1
|
McIntosh T, Walsh H, Baldwin K, Iltis A, Mohan S, Sawinski D, Goodman M, DuBois JM. Evaluating ApoL1 Genetic Testing Policy Options for Transplant Centers: A Delphi Consensus Panel Project with Stakeholders. Clin J Am Soc Nephrol 2024; 19:494-502. [PMID: 38190141 PMCID: PMC11020447 DOI: 10.2215/cjn.0000000000000397] [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: 09/29/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Apolipoprotein L1 (ApoL1) variants G1 and G2 are associated with a higher risk of kidney disease. ApoL1 risk variants are predominantly seen in individuals with sub-Saharan African ancestry. In most transplant centers, potential organ donors are being selectively genetically tested for ApoL1 risk variants. Transplant programs have highly variable ApoL1 testing practices and need guidance on essential ApoL1 clinical policy questions. METHODS We conducted a Delphi consensus panel focused on ApoL1 clinical policy questions, including who gets tested, who decides whether testing occurs, how test results are shared, who receives test results, and how test results are used. A total of 27 panelists across seven stakeholder groups participated: living kidney donors ( n =4), deceased donor family members ( n =3), recipients of a deceased donor kidney ( n =4), recipients of a living donor kidney ( n =4), nephrologists ( n =4), transplant surgeons ( n =4), and genetic counselors ( n =4). Nineteen panelists (70%) identified as Black. The Delphi panel process involved two rounds of educational webinars and three rounds of surveys administered to panelists, who were asked to indicate whether they support, could live with, or oppose each policy option. RESULTS The panel reached consensus on one or more acceptable policy options for each clinical policy question; panelists supported 18 policy options and opposed 15. Key elements of consensus include the following: ask potential donors about African ancestry rather than race; make testing decisions only after discussion with donors; encourage disclosure of test results to blood relatives and organ recipients but do not require it; use test results to inform decision making, but never for unilateral decisions by transplant programs. CONCLUSIONS The panel generally supported policy options involving discussion and shared decision making among patients, donors, and family stakeholders. There was general opposition to unilateral decision making and prohibiting donation altogether.
Collapse
Affiliation(s)
- Tristan McIntosh
- Bioethics Resaerch Center, Washington University School of Medicine, St. Louis, Missouri
| | - Heidi Walsh
- Bioethics Resaerch Center, Washington University School of Medicine, St. Louis, Missouri
| | - Kari Baldwin
- Bioethics Resaerch Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ana Iltis
- Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, North Carolina
| | - Sumit Mohan
- Mailman School of Public Health, Columbia University, New York, New York
| | | | - Melody Goodman
- School of Global Public Health, New York University, New York, New York
| | - James M. DuBois
- Bioethics Resaerch Center, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
2
|
Eades-Brown NT, Oguntoye AO, Aldossary D, Ezenwa MO, Duckworth L, Dede D, Johnson-Mallard V, Yao Y, Gallo A, Wilkie DJ. Adherence to a reproductive health intervention for young adults with sickle cell. J Am Assoc Nurse Pract 2024:01741002-990000000-00207. [PMID: 38408228 DOI: 10.1097/jxx.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/29/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND The CHOICES intervention is tailored specifically for young adults with sickle cell disease (SCD) or sickle cell trait (SCT). The face-to-face (F2F) delivery format is feasible with efficacy for improving knowledge about reproductive health for those with SCD or SCT. PURPOSE The purpose of the study was to compare the participant adherence to a remote online CHOICES intervention study (N = 107) and a F2F CHOICES intervention study (N = 234). METHODOLOGY In both studies, participants with SCD or SCT were randomized into experimental or usual care control groups. Descriptive statistics were collected for all participants by group in both studies. Adherence was measured by retention at each data collection time point. Independent t-tests were conducted to compare mean participant adherence of the F2F and online studies postbaseline (6, 12, 18, and 24 months). RESULTS There was a significant difference in mean adherence postbaseline between the studies (p = .005). The results suggest that more research is necessary for proper online participant retention. CONCLUSION Advance practice nurses that are well informed on CHOICES can transmit the availability of this evidence-based intervention to this special population. Special referral for the CHOICES intervention, which is tailored specifically for young adults with SCD or SCT, may increase adherence to the intervention if it comes from trusted health care providers. IMPLICATIONS Nurse practitioners are educators in primary and acute care settings. Encounters with reproductive age populations with SCD or SCT can occur in both settings.
Collapse
Affiliation(s)
| | - Anne O Oguntoye
- College of Nursing, University of Florida, Gainesville, Florida
| | - Dalal Aldossary
- College of Nursing, University of Florida, Gainesville, Florida
- Department of Nursing Fundamentals, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Miriam O Ezenwa
- College of Nursing, University of Florida, Gainesville, Florida
| | | | - Duane Dede
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | | | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, Florida
| | - Agatha Gallo
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, Florida
| |
Collapse
|
3
|
Iltis AS, Rolf L, Yaeger L, Goodman MS, DuBois JM. Attitudes and beliefs regarding race-targeted genetic testing of Black people: A systematic review. J Genet Couns 2023; 32:435-461. [PMID: 36644818 DOI: 10.1002/jgc4.1653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023]
Abstract
Geographical ancestry has been associated with an increased risk of various genetic conditions. Race and ethnicity often have been used as proxies for geographical ancestry. Despite numerous problems associated with the crude reliance on race and ethnicity as proxies for geographical ancestry, some genetic testing in the clinical, research, and employment settings has been and continues to be race- or ethnicity-based. Race-based or race-targeted genetic testing refers to genetic testing offered only or primarily to people of particular racial or ethnic groups because of presumed differences among groups. One current example is APOL1 testing of Black kidney donors. Race-based genetic testing raises numerous ethical and policy questions. Given the ongoing reliance on the Black race in genetic testing, it is important to understand the views of people who identify as Black or are identified as Black (including African American, Afro-Caribbean, and Hispanic Black) regarding race-based genetic testing that targets Black people because of their race. We conducted a systematic review of studies and reports of stakeholder-engaged projects that examined how people who identify as or are identified as Black perceive genetic testing that specifically presumes genetic differences exist among racial groups or uses race as a surrogate for ancestral genetic variation and targets Black people. Our review identified 14 studies that explicitly studied this question and another 13 that implicitly or tacitly studied this matter. We found four main factors that contribute to a positive attitude toward race-targeted genetic testing (facilitators) and eight main factors that are associated with concerns regarding race-targeted genetic testing (barriers). This review fills an important gap. These findings should inform future genetic research and the policies and practices developed in clinical, research, public health, or other settings regarding genetic testing.
Collapse
Affiliation(s)
| | - Liz Rolf
- Washington University in St. Louis School of Medicine
| | - Lauren Yaeger
- Washington University in St. Louis School of Medicine
| | | | | |
Collapse
|
4
|
Oguntoye AO, Eades NT, Ezenwa MO, Krieger J, Jenerette C, Adegbola M, Jacob E, Johnson-Mallard V, Yao Y, Gallo A, Wilkie DJ. Factors associated with young adult engagement with a web-based sickle cell reproductive health intervention. PEC INNOVATION 2022; 1:100063. [PMID: 36618121 PMCID: PMC9815666 DOI: 10.1016/j.pecinn.2022.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To determine the factors predicting the engagement of young adults who have sickle cell disease (SCD) or sickle cell trait (SCT) with an online reproductive health education intervention and engagement effects on knowledge. Methods The cross-sectional study included 167 participants who completed the web-based intervention either face-to-face (F2F) or online delivery (OL). Measures include: time used relative to length of the intervention narration and media (engagement) and the SCKnowIQ questionnaire. Ordinal regression was conducted. Results The sample mean age was 26-years (SD=5), 68% were female, 54% had SCD, and 68% were in the F2F group. Adjusting for age, partner sickle cell status, marital status, and education, participants who were female (p=.003), had SCD (p=.018), or had F2F delivery (p < .001) were more likely to spend more time on the intervention. Adjusting for baseline knowledge and modality, more time spent on the intervention was associated with higher posttest knowledge (p=.006). Conclusions Future studies are necessary to understand reasons underpinning engagement and to investigate other unmeasured factors, such as intervention interactivity elements, that could also be associated with engagement. Innovation This study of young adults with SCD or SCT provides much needed insight about their engagement with online reproductive health education.
Collapse
Affiliation(s)
- Anne O. Oguntoye
- College of Nursing, University of Florida, Gainesville, FL, USA,Corresponding author at: College of Nursing, University of Florida Gainesville, FL 32611, USA. (A.O. Oguntoye)
| | - Nyema T. Eades
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Janice Krieger
- College of Journalism & Communications, University of Florida, Gainesville, FL, USA
| | | | - Maxine Adegbola
- College of Nursing and Health Innovation, University of Texas Arlington, Arlington, TX, USA
| | - Eufemia Jacob
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - Agatha Gallo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Diana J. Wilkie
- College of Nursing, University of Florida, Gainesville, FL, USA
| |
Collapse
|
5
|
Wainstein T, Elliott AM, Austin JC. Considerations for the use of qualitative methodologies in genetic counseling research. J Genet Couns 2022; 32:300-314. [PMID: 36271905 DOI: 10.1002/jgc4.1644] [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: 07/15/2022] [Revised: 08/26/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022]
Abstract
An abundance of qualitative research is being conducted within the genetic counseling field. As this area of research expands, many within our community are "learning through doing", an approach which is practical, but may lack theoretical grounding. This can result in study outputs that do not have the sort of utility for informing clinical practice that is the hallmark of excellent clinical qualitative research. Furthermore, our alignment as a discipline within the health sciences, which still tends to favor quantitative approaches, means that we may often be obliged to justify the use of qualitative methodologies, especially when we intend to use the findings for informing clinical practice. We aim to address these issues by providing guidance about how we, individually and collectively, might think about what excellent qualitative research can look like in our field. In addition to providing information and resources about current best-practices, we discuss how quality can be ensured and evaluated. We seek to legitimize the idea of developing a philosophy of research in pursuit of establishing genetic counseling as an academic discipline. We argue that the principles, ethics, values, and practices of genetic counseling are sufficiently unique that establishing a discipline-specific qualitative research framework is not only warranted, but essential. Ultimately, we hope that this paper can serve as a launching point from which additional discussion about qualitative research can emanate as we strive towards the elevation of this form of inquiry in our field.
Collapse
Affiliation(s)
- Tasha Wainstein
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Research Institute, Vancouver, British Columbia, Canada.,BC Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jehannine C Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Johnson-Mallard V, Oguntoye A, Eades N, Aldossary D, Kuenzli G, Ezenwa MO, Gallo AM, Wilkie DJ. Development of an Online Reproductive Health Intervention for Individuals with Sickle Cell Disease or Trait. WOMEN'S HEALTH REPORTS 2021; 2:142-148. [PMID: 34036297 PMCID: PMC8140351 DOI: 10.1089/whr.2020.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 11/13/2022]
Abstract
The purpose of this article is to describe the method of developing an internet-based reproductive options intervention to increase informed reproductive decision-making among individuals with sickle cell disease (SCD) or sickle cell trait (SCT). An interprofessional team of graphics and media specialist, nurses, physicians, and researchers collaborated to develop the intervention. Individuals from the community served as advisory board members who reviewed and advised on webpage design, content, delivery, and media. The intervention was theory based, delivered online, and experientially oriented for young adults of reproductive age with SCD or SCT. The intervention was culturally specific, supporting individuals with SCD or SCT in making informed reproductive decisions about transmission of SCD or SCT to their offspring. The intervention could be strengthened to include content on implementing behaviors concordant with informed reproductive decisions. Health care providers can use the result of this study to enhance their knowledge about the complexity of parenting options.
Collapse
Affiliation(s)
| | - Anne Oguntoye
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Nyema Eades
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Dalal Aldossary
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Grace Kuenzli
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Miriam O Ezenwa
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Agatha M Gallo
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
7
|
Smith M, Mercado-Sierra M. Health beliefs as a predictor of screening behaviors among college students. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:460-473. [PMID: 33823751 DOI: 10.1080/19371918.2021.1905130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Twenty million people live with a sickle cell disease (SCD) diagnosis globally; about 100,000 reside in the United States of America (US). Although SCD continues to threaten the health, mostly of particular groups in the US, there is a lack of knowledge on risk factors such as unawareness of carrier status, inheritance patterns, and resistance to SCT screening among childbearing age individuals. A cross-sectional survey design using a modified version of the Health Belief Survey assessed college students' SCD beliefs and screening behaviors. Four hundred sixteen students from a North Texas university campus participated in the survey. Although most participants believed that knowing their carrier status was important, only 26% were aware of their status. Findings demonstrated that health beliefs were a significant predictor of screening behaviors. The Universal, Selective, and Indicated Prevention Approach was suggested as a suitable approach to educate, transform health beliefs, and augment screening participation.
Collapse
Affiliation(s)
- Marcella Smith
- School of Social Work, Texas A&M University-Commerce, Commerce, Texas, USA
| | | |
Collapse
|