inclusion criteria and were comprehensively coded using MAXQDA. Their analysis showed that concerning the subjective implications of genetic and genomic testing, the areas of ambivalence (desire of treatment, desire for knowledge, uncertainty, and guilt) reported by patients and their parents seem to mirror the healthcare professionals' concerns. The ethical and psychological issues about predisposition testing, long discussed in the context of hereditary retinoblastoma and Li-Fraumeni syndrome, represent a useful starting point for a wider discussion of a genetic and genomic testing pathway in pediatric oncology more broadly.
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Affiliation(s)
- Marion Droin-Mollard
- UF de Psychologie et Psychiatrie de Liaison et d'Urgences, DMU Psychiatrie et Addictologie, et Département de Génétique, APHP, Centre-Universités de Paris, Paris, France
| | - Lucile Hervouet
- IRIS Institut de Recherche Interdisciplinaire Sur les Enjeux Sociaux (UMR 8156 CNRS - 997 INSERM - EHESS - UPSN), Campus Condorcet, Aubervilliers, France
| | - Khadija Lahlou-Laforêt
- UF de Psychologie et Psychiatrie de Liaison et d'Urgences, DMU Psychiatrie et Addictologie, et Département de Génétique, APHP, Centre-Universités de Paris, Paris, France
- Consultation Multidisciplinaire d'oncogénétique Des Cancers Rares, Hopital européen Georges Pompidou, Paris, France
| | - Sandrine de Montgolfier
- Université Paris Est Créteil, Créteil, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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2
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Droin-Mollard M, de Montgolfier S, Gimenez-Roqueplo AP, Flahault C, Petit A, Bourdeaut F, Julia S, Rial-Sebbag E, Coupier I, Simaga F, Brugières L, Guerrini-Rousseau L, Claret B, Cavé H, Strullu M, Hervouet L, Lahlou-Laforêt K. Psychological and ethical issues raised by genomic in paediatric care pathway, a qualitative analysis with parents and childhood cancer patients. Eur J Hum Genet 2024:10.1038/s41431-024-01653-4. [PMID: 38997469 DOI: 10.1038/s41431-024-01653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
In paediatric oncology, genomics raises new ethical, legal and psychological issues, as somatic and constitutional situations intersect throughout the care pathway. The discovery of potential predisposition in this context is sometimes carried out outside the usual framework. This article focuses on the views of children, adolescents, and young adults (AYA) with cancer and their parents about their experience with genomic testing. Forty-eight semi-structured interviews were performed with children or AYAs with cancer and one of their parents, before and/or after receiving the genetic test results. The interviews were fully transcribed, coded and thematically analysed using an inductive method. This analysis revealed several themes that are key issues: perceived understanding and consenting, apprehension about the test outcomes (expectations and fears), perception and attitude towards incidental findings. The main expectation was an aetiological explanation. Children and AYAs also emphasised the altruistic meaning of genetic testing, while parents seemed to expect a therapeutic and preventive approach for their child and the rest of the family. Parents were more concerned about a family risk, while patients were more afraid of cancer relapse or transmission to their descendants. Both groups suggested possible feelings of guilt concerning family transmission and imaginary representations of what genomics may allow. Incidental findings were not understood by patients, while some parents perceived the related issues and hesitated between wanting or not to know. A multidisciplinary approach would be an interesting way to help parents and children and AYAs to better grasp the complexity of genetic and/or genomic testing.
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Affiliation(s)
- Marion Droin-Mollard
- UF of Psychology and Liaison and Emergency Psychiatry, DMU Psychiatry and Addictology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Sandrine de Montgolfier
- IRIS Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (UMR 8156 CNRS-997 INSERM-EHESS-UPSN), Campus Condorcet, Aubervilliers, France.
- University of Paris Est Créteil, Créteil, France.
- Aix Marseille Universite, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Anne-Paule Gimenez-Roqueplo
- Département de Médecine Génomique des Tumeurs et des Cancers, Consultation d'oncogénétique Multidisciplinaire des Cancers Rares, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, PARCC, INSERM, Paris, France
| | - Cécile Flahault
- UF of Psychology and Liaison and Emergency Psychiatry, DMU Psychiatry and Addictology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé UR4057, Paris, France
| | - Arnaud Petit
- Service d'Hématologie et d'Oncologie Pédiatrique, Hôpital Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Franck Bourdeaut
- SIREDO Pediatric Oncology Center, Laboratory of Translational Research in Pediatric Oncology-INSERMU830, Institut Curie, Paris Sciences Lettres Research University, Paris, France
- Université Paris-Cité, Paris, France
| | - Sophie Julia
- UMR 1027 INSERM, University of Toulouse & Toulouse University Hospital, Toulouse, France
- Medical Genetics Department, Purpan Hospital, Toulouse, France
| | - Emmanuelle Rial-Sebbag
- UMR 1027 INSERM, University of Toulouse & University Toulouse III-Paul Sabatier, Toulouse, France
| | - Isabelle Coupier
- CHU Montpellier, Hôpital Arnaud de Villeneuve Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France
- INSERM896, CRCM Val d'Aurelle, Montpellier, France
| | | | - Laurence Brugières
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Léa Guerrini-Rousseau
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- Molecular Predictors and New Targets in Oncology, Inserm U981 Team "Genomics and Oncogenesis of Pediatric Brain Tumors", Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Béatrice Claret
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- Psycho-Oncology Unit, Supportive Care Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Hélène Cavé
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Département de Génétique, Paris, France
- INSERM UMR_S1131, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris, France
| | - Marion Strullu
- INSERM UMR_S1131, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Service d'Hémato-Immunologie Pédiatrique, Paris, France
| | - Lucile Hervouet
- IRIS Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (UMR 8156 CNRS-997 INSERM-EHESS-UPSN), Campus Condorcet, Aubervilliers, France
| | - Khadija Lahlou-Laforêt
- UF of Psychology and Liaison and Emergency Psychiatry, DMU Psychiatry and Addictology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Département de Médecine Génomique des Tumeurs et des Cancers, Consultation d'oncogénétique Multidisciplinaire des Cancers Rares, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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Bon SBB, Wouters RHP, Bakhuizen JJ, Jongmans MCJ, van den Heuvel-Eibrink MM, Grootenhuis MA. Experiences of pediatric cancer patients (age 12-18 years) with extensive germline sequencing for cancer predisposition: a qualitative study. Eur J Hum Genet 2024; 32:567-575. [PMID: 38409533 PMCID: PMC11061193 DOI: 10.1038/s41431-024-01565-3] [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: 10/06/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
This study explored the experiences and needs of adolescents, ranging from 12 to 18 years old, who have recently been diagnosed with cancer and participated in a nationwide germline genetic sequencing study within the context of pediatric oncology. The 21 adolescents in this qualitative interview study viewed genetic sequencing as an integral part of their cancer journey. They often characterized germline sequencing as "good-to-know" without specifying immediate utility. While the adolescents comprehended the significance of germline genetic sequencing, they were less focused on its potential long-term implications. Adolescents expressed a strong desire to be actively engaged in decisions related to genetics. They advocated for a participatory role in genetic decision-making from a young age onwards. They recommended that re-consent should be sought before re-analysis of their genetic data is performed and believe that patients should have the opportunity to provide (re-)consent once they reach adulthood. Moreover, the adolescents emphasized the importance of developing counseling materials that are not only concise but also visually attractive. In conclusion, this study underscores the positive perception that adolescents diagnosed with cancer hold regarding germline genetic sequencing. They articulate a strong interest in being actively involved in genetic decision-making. To address these articulated needs and preferences, we recommend the development of visually engaging counseling materials. These materials should effectively convey both the immediate and long-term implications of genetic sequencing, enabling adolescents with cancer to make informed decisions about genetic sequencing.
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Affiliation(s)
- Sebastian B B Bon
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Roel H P Wouters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jette J Bakhuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolijn C J Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina's Children's Hospital, Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina's Children's Hospital, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina's Children's Hospital, Utrecht, The Netherlands
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Greene BL, Rosenberg AR, Marron JM. A Communication and Decision-Making Framework for Pediatric Precision Medicine. Pediatrics 2024; 153:e2023062850. [PMID: 38505927 PMCID: PMC10979296 DOI: 10.1542/peds.2023-062850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/21/2024] Open
Abstract
Advances in genomic testing have been pivotal in moving childhood cancer care forward, with genomic testing now a standard diagnostic tool for many children, adolescents, and young adults with cancer. Beyond oncology, the role of genomic testing in pediatric research and clinical care is growing, including for children with developmental differences, cardiac abnormalities, and epilepsy. Despite more standard use in their patients, pediatricians have limited guidance on how to communicate this complex information or how to engage parents in decisions related to precision medicine. Drawing from empirical work in pediatric informed consent and existing models of shared decision-making, we use pediatric precision cancer medicine as a case study to propose a conceptual framework to approach communication and decision-making about genomic testing in pediatrics. The framework relies on identifying the type of genomic testing, its intended role, and its anticipated implications to inform the scope of information delivered and the parents' role in decision-making (leading to shared decision-making along a continuum from clinician-guided to parent-guided). This type of framework rests on practices known to be standard in other complex decision-making but also integrates unique features of genomic testing and precision medicine. With the increasing prominence of genomics and precision medicine in pediatrics, with our communication and decision-making framework, we aim to guide clinicians to better support their pediatric patients and their parents in making informed, goal-concordant decisions throughout their care trajectory.
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Affiliation(s)
- Brittany L. Greene
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Abby R. Rosenberg
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Jonathan M. Marron
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts
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Hines-Dowell S, McNamara E, Mostafavi R, Taylor L, Harrison L, McGee RB, Blake AK, Lewis S, Perrino M, Mandrell B, Nichols KE. Genomes for Nurses: Understanding and Overcoming Barriers to Nurses Utilizing Genomics. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:140-147. [PMID: 38347731 DOI: 10.1177/27527530231214540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background: Genomic testing is an increasingly important technology within pediatric oncology that aids in cancer diagnosis, provides prognostic information, identifies therapeutic targets, and reveals underlying cancer predisposition. However, nurses lack basic knowledge of genomics and have limited self-assurance in using genomic information in their daily practice. This single-institution project was carried out at an academic pediatric cancer hospital in the United States with the aim to explore the barriers to achieving genomics literacy for pediatric oncology nurses. Method: This project assessed barriers to genomic education and preferences for receiving genomics education among pediatric oncology nurses, nurse practitioners, and physician assistants. An electronic survey with demographic questions and 15 genetics-focused questions was developed. The final survey instrument consisted of nine sections and was pilot-tested prior to administration. Data were analyzed using a ranking strategy, and five focus groups were conducted to capture more-nuanced information. The focus group sessions lasted 40 min to 1 hour and were recorded and transcribed. Results: Over 50% of respondents were uncomfortable with or felt unprepared to answer questions from patients and/or family members about genomics. This unease ranked as the top barrier to using genomic information in clinical practice. Discussion: These results reveal that most nurses require additional education to facilitate an understanding of genomics. This project lays the foundation to guide the development of a pediatric cancer genomics curriculum, which will enable the incorporation of genomics into nursing practice.
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Affiliation(s)
| | | | | | - Leslie Taylor
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lynn Harrison
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rose B McGee
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alise K Blake
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sara Lewis
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Kim E Nichols
- St. Jude Children's Research Hospital, Memphis, TN, USA
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Peter M, Hammond J, Sanderson SC, Gurasashvili J, Hunter A, Searle B, Patch C, Chitty LS, Hill M, Lewis C. Knowledge, attitudes and decision regret: a longitudinal survey study of participants offered genome sequencing in the 100,000 Genomes Project. Eur J Hum Genet 2023; 31:1407-1413. [PMID: 37789083 PMCID: PMC10689827 DOI: 10.1038/s41431-023-01470-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
We used cross-sectional surveys to compare the knowledge, attitudes, and decision regret of participants who had consented for genome sequencing (GS) for rare disease diagnosis in the 100,000 Genomes Project (100kGP) across two timepoints (at the time of consenting for GS (T1) and 12-18 months later (T2)). At T1, participants (n = 504) completed a survey that included measures of general knowledge of GS ("Knowledge of Genome Sequencing" (KOGS)), specific knowledge of GS and attitudes towards GS ("General attitudes" and "Specific attitudes"). At T2, participants (n = 296) completed these same assessments (apart from the specific knowledge scale) together with an assessment of decision regret towards GS ("Decisional Regret Scale"). At 12-18 months after consenting for GS, participants' basic knowledge of GS had remained stable. General knowledge of GS varied across topics; concepts underlying more general information about genetics were better understood than the technical details of genomic testing. Attitudes towards GS at T2 were generally positive, and feelings towards GS (both positive and negative) remained unchanged. However, those who were more positive about the test at the outset had greater specific knowledge (as opposed to general knowledge) of GS. Finally, although the majority of participants indicated feeling little regret towards undergoing GS, those with low positive attitude and high negative attitude about GS at T1 reported greater decision regret at T2. Careful assessment of patient knowledge about and attitudes towards GS at the time of offering testing is crucial for supporting informed decision making and mitigating later regret.
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Affiliation(s)
- Michelle Peter
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jennifer Hammond
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Saskia C Sanderson
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jana Gurasashvili
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Beverly Searle
- Unique - Rare Chromosome Disorder Support Group, Oxted, UK
| | - Christine Patch
- Engagement and Society, Wellcome Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1RQ, UK
| | - Lyn S Chitty
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.
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Mandrell BN, Blake AK, Sharp KMH, Gattuso JS, McGee RB, Harrison L, Ouma A, Caples M, Johnson LM, Nichols KE. Parental Understanding of Their Child's Germline Genomic Testing: Intent of Disclosure to Their Child and Family. J Pers Med 2023; 13:1656. [PMID: 38138883 PMCID: PMC10744428 DOI: 10.3390/jpm13121656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
Genomic testing is becoming increasingly common in the care of pediatric patients with cancer. Parental understanding of germline results and their intent and timing of results disclosure to their child and family may have significant implications on the family unit. The purpose of this study was to examine parental understanding of germline genomic results and plans for disclosure to their child and other relatives. Semi-structured interviews were conducted with 64 parents of children with cancer, approximately eight weeks after parents had received their child's results. Parents of children with negative results (n = 20), positive results (n = 15), or variants of uncertain significance (n = 29), were interviewed. Fifty-three parents (83%) correctly identified their child's results as negative, uncertain, or positive. Most parents had disclosed results to family members; however, only 11 parents (17%) acknowledged discussing results with their child. Most parents delayed disclosure due to the young age of their child at the time of testing. In summary, most parents appropriately described their child's germline genomic results, yet few discussed the results with their child due to age. Families should be followed with supportive counseling to assist parents in the timing and content of result disclosure to their children.
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Affiliation(s)
- Belinda N. Mandrell
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.S.G.); (M.C.)
| | - Alise K. Blake
- Division of Cancer Predisposition, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (A.K.B.); (R.B.M.); (L.H.); (A.O.); (K.E.N.)
| | | | - Jami S. Gattuso
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.S.G.); (M.C.)
| | - Rose B. McGee
- Division of Cancer Predisposition, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (A.K.B.); (R.B.M.); (L.H.); (A.O.); (K.E.N.)
| | - Lynn Harrison
- Division of Cancer Predisposition, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (A.K.B.); (R.B.M.); (L.H.); (A.O.); (K.E.N.)
| | - Annastasia Ouma
- Division of Cancer Predisposition, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (A.K.B.); (R.B.M.); (L.H.); (A.O.); (K.E.N.)
| | - Mary Caples
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.S.G.); (M.C.)
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Kim E. Nichols
- Division of Cancer Predisposition, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (A.K.B.); (R.B.M.); (L.H.); (A.O.); (K.E.N.)
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8
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Howard Sharp KM, Nichols KE. Insights into parent and adolescent patient understanding of genomic sequencing. Cancer 2023; 129:3519-3521. [PMID: 37698526 DOI: 10.1002/cncr.34996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
In a rapidly evolving genomics landscape, parents of children with cancer are asked to consider complex genetic concepts in order to make decisions about sequencing and comprehend the implications of results, all while facing a challenging diagnosis. To optimize parent and patient understanding, it is critical that the clinicians offering sequencing and disclosing results are aware of patient and family expectations and sufficiently educate them about the processes, procedures, and potential outcomes of paired tumor–germline sequencing.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kim E Nichols
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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9
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Gereis JM, Hetherington K, Robertson EG, Daly R, Donoghoe MW, Ziegler DS, Marshall GM, Lau LMS, Marron JM, Wakefield CE. Parents' and adolescents' perspectives and understanding of information about childhood cancer precision medicine. Cancer 2023; 129:3645-3655. [PMID: 37376781 DOI: 10.1002/cncr.34914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/24/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Precision medicine is projected to become integral to childhood cancer care. As such, it is essential to support families to understand what precision medicine entails. METHODS A total of 182 parents and 23 adolescent patients participating in Precision Medicine for Children with Cancer (PRISM), an Australian precision medicine clinical trial for high-risk childhood cancer, completed questionnaires after study enrollment (time 0 [T0]). Of the parents, 108 completed a questionnaire and 45 completed an interview following return of precision medicine results (time 1 [T1]). We analyzed the mixed-methods data comprising measures exploring families' perceptions and understanding of PRISM's participant information sheet and consent form (PISCF), and factors associated with understanding. RESULTS Most parents were satisfied with the PISCF, rating it as at least "somewhat" clearly presented (n = 160/175; 91%) and informative (n = 158/175; 90%). Many suggested improvements including the use of clearer language and a more visually engaging format. Parents' actual understanding of precision medicine was low on average, but scores improved between T0 and T1 (55.8/100-60.0/100; p = .012). Parents from culturally and/or linguistically diverse backgrounds (n = 42/177; 25%) had lower actual understanding scores than those from a Western/European background whose first language was English (p = .010). There was little correlation between parents' perceived and actual understanding scores (p = .794; Pearson correlation -0.020; 95% CI, -0.169 to 0.116). Most adolescent patients read the PISCF either "briefly" or "not at all" (70%) and had a perceived understanding score of 63.6/100 on average. CONCLUSIONS Our study revealed gaps in families' understanding of childhood cancer precision medicine. We highlighted areas for potential intervention such as through targeted information resources. PLAIN LANGUAGE SUMMARY Precision medicine is projected to become part of the standard of care for children with cancer. Precision medicine aims to give the right treatment to the right patient and involves several complex techniques, many of which may be challenging to understand. Our study analyzed questionnaire and interview data from parents and adolescent patients enrolled in an Australian precision medicine trial. Findings revealed gaps in families' understanding of childhood cancer precision medicine. Drawing on parents' suggestions and the literature, we make brief recommendations about improving information provision to families, such as through targeted information resources.
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Affiliation(s)
- Jessica M Gereis
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Kate Hetherington
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Eden G Robertson
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rebecca Daly
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Mark W Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - David S Ziegler
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Loretta M S Lau
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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10
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McGill BC, Wakefield CE, Tucker KM, Daly RA, Donoghoe MW, Vetsch J, Warby M, Fuentes‐Bolanos NA, Barlow‐Stewart K, Kirk J, Courtney E, O’Brien TA, Marshall GM, Pinese M, Cowley MJ, Tyrrell V, Deyell RJ, Ziegler DS, Hetherington K. Parents' expectations, preferences, and recall of germline findings in a childhood cancer precision medicine trial. Cancer 2023; 129:3620-3632. [PMID: 37382186 PMCID: PMC10952780 DOI: 10.1002/cncr.34917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Germline genome sequencing in childhood cancer precision medicine trials may reveal pathogenic or likely pathogenic variants in cancer predisposition genes in more than 10% of children. These findings can have implications for diagnosis, treatment, and the child's and family's future cancer risk. Understanding parents' perspectives of germline genome sequencing is critical to successful clinical implementation. METHODS A total of 182 parents of 144 children (<18 years of age) with poor-prognosis cancers enrolled in the Precision Medicine for Children with Cancer trial completed a questionnaire at enrollment and after the return of their child's results, including clinically relevant germline findings (received by 13% of parents). Parents' expectations of germline genome sequencing, return of results preferences, and recall of results received were assessed. Forty-five parents (of 43 children) were interviewed in depth. RESULTS At trial enrollment, most parents (63%) believed it was at least "somewhat likely" that their child would receive a clinically relevant germline finding. Almost all expressed a preference to receive a broad range of germline genomic findings, including variants of uncertain significance (88%). Some (29%) inaccurately recalled receiving a clinically relevant germline finding. Qualitatively, parents expressed confusion and uncertainty after the return of their child's genome sequencing results by their child's clinician. CONCLUSIONS Many parents of children with poor-prognosis childhood cancer enrolled in a precision medicine trial expect their child may have an underlying cancer predisposition syndrome. They wish to receive a wide scope of information from germline genome sequencing but may feel confused by the reporting of trial results.
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11
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Howard Sharp KM, Li C, Lu Z, Clark ME, Jurbergs N, Ouma A, Harrison L, Gerhardt E, Taylor L, Hamilton KV, McGee RB, Nuccio R, Hines-Dowell S, Gattuso JS, Pritchard M, Mandrell BN, Tercyak KP, Nichols KE, Johnson LM. Parent Quality of Life After Disclosure of Pediatric Oncology Germline Sequencing Results. JCO Precis Oncol 2023; 7:e2300159. [PMID: 37944075 DOI: 10.1200/po.23.00159] [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: 04/03/2023] [Revised: 07/06/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To characterize parents' quality of life (QoL) after germline genomic sequencing for their children with cancer. METHODS Participants were n = 104 parents of children with cancer enrolled in a prospective study of clinical tumor and germline genomic sequencing. Parents completed surveys at study consent (T0), before disclosure of their child's germline results (T1), and again ≥5 weeks after results disclosure (T2). Bivariate associations with QoL were examined, followed by a multivariable regression model predicting parents' psychological distress. RESULTS At T2, parental distress significantly differed by their children's germline result type (positive, uncertain, negative; P = .038), parent relationship status (P = .04), predisclosure genetics knowledge (P = .006), and predisclosure worry about sequencing (P < .001). Specifically, parents of children with positive (ie, pathogenic or likely pathogenic) results experienced greater distress than those of children with negative results (P = .029), as did parents who were single, more knowledgeable about genetics, and with greater worry. In the adjusted regression model, a positive germline result remained significantly associated with parents' lower QoL at T2 follow-up (F [4,92] = 9.95; P < .001; R2 = .30; β = .19; P = .031). CONCLUSION Germline genomic sequencing for children with cancer is associated with distress among parents when revealing an underlying cancer predisposition among their affected children. Genetic education and counseling before and after germline sequencing may help attenuate this impact on QoL by addressing parents' concerns about test results and their health implications. Assessing parents' worry early in the testing process may also aid in identifying those most likely in need of psychosocial support.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Chen Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Mary Egan Clark
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Annastasia Ouma
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie Taylor
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Kayla V Hamilton
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Rose B McGee
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Regina Nuccio
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Stacy Hines-Dowell
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Jami S Gattuso
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Michelle Pritchard
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Belinda N Mandrell
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kim E Nichols
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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12
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Sharma A, Young A, Carroll Y, Darji H, Li Y, Mandrell B, Nelson MN, Owens CL, Irvine M, Caples M, Jerkins LP, Unguru Y, Hankins JS, Johnson LM. Gene therapy in sickle cell disease: Attitudes and informational needs of patients and caregivers. Pediatr Blood Cancer 2023; 70:e30319. [PMID: 36975201 PMCID: PMC10187715 DOI: 10.1002/pbc.30319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/23/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited blood disorder that results in serious morbidity and early mortality. Novel therapies for SCD, most notably genetic therapies (GTs) and HLA-mismatched donor hematopoietic cell transplantation, are in clinical trials. While potentially curative, these interventions are some of the most intensive treatments for SCD and are associated with serious and life-altering side effects, which may manifest several years after treatment. Little is known about knowledge, beliefs, and attitudes of individuals with SCD, or their caregivers, toward existing and these emerging therapies. METHODS Patients with SCD at least 13 years of age (n = 66) and caregivers (n = 38) were surveyed about knowledge, attitudes, and beliefs surrounding treatments for SCD. RESULTS Only 4.8% felt "extremely knowledgeable" about GT for SCD while the majority (63.4%) reported little knowledge. Overall, health literacy was low among respondents. Most respondents had a neutral attitude regarding the safety of GT for SCD, and whether it was a good treatment for the disorder (56.7% and 58.6%, respectively). Only a few respondents endorsed the idea that GT was "unsafe" or "not a good treatment" (5.8% and 4.8%, respectively). There was an association between increasing knowledge about GT and agreement that it is safe (p = .012) and a good treatment for SCD (p = .031). CONCLUSIONS Given that very few patients with SCD feel knowledgeable about GT and a majority have neutral feelings about the safety and utility of this new approach, culturally appropriate patient-centered education is urgently needed as these treatments get regulatory approval and proceed to the clinic.
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Affiliation(s)
- Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital
| | - Amanda Young
- Department of Communication and Film, University of Memphis
| | - Yvonne Carroll
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Himani Darji
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Yimei Li
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Belinda Mandrell
- Division of Nursing Research, St. Jude Children’s Research Hospital
| | | | | | - Mary Irvine
- Hospitalist Program, St. Jude Children’s Research Hospital
| | - Mary Caples
- Division of Nursing Research, St. Jude Children’s Research Hospital
| | | | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children’s Hospital at Sinai
- Berman Institute of Bioethics, Johns Hopkins University
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Liza-Marie Johnson
- Hospitalist Program, St. Jude Children’s Research Hospital
- Department of Oncology, St. Jude Children’s Research Hospital
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13
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Gereis J, Hetherington K, Ha L, Robertson EG, Ziegler DS, Barlow-Stewart K, Tucker KM, Marron JM, Wakefield CE. Parents' understanding of genome and exome sequencing for pediatric health conditions: a systematic review. Eur J Hum Genet 2022; 30:1216-1225. [PMID: 35999452 PMCID: PMC9626631 DOI: 10.1038/s41431-022-01170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Genome and exome sequencing (GS/ES) are increasingly being used in pediatric contexts. We summarize evidence regarding the actual and perceived understanding of GS/ES of parents of a child offered testing for diagnosis and/or management of a symptomatic health condition. We searched four databases (2008-2021) and identified 1264 unique articles, of which 16 met inclusion criteria. We synthesized data from qualitative and quantitative studies and organized results using Ayuso et al. (2013)'s framework of key elements of information for informed consent to GS/ES. Many of the parents represented had prior experience with genetic testing and accessed a form of genetic counseling. Parents' understanding was varied across the domains evaluated. Parents demonstrated understanding of the various potential direct clinical benefits to their child undergoing GS/ES, including in relation to other genetic tests. We found parents had mixed understanding of the nature of potential secondary findings, and of issues related to data privacy, confidentiality, and usage of sequencing results beyond their child's clinical care. Genetic counseling consultations improved understanding. Our synthesis indicates that ES/GS can be challenging for families to understand and underscores the importance of equipping healthcare professionals to explore parents' understanding of ES/GS and the implications of testing for their child.
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Affiliation(s)
- Jessica Gereis
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Kate Hetherington
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Lauren Ha
- grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Health Sciences, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Eden G. Robertson
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - David S. Ziegler
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia
| | - Kristine Barlow-Stewart
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Katherine M. Tucker
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Jonathan M. Marron
- grid.65499.370000 0001 2106 9910Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XCenter for Bioethics, Harvard Medical School, Boston, MA USA
| | - Claire E. Wakefield
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
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14
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Johnson LM. Time for a Reboot: Multimodal approaches to improving informed consent communication in pediatric oncology. Pediatr Blood Cancer 2022; 69:e29855. [PMID: 35731842 DOI: 10.1002/pbc.29855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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15
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Mandrell BN, Johnson LM, Caples M, Gattuso J, Maciaszek JL, Mostafavi R, Sharp KMH, Nichols KE. Parental Preferences Surrounding Timing and Content of Consent Conversations for Clinical Germline Genetic Testing Following a Child's New Cancer Diagnosis. JCO Precis Oncol 2022; 6:e2200323. [PMID: 36265116 PMCID: PMC9848596 DOI: 10.1200/po.22.00323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Clinical genomic testing is increasingly being used to direct pediatric cancer care. Many centers are interested in offering testing of tumors and paired germline tissues at or near the time of cancer diagnosis. We conducted this study to better understand parent preferences surrounding timing and content of consent conversations for clinical germline genetic testing of their children with cancer as a part of real-time cancer care. PATIENTS AND METHODS A seven-question survey developed by the Division of Cancer Predisposition and collaborators at St Jude Children's Research Hospital (St Jude) was distributed to members of the St Jude Patient Family Advisory Council, which included parents of childhood cancer survivors and bereaved parents whose children with cancer had died. Parents were asked to provide free text comments after each question. Qualitative methods were used to derive codes from parent comments, and survey results were depicted using descriptive statistics. RESULTS The survey was completed by 172 parents. Ninety-three (54%) endorsed an approach for consent conversations ≥ 1 month after cancer diagnosis, whereas 58 (34%) endorsed an approach at 1-2 weeks and 21 (12%) at 1-2 days. Needing time to adjust to a new or relapsed cancer diagnosis and feeling overwhelmed were frequent themes; however, parents acknowledged the urgency and importance of testing. Parents desired testing of as many cancer-related genes as possible, with clinical utility the most important factor for proceeding with testing. Most parents (75%) desired germline results to be disclosed in person, preferably by a genetic counselor. CONCLUSION Parents described urgency and benefits associated with germline testing, but desired flexibility in timing to allow for initial adjustment after their child's cancer diagnosis.
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Affiliation(s)
- Belinda N. Mandrell
- Division of Nursing Research, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN
| | - Liza Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Mary Caples
- Division of Nursing Research, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN
| | - Jami Gattuso
- Division of Nursing Research, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN
| | - Jamie L. Maciaszek
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Roya Mostafavi
- Division of Cancer Predisposition, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Kim E. Nichols
- Division of Cancer Predisposition, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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16
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Johnson LM, Mandrell BN, Li C, Lu Z, Gattuso J, Harrison LW, Mori M, Ouma AA, Pritchard M, Sharp KMH, Nichols KE. Managing Pandora's Box: Familial Expectations around the Return of (Future) Germline Results. AJOB Empir Bioeth 2022; 13:152-165. [PMID: 35471132 DOI: 10.1080/23294515.2022.2063994] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric oncology patients are increasingly being offered germline testing to diagnose underlying cancer predispositions. Meanwhile, as understanding of variant pathogenicity evolves, planned reanalysis of genomic results has been suggested. Little is known regarding the types of genomic information that parents and their adolescent children with cancer prefer to receive at the time of testing or their expectations around the future return of genomic results. METHODS Parents and adolescent children with cancer eligible for genomic testing for cancer predisposition were surveyed regarding their attitudes and expectations for receiving current and future germline results (ClinicalTrials.gov Identifier: NCT02530658). RESULTS All parents (100%) desired to learn about results for treatable or preventable conditions, with 92.4% wanting results even when there is no treatment or prevention. Parents expressed less interest in receiving uncertain results for themselves (88.3%) than for their children (95.3%). Most parents (95.9%) and adolescents (87.9%) believed that providers have a responsibility to share new or updated germline results indefinitely or at any point during follow-up care. Fewer parents (67.5%) indicated that they would want results if their child was deceased: 10.3% would not want to be contacted, 19.3% were uncertain. CONCLUSIONS Expectations for return of new or updated genomic results are high among pediatric oncology families, although up to one third of parents have reservations about receiving such information in the event of their child's death. These results underscore the importance of high-quality pre-and post-test counseling, conducted by individuals trained in consenting around genomic testing to elicit family preferences and align expectations around the return of germline results.
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Affiliation(s)
- Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Belinda N Mandrell
- Department of Pediatrics, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chen Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jami Gattuso
- Department of Pediatrics, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lynn W Harrison
- Department of Oncology, Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Motomi Mori
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Annastasia A Ouma
- Department of Oncology, Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Department of Pediatrics, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Kim E Nichols
- Department of Oncology, Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN, USA
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17
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Gupta A, Cafazzo JA, IJzerman MJ, Swart JF, Vastert S, Wulffraat NM, Benseler S, Marshall D, Yeung R, Twilt M. Genomic Health Literacy Interventions in Pediatrics: Scoping Review. J Med Internet Res 2021; 23:e26684. [PMID: 34951592 PMCID: PMC8742210 DOI: 10.2196/26684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/21/2021] [Accepted: 11/10/2021] [Indexed: 01/16/2023] Open
Abstract
Background The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results Of the 4618 studies, 14 studies (n=6, 43% qualitative, n=6, 43% mixed methods, and n=2, 14% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts.
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Affiliation(s)
- Aarushi Gupta
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre of Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre of Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Maarten J IJzerman
- Department of Health and Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Twente, Netherlands.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joost F Swart
- Division of Pediatrics, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Sebastiaan Vastert
- Division of Pediatrics, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Nico M Wulffraat
- Division of Pediatrics, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Susanne Benseler
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah Marshall
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rae Yeung
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, AB, Canada.,Immunology and Institute of Medical Science, University of Toronto, Toronto, AB, Canada
| | - Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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18
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Hirsch S, Dikow N, Pfister SM, Pajtler KW. Cancer predisposition in pediatric neuro-oncology-practical approaches and ethical considerations. Neurooncol Pract 2021; 8:526-538. [PMID: 34594567 DOI: 10.1093/nop/npab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A genetic predisposition to tumor development can be identified in up to 10% of pediatric patients with central nervous system (CNS) tumors. For some entities, the rate of an underlying predisposition is even considerably higher. In recent years, population-based approaches have helped to further delineate the role of cancer predisposition in pediatric oncology. Investigations for cancer predisposition syndrome (CPS) can be guided by clinical signs and family history leading to directed testing of specific genes. The increasingly adopted molecular analysis of tumor and often parallel blood samples with multi-gene panel, whole-exome, or whole-genome sequencing identifies additional patients with or without clinical signs. Diagnosis of a genetic predisposition may put an additional burden on affected families. However, information on a given cancer predisposition may be critical for the patient as potentially influences treatment decisions and may offer the patient and healthy carriers the chance to take part in intensified surveillance programs aiming at early tumor detection. In this review, we discuss some of the practical and ethical challenges resulting from the widespread use of new diagnostic techniques and the most important CPS that may manifest with brain tumors in childhood.
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Affiliation(s)
- Steffen Hirsch
- Hopp-Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp-Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp-Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
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19
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Mandrell BN, Gattuso JS, Pritchard M, Caples M, Howard Sharp KM, Harrison L, Ouma AA, Valdez JM, Johnson LM, Nichols KE. Knowledge Is Power: Benefits, Risks, Hopes, and Decision-Making Reported by Parents Consenting to Next-Generation Sequencing for Children and Adolescents with Cancer. Semin Oncol Nurs 2021; 37:151167. [PMID: 34127338 DOI: 10.1016/j.soncn.2021.151167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To qualitatively describe parent perspectives of next-generation genomic sequencing (NGS) for their children with cancer, including perceived benefits, risks, hopes/expectations, and decision-making process when consenting or not consenting to NGS and prior to result disclosure. DATA SOURCES Qualitative interviews were used. CONCLUSION Altruism is an important factor in parents consenting to NGS testing, as well as making sense of their child's cancer and legacy building. Parents described realistic hopes and expectations associated with NGS participation. Although parents endorsed the likelihood of no medical benefit, those consenting to NGS felt there was no reason not to participate. Parents declining participation expressed avoidance of worry and parent guilt if a germline variant were to be disclosed. IMPLICATIONS FOR NURSING PRACTICE As NGS evolves into a component of the routine diagnostic workup for pediatric cancer patients, genetic nurses play a role in conducting informed consent conversations and ensuring that patients and families have realistic hopes and expectations associated with NGS.
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Affiliation(s)
- Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN.
| | - Jami S Gattuso
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Michele Pritchard
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Mary Caples
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Lynn Harrison
- Department of Oncology, Division Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
| | - Annastasia A Ouma
- Department of Oncology, Division Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
| | - Jessica M Valdez
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque
| | - Liza-Marie Johnson
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN
| | - Kim E Nichols
- Department of Oncology, Division Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
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20
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Rogers BR, Johnson LM. Informed Consent Conversations: Neither the Beginning nor the End. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:76-78. [PMID: 33945412 DOI: 10.1080/15265161.2021.1907481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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21
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Murray AK, McGee RB, Mostafavi RM, Wang X, Lu Z, Valdez JM, Terao MA, Nichols KE. Creating a cancer genomics curriculum for pediatric hematology-oncology fellows: A national needs assessment. Cancer Med 2021; 10:2026-2034. [PMID: 33624449 PMCID: PMC7957159 DOI: 10.1002/cam4.3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/08/2022] Open
Abstract
Background With the advent of next generation sequencing, tumor and germline genomic testing are increasingly being used in the management of pediatric cancer patients. Despite this increase in testing, many pediatric hematology–oncology (PHO) providers are not confident interpreting or utilizing tumor or germline genomic results to care for their patients. Methods We developed and delivered a needs assessment survey to PHO program directors, attendings, and fellows in the United States to understand this deficiency, gather data on existing cancer genomics educational initiatives, and query preferences for creating a future curriculum. Results The survey includes 31 (41%) of 74 invited PHO program directors, 110 (11%) of 1032 invited attendings, and 79 fellows. The majority of attending physicians and fellows responding to the survey agree that understanding tumor (95% attending physicians; 95% fellows) and germline (86% attending physicians; 94% fellows) genomic information is essential for their practice. However, only 9 of 31 (29%) responding programs report that they have an existing cancer genomics curriculum. Most program directors indicated that the ideal genomics curriculum would occur during the first year of fellowship and incorporate direct patient care, online modules, and problem‐based learning. Attending physicians and fellows identified that addressing indications for ordering tumor and germline genomic testing, counseling about the risks and benefits of such testing, and interpreting and individualizing clinical management based on tumor and germline results should be included in a future curriculum. Conclusion The results of this study reveal a great need to develop a curriculum that can be offered across PHO fellowship programs to expand knowledge in the area of cancer genomics.
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Affiliation(s)
- Alise K Murray
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rose B McGee
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Roya M Mostafavi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiaoqing Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica M Valdez
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Michael A Terao
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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22
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Marron JM. Informed consent for genetic testing in hematology. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:213-218. [PMID: 33275700 PMCID: PMC7727563 DOI: 10.1182/hematology.2020000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Informed consent is a fundamental component of modern health care. All competent adult patients have the legal and ethical authority to accept (consent) or refuse (dissent) recommended health-related interventions. Various models of informed consent have been described, and herein I introduce a model that divides informed consent into 7 distinct elements: competence, voluntariness, disclosure, recommendation, understanding, decision, and authorization. Genetic testing, which is rapidly becoming a common feature of both clinical care and research in hematology, adds additional layers of complexity to each of these consent elements. Using the example case of Mr. Smith, a man with newly diagnosed acute myeloid leukemia whose clinicians offer him genetic testing of the leukemia through a clinical trial, I highlight the challenges and controversies of informed consent for genetic testing, focusing on each consent element as it pertains to genetic testing in such a setting. Ultimately, given the growing importance of genetic testing for hematologic disorders, clinicians, and researchers in hematology should be facile at participating in all aspects of informed consent for genetic testing.
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23
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Juarez OA, Pencheva BB, Bellcross C, Schneider KW, Turner J, Porter CC. Cancer genetic counseling for childhood cancer predisposition is associated with improved levels of knowledge and high satisfaction in parents. J Genet Couns 2020; 30:710-719. [PMID: 33179831 DOI: 10.1002/jgc4.1357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/28/2022]
Abstract
Previous surveys of adults with cancer have revealed increased levels of genetic knowledge, varying levels of worry, and high satisfaction with cancer genetic counseling. We sought to determine the impact of cancer genetic counseling on parental levels of genetic knowledge, worry about cancer, and satisfaction in the context of suspected cancer predisposition in a child. We hypothesized that parents would be satisfied with cancer genetic counseling and that cancer genetic counseling would improve baseline parental genetic knowledge and decrease levels of worry. Parents were recruited from a pediatric cancer predisposition clinic in the United States. A survey was administered to two cohorts: One cohort had received cancer genetic counseling in the past and only completed one survey (post-only, n = 26), and another cohort completed the survey before and after cancer genetic counseling (pre/post, n = 23). The survey included questions on demographics, knowledge of genetics, worry levels, and satisfaction with the cancer genetic counseling service. The post-genetic counseling survey also contained a free-text section for parents to indicate what they took away from the sessions. Parental levels of genetics knowledge increased by an average of 1.9 points (p = .01), with 65.2% of parents demonstrating an increase in genetics knowledge score. Average worry levels did not change significantly (p = .37), with 52.2% of parents indicating decreased worry, and 34.8% indicating increased worry. Overall, 91.8% of parents reported high levels of satisfaction. Our results show that cancer genetic counseling in a pediatric cancer predisposition clinic improves parental levels of genetics knowledge. Satisfaction rates suggest that parents find this service beneficial. These results demonstrate the positive impacts of cancer genetic counseling on parents of children in which a hereditary cancer syndrome is known or suspected.
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Affiliation(s)
| | - Bojana B Pencheva
- Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Kami W Schneider
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joyce Turner
- Children's National Health System Rare Disease Institute, Washington, DC, USA
| | - Christopher C Porter
- Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
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24
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Howard Sharp KM, Jurbergs N, Ouma A, Harrison L, Gerhardt E, Taylor L, Hamilton K, McGee RB, Nuccio R, Quinn E, Hines-Dowell S, Kesserwan C, Sunkara A, Gattuso JS, Pritchard M, Mandrell B, Relling MV, Haidar CE, Kang G, Johnson LM, Nichols KE. Factors Associated with Declining to Participate in a Pediatric Oncology Next Generation Sequencing Study. JCO Precis Oncol 2020; 4:202-211. [PMID: 32395682 PMCID: PMC7213582 DOI: 10.1200/po.19.00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE For the advances of pediatric oncology next generation sequencing (NGS) research to equitably benefit all children, a diverse and representative sample of participants is needed. However, little is known about demographic and clinical characteristics that differentiate families who decline enrollment in pediatric oncology NGS research. METHODS Demographic and clinical data were retrospectively extracted for 363 pediatric oncology patients (0-21 years) approached for enrollment on Genomes for Kids (G4K), a study examining the feasibility of comprehensive clinical genomic analysis of tumors and paired normal samples. Demographic and clinical factors that significantly differentiated which families declined were subsequently compared to enrollment in Clinical Implementation of Pharmacogenetics (PG4KDS) for 348 families, a pharmacogenomics study with more explicit therapeutic benefit examining genes affecting drug responses and metabolism. RESULTS Fifty-three (14.6%) families declined enrollment in G4K. Race/ethnicity was the only variable that significantly differentiated study refusal using multivariate logistic regression, with families of black children more likely to decline enrollment compared to families of non-Hispanic or Hispanic white children. Reasons for declining G4K were generally consistent with other pediatric genomics research, with feeling overwhelmed and insurance discrimination fears most frequently cited. Families of black children were also more likely to decline enrollment in PG4KDS. Thirteen (3.7%) of the 348 families approached for both studies declined PG4KDS. CONCLUSION Race/ethnicity differentiated study declination across two different pediatric oncology genomics studies, suggesting enrollment disparities in the context of pediatric oncology genomics research. Genomics research participant samples that do not fully represent racial and ethnic minorities risk further exacerbating health disparities. Additional work is needed to understand the nuances of parental decision making in genomic research and facilitate enrollment of diverse patient populations.
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Affiliation(s)
| | - Niki Jurbergs
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, TN
| | - Annastasia Ouma
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Leslie Taylor
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Kayla Hamilton
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Rose B. McGee
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Regina Nuccio
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Emily Quinn
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Stacy Hines-Dowell
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Chimene Kesserwan
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
| | - Anusha Sunkara
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Jami S. Gattuso
- Division of Nursing Research, St Jude Children’s Research Hospital, Memphis, TN
| | - Michelle Pritchard
- Division of Nursing Research, St Jude Children’s Research Hospital, Memphis, TN
| | - Belinda Mandrell
- Division of Nursing Research, St Jude Children’s Research Hospital, Memphis, TN
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, TN
| | - Cyrine E. Haidar
- Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, TN
| | - Guolian Kang
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Liza M. Johnson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Kim E. Nichols
- Division of Cancer Predisposition, St Jude Children’s Research Hospital, Memphis, TN
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25
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Mandrell BN, Hines-Dowell S, Nishigaki M. Genetics and Genomics: Precision Health in Pediatric Oncology. PEDIATRIC ONCOLOGY 2020. [DOI: 10.1007/978-3-030-25804-7_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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