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Phillips A, Vears DF, Van Hoyweghen I, Borry P. Clinician perspectives on policy approaches to genetic risk disclosure in families. Fam Cancer 2024; 23:177-186. [PMID: 38548926 PMCID: PMC11233314 DOI: 10.1007/s10689-024-00375-2] [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: 10/24/2023] [Accepted: 03/12/2024] [Indexed: 06/06/2024]
Abstract
Genomic sequencing has emerged as a powerful tool with significant implications for patients and their relatives, however, empirical evidence suggests that effective dissemination of risk information within families remains a challenge. Policy responses to address this issue vary across countries, with Belgium notably lacking specific regulations governing nondisclosure of genetic risk. In this study, we conducted semi-structured interviews with clinicians from Belgian clinical genetics centers to gain insight into their perspectives on policy approaches to the disclosure of genetic risk within families. Using real-world examples of legislation and court rulings from France, Australia, and the UK, we explored clinician viewpoints on the roles and responsibilities of both patients and clinicians in the family communication process. Clinicians expressed confusion regarding what was legally permissible regarding contacting at-risk relatives. While there was a consensus among participants that patients have a responsibility to inform their at-risk relatives, participants were hesitant to support the legal enforcement of this duty. Clinicians mostly recognized some responsibility to at-risk relatives, but the extent of this responsibility was a subject of division. Our findings highlight the need for a comprehensive policy that clarifies the roles and responsibilities of clinicians and patients to inform at-risk relatives. Furthermore, the study underscores the practical challenges clinicians face in supporting patients through the complex process of family communication, suggesting a need for additional resources and the exploration of alternative approaches to communication.
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Affiliation(s)
- Amicia Phillips
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium.
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Melbourne Law School, University of Melbourne, Parkville, Australia
| | - Ine Van Hoyweghen
- Life Sciences and Society Lab, Center for Sociological Research, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium
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Poulton A, Curnow L, Eratne D, Sexton A. Family Communication about Diagnostic Genetic Testing for Younger-Onset Dementia. J Pers Med 2023; 13:jpm13040621. [PMID: 37109007 PMCID: PMC10144767 DOI: 10.3390/jpm13040621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Younger-onset dementia (YOD) refers to onset before 65 years of age and may be associated with a genetic cause. Family communication surrounding any genetic risk is complex, and this process may be further complicated in a YOD context due to its effects on cognition, behaviour, and associated psychosocial consequences. This study aimed to investigate how individuals experience family communication about potential genetic risk and testing for YOD. Thematic analysis was performed on verbatim transcripts of nine semi-structured interviews undertaken with family members who attended a neurogenetics clinic due to a relative diagnosed with YOD. The interviews explored the participants’ experiences of learning that YOD might be inherited and the ensuing family communication about genetic testing. Four key themes emerged: (1) a clinical diagnostic odyssey was common and could be a motivator for genomic testing, (2) pre-existing family tension and/or disconnection was a common barrier, (3) family members’ autonomy was considered, and (4) avoidant coping strategies influenced communication. Communication regarding potential YOD genetic risk is a complicated process and may be influenced by pre-existing family dynamics, individual coping mechanisms, and a desire to promote autonomy in relatives. To promote effective risk communication, genetic counsellors should pre-emptively address family tensions that may be exacerbated in the context of genetic testing for YOD, with awareness that family strain during a preceding period of diagnostic odyssey is common. Genetic counsellors can offer psychosocial support to facilitate coping with this tension in an adaptive way. The findings also indicated the importance of extending genetic counselling support to relatives.
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Affiliation(s)
- Alice Poulton
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3051, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC 3051, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Monash IVF Group Ltd., Cremorne, VIC 3121, Australia
| | - Lisette Curnow
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Victorian Clinical Genetics Services, Royal Children’s Hospital, Parkville, VIC 3010, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC 3051, Australia
- Melbourne Neuropsychiarty Centre, The University of Melbourne, Parkville, VIC 3051, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC 3051, Australia
- Walter and Elize Hall Institue of Medical Research, The University of Melbourne, Parkville, VIC 3051, Australia
| | - Adrienne Sexton
- Genomic Medicine, The Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia
- Department of Medicine-Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3052, Australia
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Kimura M, Matsuzaki S, Ishii K, Ogawa M, Kato K. Individual experiences and issues in predictive genetic testing for untreatable hereditary neuromuscular diseases in Japan. Eur J Med Genet 2022; 66:104667. [PMID: 36410650 DOI: 10.1016/j.ejmg.2022.104667] [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: 01/03/2022] [Revised: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
Predictive genetic testing (PT) for hereditary diseases that do not have effective treatment or prevention strategies places a psychological burden on parties and their families. There has been little research on the psychosocial aspects of PT in Japan, nor are there any guidelines. To address this gap, we conducted a questionnaire survey of parties at genetic risk for untreatable hereditary neuromuscular diseases, and the National Liaison Conference of Genetic Medicine Departments (GMDs). Of the 63 parties who responded to the survey, 10 (15.9%) had undergone PT. Of the 67 GMDs, only 18 facilities (26.9%) were conducting PT with written procedures. At least two of the six parties with such results felt that some follow-up would be helpful. One party had taken PT for preimplantation genetic testing for monogenic (PGT-M); four, who had no experience, provided free text responses indicating that PGT-M or prenatal genetic testing was chosen as a motivation. Eight were unaware of PT, and six were unaware of their blood relatives' diseases being "hereditary." The results highlighted the need to: 1) develop guidelines for PT in untreatable hereditary diseases; 2) provide access to PT information; and 3) share the "heritability" of diseases with family and relatives.
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Affiliation(s)
- Midori Kimura
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Sawako Matsuzaki
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kanako Ishii
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanobu Ogawa
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Having an eye for myotonic dystrophy: A qualitative study on experiences and support needs in myotonic dystrophy type 1 patients with a diagnostic delay after early-onset cataract. Neuromuscul Disord 2022; 32:829-835. [DOI: 10.1016/j.nmd.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022]
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Tiller J, Bilkey G, Macintosh R, O'Sullivan S, Groube S, Palover M, Pachter N, Rothstein M, Lacaze P, Otlowski M. Disclosing genetic information to family members without consent: Five Australian case studies. Eur J Med Genet 2020; 63:104035. [PMID: 32805446 DOI: 10.1016/j.ejmg.2020.104035] [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: 06/25/2020] [Revised: 07/22/2020] [Accepted: 08/08/2020] [Indexed: 12/30/2022]
Abstract
Genetic risk information is relevant to individual patients and also their blood relatives. Health practitioners (HPs) routinely advise patients of the importance of sharing genetic information with family members, especially for clinically actionable conditions where prevention is possible. However, some patients refuse to share genetic results with at-risk relatives, and HPs must choose whether to use or disclose genetic information without consent. This requires an understanding of their legal and ethical obligations, which research shows many HPs do not have. A recent UK case held that HPs have a duty to a patient's relatives where there is a proximate relationship, to conduct a balancing exercise of the benefit of disclosure of the genetic risk information to the relative against the interest of the patient in maintaining confidentiality. In Australia, there is currently no legal duty to disclose genetic information to a patient's at-risk relatives, but there are laws and guidelines governing unconsented use/disclosure of genetic information. These laws are inconsistent across different Australian states and health contexts, requiring greater harmonisation. Here we provide an up-to-date and clinically accessible resource summarising the laws applying to HPs across Australia, and outline five Australian case studies which have arisen in clinical genetics services, regarding the disclosure of genetic results to relatives without consent. The issues addressed here are relevant to any Australian HP with access to genetic information, as well as HPs and policy-makers in other jurisdictions considering these issues.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, Monash University, Melbourne, Australia.
| | - Gemma Bilkey
- Western Australian Department of Health, Perth, Australia
| | - Rebecca Macintosh
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Australia
| | | | | | | | | | | | - Paul Lacaze
- Public Health Genomics, Monash University, Melbourne, Australia
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