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van Pottelberghe S, Kupper N, Scheirlynck E, Amin AS, Wilde AAM, Hofman N, Callus E, Biller R, Nekkebroeck J, Van Dooren S, Hes FJ, van der Crabben SN. Are disease-specific patient-reported outcomes measures (PROMs) used in cardiogenetics? A systematic review. Eur J Hum Genet 2024; 32:607-618. [PMID: 38097768 PMCID: PMC11153546 DOI: 10.1038/s41431-023-01510-w] [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: 07/10/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 06/07/2024] Open
Abstract
Patient-reported outcome measures (PROMs) are used to facilitate patient-centered care (PCC). While studies in patients with cardiac conditions have revealed poorer health-related quality of life (HRQoL) and elevated emotional stress, studies in inherited cardiac conditions (ICC) seem rare. A systematic review evaluated which (specific domains of) PROMs are used in patients with ICC. From three databases (PubMed, PsychINFO, and Web of Science) quantitative studies investigating PROMs in patients with ICC were included. A Cochrane-based assessment tool was used to evaluate quality and potential risk of bias per subdomain. Data from 17 eligible articles were extracted. Among the included studies, risk of bias was predominantly high (35%) or unclear (30%). Most (n = 14) studies used a generic health status measure (SF-36, SF-12); 3 studies used a disease-specific PROM (KCCQ- cardiomyopathy and MLFHQ-heart failure). In addition to HRQoL measures, several studies used affective psychological measures (i.e., HADS, CAQ-18, IES-R, and IPQ). The mental health component of the PROMs showed lower scores overall in patients with ICC compared to population norms. Nine studies using HADS and GAD-7/PHQ-9 showed a prevalence of clinically significant anxiety (17-47%) and depression levels (8.3-28%) that were higher than the population norm (8.3% and 6.3%, respectively). HRQoL in patients with ICC is primarily assessed with generic PROMs. Results further confirmed high psychological morbidity in this population. Generic PROMS measures evaluate overall health status, but lack sensitivity to ICC-specific factors like heredity-related concerns. We propose developing a PROM specific for ICC to optimize PCC.
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Affiliation(s)
- Saar van Pottelberghe
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands.
| | - Nina Kupper
- Center of Research on Psychological Disorders and Somatic Diseases; Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Esther Scheirlynck
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Cardiology Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ahmad S Amin
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Nynke Hofman
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Edward Callus
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Clinical Psychology Service, IRCCS Policlinico San Donato Research and University Hospital, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ruth Biller
- European Patient Advocacy Group of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- ARVC-Selbsthilfe e.V., ARVC Patient Association, Munich, Germany
| | - Julie Nekkebroeck
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
| | - Sonia Van Dooren
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Clinical Sciences, Research Group Reproduction and Genetics, Brussel Interuniversity Genomics High Throughput Core (BRIGHTcore), Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Frederik J Hes
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
| | - Saskia N van der Crabben
- Member of the European Reference Network for Rare, Low Prevalence, and/or Complex Diseases of the Heart: ERN GUARD-Heart, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Mitchell LA, Jivani K, Young MA, Jacobs C, Willis AM. Systematic review of the uptake and outcomes from returning secondary findings to adult participants in research genomic testing. J Genet Couns 2024. [PMID: 38197527 DOI: 10.1002/jgc4.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
The increasing use of genomic sequencing in research means secondary findings (SF) is more frequently detected and becoming a more pressing issue for researchers. This is reflected by the recent publication of multiple guidelines on this issue, calling for researchers to have a plan for managing SF prior to commencing their research. A deeper understanding of participants' experiences and outcomes from receiving SF is needed to ensure that the return of SF is conducted ethically and with adequate support. This review focuses on the uptake and outcomes of receiving actionable SF for research participants. This review included studies from January 2010 to January 2023. Databases searched included Medline, Embase, PsycINFO, and Scopus. Of the 3903 studies identified, 29 were included in the analysis. The uptake of SF ranged between 20% and 97%, and outcomes were categorized into psychological, clinical, lifestyle and behavioral, and family outcomes. The results indicate there is minimal psychological impact from receiving SF. Almost all participants greatly valued receiving SF. These findings highlight considerations for researchers when returning results, including the importance of involving genetic health professionals in consenting, results return process, and ensuring continuity of care by engaging healthcare providers.
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Affiliation(s)
- Lucas A Mitchell
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Karishma Jivani
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mary-Anne Young
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Amanda M Willis
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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3
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van Pottelberghe S, Heine F, Van Dooren S, Hes F, Kupper N. Barriers and facilitators for the implementation of patient-centered care in cardiogenetics: a Delphi study among ERN GUARD-heart members. Eur J Hum Genet 2023; 31:1371-1380. [PMID: 36543931 PMCID: PMC9768771 DOI: 10.1038/s41431-022-01268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/24/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Current clinical practice regarding inherited cardiac conditions has a biomedical focus, while psychological and social expertize and capacity are often lacking. As patient-centered care entails a multidisciplinary approach, the present study (a) explores barriers and facilitators of implementing patient-centered care in cardiogenetics and (b) contrasts various stakeholder viewpoints and perceived influence. We performed a three-round modified Delphi study using the input of a virtual expert panel comprising 25 medical professionals, 9 psychosocial professionals working in cardiogenetics, and 6 patient representatives. In round 1, the brainstorming phase and workshop breakout sessions were transcribed verbatim, coded and processed into unique statements listed as barriers and facilitators. In round 2, we asked the expert panel to validate, add or revise the list of barriers and facilitators. In round 3, the most relevant barriers and facilitators were ranked in importance. The experts identified 6 barriers dispersed across various levels of implementation. Having a blind spot for the patient perspective was of the highest importance, while the lack of multidisciplinary communication was ranked the lowest. We selected 9 facilitators: 2 were workflow related, 5 advocated various aspects of increased multidisciplinarity, and 2 suggested improvements in patient communication. This study revealed health system and organizational barriers and facilitators predominantly in implementing patient-centered care and only some patient-level factors. Some barriers and facilitators may be addressed easily (e.g., improving communication), while others may prove more complicated (e.g., biomedical thinking). Close interdisciplinary collaboration seems to be needed to implement PCC in cardiogenetics successfully.
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Affiliation(s)
- Saar van Pottelberghe
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Centre for Medical Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium.
- Member of the European Reference Network for rare, low prevalence and/or complex diseases of the heart: ERN GUARD-Heart, Amsterdam, the Netherlands.
| | - Fenja Heine
- Center of Research on Psychological disorders and Somatic diseases; Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Sonia Van Dooren
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Centre for Medical Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium
- Member of the European Reference Network for rare, low prevalence and/or complex diseases of the heart: ERN GUARD-Heart, Amsterdam, the Netherlands
| | - Frederik Hes
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Centre for Medical Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium
- Member of the European Reference Network for rare, low prevalence and/or complex diseases of the heart: ERN GUARD-Heart, Amsterdam, the Netherlands
| | - Nina Kupper
- Center of Research on Psychological disorders and Somatic diseases; Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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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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5
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Frijstein MM, Hamers SL, van Driel WJ, Bleiker EMA, van der Kolk L, Sijstermans R, Lok CAR. Effects of a pre-visit online information tool about genetic counselling for ovarian cancer patients, a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2023; 113:107786. [PMID: 37148840 DOI: 10.1016/j.pec.2023.107786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients. METHODS Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients' satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling. RESULTS The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed. CONCLUSION Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling. PRACTICE IMPLICATIONS Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.
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Affiliation(s)
- M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - S L Hamers
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - W J van Driel
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - E M A Bleiker
- Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - L van der Kolk
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Sijstermans
- Division of Informatics and Automatisation, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C A R Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands.
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Vlaming M, Bleiker EMA, van Oort IM, Kiemeney LALM, Ausems MGEM. Mainstream germline genetic testing in men with metastatic prostate cancer: design and protocol for a multicenter observational study. BMC Cancer 2022; 22:1365. [PMID: 36581909 PMCID: PMC9801568 DOI: 10.1186/s12885-022-10429-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In international guidelines, germline genetic testing is recommended for patients with metastatic prostate cancer. Before undergoing germline genetic testing, these patients should receive pre-test counseling. In the standard genetic care pathway, pre-test counseling is provided by a healthcare professional of a genetics department. Because the number of patients with metastatic prostate cancer is large, the capacity in the genetics departments might be insufficient. Therefore, we aim to implement so-called mainstream genetic testing in the Netherlands for patients with metastatic prostate cancer. In a mainstream genetic testing pathway, non-genetic healthcare professionals discuss and order germline genetic testing. In our DISCOVER study, we will assess the experiences among patients and non-genetic healthcare professionals with this new pathway. METHODS A multicenter prospective observational cohort study will be conducted in 15 hospitals, in different regions of the Netherlands. We developed an online training module on genetics in prostate cancer and the counseling of patients. After completion of this module, non-genetic healthcare professionals will provide pre-test counseling and order germline genetic testing in metastatic prostate cancer patients. Both non-genetic healthcare professionals and patients receive three questionnaires. We will determine the experience with mainstream genetic testing, based on satisfaction and acceptability. Patients with a pathogenic germline variant will also be interviewed. We will determine the efficacy of the mainstreaming pathway, based on time investment for non-genetic healthcare professionals and the prevalence of pathogenic germline variants. DISCUSSION This study is intended to be one of the largest studies on mainstream genetic testing in prostate cancer. The results of this study can improve the mainstream genetic testing pathway in patients with prostate cancer. TRIAL REGISTRATION The study is registered in the WHO's International Clinical Trials Registry Platform (ICTRP) under number NL9617.
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Affiliation(s)
- Michiel Vlaming
- Division Laboratories, Pharmacy and Biomedical Genetics, dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
- Family Cancer Clinic, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud university medical center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Lambertus A L M Kiemeney
- Department of Urology, Radboud university medical center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department for Health Evidence, Radboud university medical center, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
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7
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Brédart A, De Pauw A, Tüchler A, Lakeman IMM, Anota A, Rhiem K, Schmutzler R, van Asperen CJ, Devilee P, Stoppa-Lyonnet D, Kop JL, Dolbeault S. Genetic clinicians' confidence in BOADICEA comprehensive breast cancer risk estimates and counselees' psychosocial outcomes: a prospective study. Clin Genet 2022; 102:30-39. [PMID: 35508697 PMCID: PMC9322298 DOI: 10.1111/cge.14147] [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: 02/22/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022]
Abstract
Counseling for familial breast cancer focuses on communicating the gene test result (GENE) to counselees, but risk prediction models have become more complex by including non‐genetic risk factors (NGRF) and polygenic risk scores (PRS). We examined genetic clinicians' confidence in counseling and counselees' psychosocial outcomes, using the BOADICEA risk prediction tool with different categories of risk factors as input. A prospective observational study in Dutch, French and German genetic clinics was performed including 22 clinicians, and 406 of 460 (88.3%) eligible cancer‐unaffected women at high breast cancer risk assessed at pre‐test and 350 (76.1%) at post‐test. We performed multilevel analyses accounting for the clinician, and counselees' characteristics. Overall, risk estimates category by GENE versus GENE+ NGRF, or GENE+NGRF+PRS differed in 11% and 25% of counselees, respectively. In multilevel analyses, clinicians felt less confident in counseling when the full model provided lower breast cancer risks than GENE (i.e., in 8% of cases). Older counselees expressed higher breast cancer risk perception and worries about the hereditary predisposition when the full model provided higher breast cancer risks than GENE only. Genetic clinicians appear confident with breast cancer risk comprehensive models, which seem only to affect perceptions of older counselees.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, Paris, France.,University of Paris, 71 avenue Edouard Vaillant, Boulogne-Billancourt, France
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, PSL University, University of Paris, 26 rue d'Ulm, Paris Cedex 05, France
| | - Anja Tüchler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Inge M M Lakeman
- Leiden University Medical Centre, Department of Clinical Genetics, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Amélie Anota
- Centre Léon Bérard, Department of Clinical Research and Innovation& Human and Social Sciences Department, 28 rue Laennec, 69373, Lyon; French National Platform Quality of Life and Cancer, Lyon, France
| | - Kerstin Rhiem
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Rita Schmutzler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - C J van Asperen
- Leiden University Medical Centre, Department of Clinical Genetics, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Cancer genetic clinic, PSL University, University of Paris, 26 rue d'Ulm, Paris Cedex 05, France
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 place Godefroy de Bouillon, 54 015 Nancy Cedex, Nancy, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, Paris, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, Villejuif cedex, France
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8
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Brédart A, Kop JL, Tüchler A, De Pauw A, Cano A, Dick J, Rhiem K, Devilee P, Schmutzler R, Stoppa-Lyonnet D, Dolbeault S. Assessment of psychosocial difficulties by genetic clinicians and distress in women at high risk of breast cancer: a prospective study. Eur J Hum Genet 2022; 30:1067-1075. [PMID: 35399119 PMCID: PMC9437045 DOI: 10.1038/s41431-022-01096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
We examined how often genetic clinicians correctly identify psychosocial difficulties in women at high breast cancer risk and explored effects of this assessment and the genetic test result on counselees’ distress. A prospective observational study of counselee–clinician dyads was performed in three French, German and Spanish genetic clinics, involving 709 counselees (participation rate, 83.4%) and 31 clinicians (participation rate, 100%). Counselee–clinician agreement in perceived psychosocial difficulties was measured after the pre-test genetic consultation. Multivariate mixed linear models accounting for clinicians were tested. Predicted distress levels were assessed after the pre- (T1) and post-test result disclosure consultations (T2). Depending on the difficulty domain, clinicians adequately assessed the presence or absence of difficulties in 51% (“familial issues”) to 59% (“emotions”) of counselees. When counselees’ and clinicians’ perceptions disagreed, difficulties were generally underestimated by clinicians. Counselees’ distress levels remained stable from T1 to T2, irrespective of clinicians’ appraisal adequacy, and the genetic test result disclosure. Psychological referral need were found in 20–42% of counselees, more frequently observed for difficulties in the “emotions” domain. Our findings suggest that the genetic test result is a suboptimal indicator for psychological referral. Instead, clinicians should focus on emotions expressed by counselees to appraise their needs for psychological support.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France. .,Psychopathology and Health Process Laboratory UR4057, Psychology Institute, Paris University, 71 Avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 Place Godefroy de Bouillon, 54015, Nancy Cedex, France
| | - Anja Tüchler
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Antoine De Pauw
- Institut Curie, Department of Genetics, INSERM U830, Paris University, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Alejandra Cano
- University Autónoma of Barcelona, Clinical and Health Psychology Department, Barcelona, Spain
| | - Julia Dick
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Department of Genetics, INSERM U830, Paris University, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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9
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Brédart A, Kop JL, De Pauw A, Cano A, Dick J, Stoppa-Lyonnet D, Dolbeault S. Préoccupations et besoins d’aide psychologiques chez les femmes à risque génétique de cancer du sein ou de l’ovaire : une étude prospective observationnelle en Allemagne, Espagne et France. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2021-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectifs et contexte : L’arrivée des tests de panel de gènes a augmenté la complexité de la communication en consultation d’oncogénétique. Une attention quant à l’impact de cette communication sur les préoccupations et les besoins d’aide psychologique s’avère d’autant plus indispensable. Cette étude vise à en quantifier le type et l’ampleur, avant et après la communication du résultat de test génétique, chez des femmes s’adressant à la consultation d’oncogénétique pour réaliser un test de susceptibilité au cancer du sein ou de l’ovaire en Allemagne, Espagne et France.
Participants et mesures : Parmi les 752 personnes invitées consécutivement à participer à cette étude, 646 (86 %) ― dont 510 (68 %) atteintes d’un cancer du sein―ont répondu à un questionnaire (PAHC (Psychosocial Aspects of Hereditary Cancer)) portant d’une part sur les préoccupations spécifiques à la démarche en oncogénétique et d’autre part sur leurs besoins d’aide psychologique ; questionnaire proposé après la consultation initiale d’oncogénétique initiale (T1) et, pour 460 (61 %) d’entre elles, deux mois après la communication du résultat du test (T2).
Résultats : Soixante-dix-neuf (17,2 %), 19 (4,1 %), 259 (56,3 %), 44 (9,6 %), 59 (12,8 %) femmes ont reçu respectivement les résultats suivants : un variant pathogène sur BRCA1/2 ou sur autre gène à risque élevé ou modéré, un résultat négatif non informatif, un résultat négatif vrai, ou la présence d’un variant dont la signification clinique est incertaine (VUS). Le type de préoccupations et les besoins d’aide psychologique se sont révélés variables selon les pays. Cependant, globalement, les préoccupations les plus fréquentes (> 70 %) étaient relatives à la perte d’un proche familial par cancer, et les moins fréquentes (< 5 %) relatives au soutien des proches. La plupart de ces préoccupations persistent deux mois plus tard, à la suite du résultat de test génétique. En revanche, le besoin d’aide psychologique a globalement diminué sur le plan statistique, excepté, selon le pays, pour les préoccupations familiales/sociales, les difficultés émotionnelles ou les aspects pratiques.
Conclusions : Dans notre étude portant sur des femmes issues de trois pays européens s’adressant à la consultation oncogénétique en vue de réaliser un test de susceptibilité au cancer du sein ou de l’ovaire, la plupart des préoccupations liées à la situation génétique persistent deux mois après la communication du résultat de test, et les besoins d’aide psychologique se manifestent surtout dans le champ des relations et des émotions.
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10
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Padmanabhan H, Hassan NT, Wong SW, Lee YQ, Lim J, Hasan SN, Yip CH, Teo SH, Thong MK, Mohd Taib NA, Yoon SY. Psychosocial outcome and health behaviour intent of breast cancer patients with BRCA1/2 and PALB2 pathogenic variants unselected by a priori risk. PLoS One 2022; 17:e0263675. [PMID: 35167615 PMCID: PMC8846504 DOI: 10.1371/journal.pone.0263675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
There is an increasing number of cancer patients undertaking treatment-focused genetic testing despite not having a strong family history or high a priori risk of being carriers because of the decreasing cost of genetic testing and development of new therapies. There are limited studies on the psychosocial outcome of a positive result among breast cancer patients who are at low a priori risk, particularly in women of Asian descent. Breast cancer patients enrolled under the Malaysian Breast Cancer Genetic Study between October 2002 and February 2018 were tested for BRCA1, BRCA2 and PALB2 genes. All 104 carriers identified were invited by a research genetic counsellor for result disclosure. Of the 104 carriers, 64% (N = 66) had low a priori risk as determined by PENN II scores. Psychosocial, risk perception and health behaviour measures survey were conducted at baseline (pre-result disclosure), and at two to six weeks after result disclosure. At baseline, younger carriers with high a priori risk had higher Cancer Worry Scale scores than those with low a priori risk but all scores were within acceptable range. Around 75% and 55% of high a priori risk carriers as well as 80% and 67% of low a priori risk carriers had problems in the "living with cancer" and "children" psychosocial domains respectively. All carriers regardless of their a priori risk demonstrated an improved risk perception that also positively influenced their intent to undergo risk management procedures. This study has shown that with sufficient counselling and support, low a priori risk carriers are able to cope psychologically, have improved perceived risk and increased intent for positive health behaviour despite having less anticipation from a family history prior to knowing their germline carrier status.
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Affiliation(s)
| | - Nur Tiara Hassan
- Genetic Counselling Unit, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu-Wan Wong
- Genetic Counselling Unit, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Yong-Quan Lee
- Genetic Counselling Unit, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Joanna Lim
- Core Laboratory Unit, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | | | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Soo-Hwang Teo
- Cancer Prevention and Population Science Unit, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Meow-Keong Thong
- Department of Paediatrics, Genetic Medicine Unit, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- * E-mail: (SYY); (MKT)
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sook-Yee Yoon
- Genetic Counselling Unit, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- * E-mail: (SYY); (MKT)
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11
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Matsukawa M, Torishima M, Satoh C, Honda S, Kosugi S. Japanese women's reasons for accompaniment status to hereditary breast and ovarian cancer-focused genetic counseling. J Genet Couns 2021; 31:497-509. [PMID: 34661949 DOI: 10.1002/jgc4.1519] [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: 01/10/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022]
Abstract
Genetic counselors routinely assess and understand clients' needs at the beginning of a session. Attending a genetic counseling session with or without companions is an objective sign that genetic counselors can easily notice. This study focused on clients' reasons for their accompaniment status for genetic counseling, which we categorize into attending with or without a companion(s). A questionnaire survey and interviews were conducted using snowball sampling, starting with the chief executive officer (CEO) of the Japanese hereditary breast and ovarian cancer (HBOC) support group. Of 32 participants, 19 continued with an in-depth interview after answering the questionnaire. Five themes were identified from the interview: (1) personal confidence, (2) decision-making style, (3) family members' habits and time availability, (4) considerations and conflicts with family members, and (5) healthcare provider's suggestion. Our data suggested that the clients expected their companion(s) to play certain roles. This indicates that the reasons of accompaniment status will be helpful for genetic counselors to understand both clients' and their families' motivations, personalities, habits, and psychosocial backgrounds. In a high-context culture such as that of Japan, accompaniment status may be a helpful sign to understand clients' true worries. In addition, some companions may be future clients in genetic counseling, due to the genetic nature of the disease. In conclusion, our study indicated that it is important for genetic counselors to record accompaniment status before the initial genetic counseling and to pay attention to its reasons at the beginning of the session, which may lead them to understand the client's psychosocial background to facilitate better client-centered genetic counseling.
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Affiliation(s)
- Manami Matsukawa
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masako Torishima
- Department of Genomic Medicine, Kyoto University School of Public Health, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Chika Satoh
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Sayaka Honda
- Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
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12
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Franiuk M, Molinari E, Battistuzzi L, Razzaboni E, De Matteis E, Turchetti D, Godino L, Chiorri C, Varesco L. Development and Validation of an Italian Adaptation of the Psychosocial Aspects of Hereditary Cancer Questionnaire. Front Psychol 2021; 12:697300. [PMID: 34354641 PMCID: PMC8329440 DOI: 10.3389/fpsyg.2021.697300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Individuals that attend cancer genetic counseling may experience test-related psychosocial problems that deserve clinical attention. In order to provide a reliable and valid first-line screening tool for these issues, Eijzenga and coworkers developed the Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire. The aim of this work was to develop an Italian adaptation of the PAHC (I-PACH). This prospective multicenter observational study included three stages: (1) development of a provisional version of the I-PAHC; (2) pilot studies aimed at testing item readability and revising the questionnaire; and (3) a main study aimed at testing the reliability and validity of the final version of the I-PAHC with the administration of a battery comprising measures of depression, anxiety, worry, stress, and life problems to 271 counselees from four cancer genetic clinics. Adapting the original PAHC to the Italian context involved adding two further domains and expanding the emotions domain to include positive emotions. While most of the items were found to be easy to understand and score, some required revision to improve comprehensibility; others were considered irrelevant or redundant and therefore deleted. The final version showed adequate reliability and validity. The I-PAHC provides comprehensive content coverage of cancer genetic-specific psychosocial problems, is well accepted by counselees, and can be considered a sound assessment tool for psychosocial issues related to cancer genetic counseling and risk assessment in Italy.
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Affiliation(s)
- Marzena Franiuk
- Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elena Molinari
- UOSD Physical Medicine and Rehabilitation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Linda Battistuzzi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | | | | | - Daniela Turchetti
- Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer and U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Lea Godino
- Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer and U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genova, Genova, Italy
| | - Liliana Varesco
- Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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13
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A Comparison of Patient-Reported Outcomes Following Consent for Genetic Testing Using an Oncologist- or Genetic Counselor-Mediated Model of Care. ACTA ACUST UNITED AC 2021; 28:1459-1471. [PMID: 33917963 PMCID: PMC8167594 DOI: 10.3390/curroncol28020138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Genetic testing for hereditary cancer risk is usually arranged by a genetic counselor after talking about possible risks and benefits. To increase access to genetic testing, oncologists have started to order genetic testing. This survey study compared patient outcomes following genetic testing ordered by a genetic counselor or an oncologist. Genetic counselor-mediated genetic testing was associated with higher patient knowledge, as well as higher experience and understanding of genetic testing. Differences were noted in the type of psychological concerns reported, with individuals having genetic counselor-mediated testing being more likely to express concerns about having a hereditary cancer predisposition and those having oncologist-mediated testing more likely to express concerns regarding general emotions. Overall, oncologist-mediated genetic testing appears to provide a streamlined alternative to genetic testing; however, all individuals may benefit from post-test genetic counseling to address any knowledge gaps and provide additional psychological support. Abstract This study compares knowledge, experience and understanding of genetic testing, and psychological outcomes among breast and ovarian cancer patients undergoing multi-gene panel testing via genetic counselor-mediated (GMT) or oncologist-mediated (OMT) testing models. A pragmatic, prospective survey of breast and ovarian cancer patients pursuing genetic testing between January 2017 and August 2019 was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. A total of 120 (80 GMT; 40 OMT) individuals completed a survey administered one week following consent to genetic testing. Compared to OMT, the GMT cohort had higher median knowledge (8 vs. 9; p = 0.025) and experience/understanding scores (8.5 vs. 10; p < 0.001) at the time of genetic testing. Significant differences were noted in the potential psychological concerns experienced, with individuals in the GMT cohort more likely to screen positive in the hereditary predisposition domain of the Psychosocial Aspects of Hereditary Cancer tool (55% vs. 27.5%; p = 0.005), and individuals in the OMT cohort more likely to screen positive in the general emotions domain (65.0% vs. 38.8%; p = 0.007). The results of this study suggest that OMT can be implemented to streamline genetic testing; however, post-test genetic counseling should remain available to all individuals undergoing genetic testing, to ensure any psychologic concerns are addressed and that individuals have a clear understanding of relevant implications and limitations of their test results.
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14
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Yoon SY, Wong SW, Lim J, Ahmad S, Mariapun S, Padmanabhan H, Hassan NT, Lau SY, Ch'ng GS, Haniffa M, Ong WP, Rethanavelu K, Moey LH, Keng WT, Omar J, Mohd Abas MN, Yong CM, Ramasamy V, Md Noor MR, Aliyas I, Lim MCK, Suberamaniam A, Mat Adenan NA, Ahmad ZA, Ho GF, Abdul Malik R, Subramaniam S, Khoo BP, Raja A, Chin YS, Sim WW, Teh BH, Kho SK, Ong ESE, Voon PJ, Ismail G, Lee CL, Abdullah BZ, Loo KS, Lim CS, Lee SJ, Lim KJL, Shafiee MN, Ismail F, Latiff ZA, Ismail MP, Mohamed Jamli MF, Kumarasamy S, Leong KW, Low J, Md Yusof M, Ahmad Mustafa AM, Mat Ali NH, Makanjang M, Tayib S, Cheah N, Lim BK, Fong CK, Foo YC, Mellor Abdullah M, Tan TS, Chow DSY, Ho KF, Raman R, Radzi A, Deniel A, Teoh DCY, Ang SF, Joseph JK, Ng PHO, Tho LM, Ahmad AR, Muin I, Bleiker E, George A, Thong MK, Woo YL, Teo SH. Oncologist-led BRCA counselling improves access to cancer genetic testing in middle-income Asian country, with no significant impact on psychosocial outcomes. J Med Genet 2021; 59:220-229. [PMID: 33526602 DOI: 10.1136/jmedgenet-2020-107416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming. METHODS The Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer. RESULTS Oncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms. CONCLUSION The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.
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Affiliation(s)
- Sook-Yee Yoon
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu Wan Wong
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Joanna Lim
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Syuhada Ahmad
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shivaani Mariapun
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | | | - Nur Tiara Hassan
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shao Yan Lau
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Gaik-Siew Ch'ng
- Genetics, Penang Hospital, Penang, Penang, Malaysia.,Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Muzhirah Haniffa
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Winnie P Ong
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Kavitha Rethanavelu
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lip Hen Moey
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wee Teik Keng
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jamil Omar
- Gynaeoncology, Institut Kanser Negara, Putrajaya, Wilayah Persekutuan Putra, Malaysia
| | | | | | | | - Mohd Rushdan Md Noor
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Ismail Aliyas
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Michael C K Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Anuradha Suberamaniam
- Gynaeoncology, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Noor Azmi Mat Adenan
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zatul Akmar Ahmad
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Gwo Fuang Ho
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Suguna Subramaniam
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Boom Ping Khoo
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Arivendran Raja
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Yeung Sing Chin
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Wee Wee Sim
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Beng Hock Teh
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Swee Kiong Kho
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Eunice S E Ong
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Ghazali Ismail
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chui Ling Lee
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | | | - Kwong Sheng Loo
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chun Sen Lim
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Saw Joo Lee
- Gynaeoncology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Mohamad Nasir Shafiee
- Gynaeoncology, Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Fuad Ismail
- Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zarina Abdul Latiff
- Clinical Genetics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mohd Pazudin Ismail
- Gynaeoncology, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | | | | | - Kin Wah Leong
- Oncology, Gleneagles Penang, Penang, Penang, Malaysia
| | - John Low
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mastura Md Yusof
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Nor Huda Mat Ali
- Gynaeoncology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Mary Makanjang
- Gynaeoncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shahila Tayib
- Gynaeoncology, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia
| | - Nellie Cheah
- Oncology, Loh Guan Lye Specialist Centre, Penang, Malaysia
| | - Boon Kiong Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chee Kin Fong
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Yoke Ching Foo
- Oncology, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | | | - Teck Sin Tan
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Doris S Y Chow
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Kean Fatt Ho
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Rakesh Raman
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Ahmad Radzi
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Azura Deniel
- Oncology, KPJ Ampang Puteri Specialist Hospital, Ampang, Kuala Lumpur, Malaysia
| | - Daren C Y Teoh
- Oncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Soo Fan Ang
- Oncology, Penang Adventist Hospital, Penang, Penang, Malaysia
| | - Joseph K Joseph
- Oncology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Paul Hock Oon Ng
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lye-Mun Tho
- Oncology, Beacon Hospital Sdn Bhd, Petaling Jaya, Malaysia
| | | | - Ileena Muin
- Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Eveline Bleiker
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Angela George
- Oncology, Royal Marsden Hospital Chelsea, London, London, UK
| | - Meow-Keong Thong
- Genetic Medicine Unit, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yin Ling Woo
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Soo Hwang Teo
- Cancer Prevention and Population Science, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia.,University Malaya Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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15
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Medendorp NM, van Maarschalkerweerd PEA, Murugesu L, Daams JG, Smets EMA, Hillen MA. The impact of communicating uncertain test results in cancer genetic counseling: A systematic mixed studies review. PATIENT EDUCATION AND COUNSELING 2020; 103:1692-1708. [PMID: 32278626 DOI: 10.1016/j.pec.2020.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Cancer genetic counseling increasingly involves discussing uncertain test results, for example because multiple genes are sequenced simultaneously. This review was performed to provide insight into how counselors' communication of uncertain test results during genetic counseling for cancer affects counselors and counselees. METHODS A systematic mixed studies review was undertaken to review research on the effects of communicating uncertain test results. Four databases were searched using a PICO search strategy. Study findings of articles meeting the inclusion criteria were synthesized narratively. RESULTS Twenty-four articles were included. Uncertain test results encompassed either an inconclusive test result or a variant of unknown significance (VUS). Counselees involved almost exclusively women at risk of hereditary breast and/or ovarian cancer. None of the articles reported effects on counselor outcomes. Counselee outcomes were categorized as cognitive, affective or behavioral. Interpretation of a VUS was overall reported as difficult, and counselees' distress and worry were repeatedly found to decrease over time after the discussion of any uncertain test result. For most other outcomes, findings were sparse and/or inconsistent. CONCLUSION Evidence on effects on counselee outcomes is scant and inconsistent. Future studies are warranted to provide insight into how counselees and counselors are affected. PRACTICE IMPLICATIONS Clinical practice could benefit from guidelines on how to address uncertain test results during pre- and posttest genetic consultations.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | | | - Laxsini Murugesu
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
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Williams G, Mueller J, Mbeledogu C, Spencer A, Parry-Harries E, Harrison A, Clough G, Greenhalgh C, Verma A. The impact of a volunteer-led community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help. PATIENT EDUCATION AND COUNSELING 2020; 103:563-570. [PMID: 31611129 DOI: 10.1016/j.pec.2019.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/20/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyse the impact of a community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help. METHODS Personalised information through peer-led champions was delivered to 5500 people in a range of settings and Cancer Awareness Measures questionnaires were completed by 119 participants at pre-arranged sessions (convenience sampling) before and after the intervention. Data were analysed using McNemar tests, Mann-Whitney U test and a Wilcoxon Signed Rank test. RESULTS Data showed increase in knowledge after the intervention for cancer screening programmes (p < 0.05), recognition of warning signs for cancer (p < 0.05), and recognition of risk factors for cancer in seven of the eleven options (p < 0.001). Results suggest a decrease in perception of barriers to seeking help (p < 0.05). The intervention had a stronger impact on recognition of cancer symptoms for people who have been affected by cancer (p = 0.02). CONCLUSION The Cancer Awareness Measures questionnaire proved an effective tool for evaluation and awareness improved after the intervention amongst those who completed it. PRACTICE IMPLICATIONS Enhancing the perceived personal relevance of information to those with experience of cancer may improve information processing and retention. The study highlights cancer awareness gaps among the public for future intervention development.
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Affiliation(s)
- Greg Williams
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Julia Mueller
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Cordelle Mbeledogu
- Manchester City Council & North Manchester CCG, Manchester City Council, Directorate of Children and Families, Public Health Team, Level 4, PO Box 532, Town Hall Extension, Manchester, M60 2LA, United Kingdom.
| | - Angela Spencer
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Emily Parry-Harries
- Kirklees Council, Civic Centre, 4(th) Floor North, High Street, Huddersfield, HD1 2NF, United Kingdom.
| | - Annie Harrison
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Gary Clough
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Christine Greenhalgh
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Arpana Verma
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
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17
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Brédart A, Dick J, Cano A, Robieux L, De Pauw A, Schmutzler R, Stoppa-Lyonnet D, Dolbeault S, Kop JL. How to facilitate psychosocial adjustment in women tested for hereditary breast or ovarian cancer susceptibility? Insights from network analysis. Psychooncology 2019; 29:550-556. [PMID: 31823434 DOI: 10.1002/pon.5302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/16/2019] [Accepted: 11/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Increasingly complex genetics counseling requires guidance to facilitate counselees' psychosocial adjustment. We explored networks of inter-relationships among coping strategies and specific psychosocial difficulties in women tested for hereditary breast or ovarian cancer. METHODS Of 752 counselees consecutively approached, 646 (86%) completed questionnaires addressing coping strategies (Brief-COPE) and psychosocial difficulties (PAHC) after the initial genetic consultation (T1), and 460 (61%) of them again after the test result (T2). We applied network analysis comparing partial correlations among these questionnaire scales, according to the type of genetic test - single gene-targeted or multigene panel, test result and, before and after testing. RESULTS Overall, 98 (21.3%), 259 (56.3%), 59 (12.8%) and 44 (9.6%) women received a pathogenic variant, uninformative negative (panel testing), variant of uncertain significance (VUS) or true negative (targeted testing) result, respectively. In most networks, connections were strongest between avoidance and general negative emotions. Cognitive restructuring was inter-related to lower psychosocial difficulties. Avoidance and familial/social relationship difficulties were strongly related in women receiving a pathogenic variant. Stronger inter-relationships were also noticed between avoidance and worries about personal cancer and concerns about hereditary predisposition in women receiving a VUS result. Differences in the prominence of inter-relationships were observed by type of testing and assessment time. CONCLUSIONS Network analysis may be fruitful to highlight prominent inter-relationships among coping strategies and psychosocial difficulties, in women tested for HBOC susceptibility, offering guidance for counseling.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Psycho-Oncology Unit, Paris, France.,University Paris Descartes, Boulogne-Billancourt, France
| | - Julia Dick
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital, Cologne, Germany
| | | | | | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital, Cologne, Germany
| | | | - Sylvie Dolbeault
- Institut Curie, Psycho-Oncology Unit, Paris, France.,Centre de Recherche en Épidémiologie et Santé des Populations (CESP), University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN-CEMA, Nancy, France
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18
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Brédart A, Anota A, Dick J, Cano A, De Pauw A, Kop JL, Aaronson NK, Bleiker EM, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. The "Psychosocial Aspects in Hereditary Cancer" questionnaire in women attending breast cancer genetic clinics: Psychometric validation across French-, German- and Spanish-language versions. Eur J Cancer Care (Engl) 2019; 29:e13173. [PMID: 31571365 DOI: 10.1111/ecc.13173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/23/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We performed a comprehensive assessment of the psychometrics of the "Psychosocial Aspects in Hereditary Cancer" (PAHC) questionnaire in French, German and Spanish. METHODS Women consecutively approached in Cancer Genetic Clinics completed the PAHC, distress and satisfaction questionnaires at pre-testing (T1) and after test result disclosure (T2). In addition to standard psychometric attributes, we assessed the PAHC ability to respond to change (i.e. improvement or deterioration from T1 to T2) in perceived difficulties and computed minimal important differences (MID) in PAHC scores as compared with self-reported needs for additional counselling. RESULTS Of 738 eligible counselees, 214 (90%) in France (Paris), 301 (92%) in Germany (Cologne) and 133 (77%) in Spain (Barcelona) completed the PAHC. A six-factor revised PAHC model yielded acceptable CFA goodness-of-fit indexes and good all scales internal consistencies. PAHC scales demonstrated expected conceptual differences with distress and satisfaction with counselling. Different levels of psychosocial difficulties were evidenced between counselees' subgroups and over time (p-values < .05). MID estimates ranged from 8 to 15 for improvement and 9 to 21 for deterioration. CONCLUSION The PAHC French, German and Spanish versions are reliable and valid for evaluating the psychosocial difficulties of women at high BC risk attending genetic clinics.
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Affiliation(s)
- Anne Brédart
- Supportive Care Department, Psycho-oncology Unit, Psychopathology and Health Process Laboratory, EA 4047, Psychology Institute, Institut Curie, University Paris Descartes, Paris, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology unit (INSERM UMR 1098), University Hospital of Besançon and French National Platform Quality of Life and Cancer, Besançon, France
| | - Julia Dick
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Jean-Luc Kop
- Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eveline M Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joan Brunet
- Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Department of Human Genetics & Division of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, Paris and CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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19
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Brédart A, Kop JL, Dick J, Cano A, De Pauw A, Anota A, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study. BMJ Open 2019; 9:e029926. [PMID: 31551380 PMCID: PMC6773290 DOI: 10.1136/bmjopen-2019-029926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES AND SETTING Advances in multigene panel testing for cancer susceptibility has increased the complexity of counselling, requiring particular attention to counselees' psychosocial needs. Changes in psychosocial problems before and after genetic testing were prospectively compared between genetic test results in women tested for breast or ovarian cancer genetic susceptibility in French, German and Spanish clinics. PARTICIPANTS AND MEASURES Among 752 counselees consecutively approached, 646 (86%) were assessed after the initial genetic consultation (T1), including 510 (68%) affected with breast cancer, of which 460 (61%) were assessed again after receiving the test result (T2), using questionnaires addressing genetic-specific psychosocial problems (Psychosocial Aspects of Hereditary Cancer (PAHC)-six scales). Sociodemographic and clinical data were also collected. RESULTS Seventy-nine (17.2%), 19 (4.1%), 259 (56.3%), 44 (9.6%) and 59 (12.8%) women received a BRCA1/2, another high/moderate-risk pathogenic variant (PV), negative uninformative, true negative (TN) or variant of uncertain significance result (VUS), respectively. On multiple regression analyses, compared with women receiving another result, those with a VUS decreased more in psychosocial problems related to hereditary predisposition (eg, coping with the test result) (ß=-0.11, p<0.05) and familial/social issues (eg, risk communication) (ß=-0.13, p<0.05), almost independently from their problems before testing. Women with a PV presented no change in hereditary predisposition problems and, so as women with a TN result, a non-significant increase in familial/social issues. Other PAHC scales (ie, emotions, familial cancer, personal cancer and children-related issues) were not affected by genetic testing. CONCLUSIONS In women tested for breast or ovarian cancer genetic risk in European genetics clinics, psychosocial problems were mostly unaffected by genetic testing. Apart from women receiving a VUS result, those with another test result presented unchanged needs in counselling in particular about hereditary predisposition and familial/social issues.
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Affiliation(s)
- Anne Brédart
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- Psychopathology and Health Process Laboratory, University Paris Descartes, Boulogne-Billancourt, Paris, France
| | - Jean-Luc Kop
- Département de Psychologie, Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Julia Dick
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Amélie Anota
- French National Quality of Life in Oncology Platform, and Methodology; Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Joan Brunet
- Medical Oncology Department, Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Division of Pathology; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Sylvie Dolbeault
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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20
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Young AL, Butow PN, Rhodes P, Tucker KM, Williams R, Healey E, Wakefield CE. Talking across generations: Family communication about BRCA1
and BRCA2
genetic cancer risk. J Genet Couns 2019; 28:516-532. [DOI: 10.1002/jgc4.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alison Luk Young
- School of Psychology; The University of Sydney; Sydney NSW Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
| | - Phyllis N. Butow
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Paul Rhodes
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Katherine M. Tucker
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital; Wollongong NSW Australia
| | - Claire E. Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
- School of Women’s and Children’s Health; University of New South Wales; Sydney NSW Australia
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21
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Gonzalez BD, Hoogland AI, Kasting ML, Cragun D, Kim J, Ashing K, Holt CL, Hughes Halbert C, Pal T, Vadaparampil ST. Psychosocial impact of BRCA testing in young Black breast cancer survivors. Psychooncology 2018; 27:2778-2785. [PMID: 30207419 DOI: 10.1002/pon.4887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/29/2018] [Accepted: 09/08/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Prior studies demonstrating minimal psychological consequences for women receiving genetic counseling/genetic testing (GC/GT) for hereditary breast and ovarian cancer rely on predominantly Caucasian women. We conducted a prospective follow-up of a subset of participants from a population-based study of Black breast cancer (BC) survivors receiving GC/GT for BRCA1 and BRCA2 mutations. METHODS Black women with invasive BC at age ≤ 50 years diagnosed between 2009 and 2012 were recruited through the Florida Cancer Registry. Participants (n = 215, age M = 44.7, SD = 6.2) were offered telephone pre- and post-test GC, a subset completed questionnaires assessing sociodemographic, clinical, and psychosocial variables. RESULTS There were no baseline differences in cancer-related distress, psychological distress, or quality of life between test result groups. Social well-being improved in women receiving negative results (P = .01), but no other outcomes demonstrated significant changes over time between groups. CONCLUSIONS Our study is among the first to demonstrate minimal negative psychosocial outcomes following GC/GT among young Black BC survivors, irrespective of test results.
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Affiliation(s)
| | - Aasha I Hoogland
- Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | | | | | | | | | | | | | - Tuya Pal
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center and Vanderbilt Genetics Institute, Nashville, TN, USA
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22
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Esplen MJ, Leszcz M, Hunter J, Wong J, Leung YW, Toner B, Messner S, Glendon G, Stuckless N, Butler C. A randomized controlled trial of a supportive expressive group intervention for women with a family history of breast cancer. Psychooncology 2018; 27:2645-2653. [PMID: 29952047 DOI: 10.1002/pon.4822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women with a family history of breast cancer (BC) often overestimate their BC risk. Heightened psychological distress may interfere with risk comprehension and screening adherence. The primary purpose of this study was to test the efficacy of a 12-week manual-based supportive-expressive (SE) group intervention for this population. METHODS Using a randomized control trial design, this study compared two interventions: a standard risk-counseling arm (RC) compared with that plus SE group intervention. The primary study outcome was BC anxiety. Secondary outcomes included psychosocial functioning, risk comprehension, BC knowledge, and screening behaviors. RESULTS A total of 161 women with a family history of BC were randomized into SE (N = 108) or RC (N = 53). Participants in both study arms significantly improved on measures of BC anxiety, psychosocial functioning, risk comprehension, and BC knowledge, with no statistical difference between study arms. Benefits were sustained at 1 year. BC screening rates were high in both arms at baseline and follow-up. CONCLUSIONS SE group therapy as an added intervention to the risk counseling was well-received, however, did not demonstrate superiority to RC alone. Future studies on treatment matching are needed to further our understanding of interventions that can support women with a family history of BC to work through residual issues, including loss and grief.
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Affiliation(s)
- Mary Jane Esplen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Princess Margaret Cancer Centre, Director, de Souza Institute, University Health Network, Toronto, Canada
| | - Molyn Leszcz
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Jonathan Hunter
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Jiahui Wong
- Department of Psychiatry, Faculty of Medicine, University of Toronto, de Souza Institute, University Health Network, Toronto, Canada
| | - Yvonne W Leung
- de Souza Institute, University Health Network, Toronto, Canada
| | - Brenda Toner
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Gord Glendon
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute, University Health Network, Toronto, Canada
| | - Noreen Stuckless
- York University, Toronto, Canada.,University of Toronto, Toronto, Canada
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Patient-Centered Care in Breast Cancer Genetic Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020319. [PMID: 29439543 PMCID: PMC5858388 DOI: 10.3390/ijerph15020319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/30/2022]
Abstract
With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.
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24
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Steffen LE, Du R, Gammon A, Mandelblatt JS, Kohlmann WK, Lee JH, Buys SS, Stroup AM, Campo RA, Flores KG, Vicuña B, Schwartz MD, Kinney AY. Genetic Testing in a Population-Based Sample of Breast and Ovarian Cancer Survivors from the REACH Randomized Trial: Cost Barriers and Moderators of Counseling Mode. Cancer Epidemiol Biomarkers Prev 2017; 26:1772-1780. [PMID: 28971986 DOI: 10.1158/1055-9965.epi-17-0389] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/12/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background: This study evaluates predictors of BRCA1/2 testing among breast and ovarian cancer survivors who received genetic counseling as part of a randomized trial and evaluates moderators of counseling mode on testing uptake.Methods: Predictors of BRCA1/2 testing within one year postcounseling were evaluated using multivariable logistic regression in a population-based sample of breast and ovarian cancer survivors at increased hereditary risk randomly assigned to in-person counseling (IPC; n = 379) versus telephone counseling (TC; n = 402). Variables that moderated the association between counseling mode and testing were identified by subgroup analysis.Results: Testing uptake was associated with higher perceived comparative mutation risk [OR = 1.32; 95% confidence interval (CI), 1.11-1.57] in the adjusted analysis. Those without cost barriers had higher testing uptake (OR = 18.73; 95% CI, 7.09-49.46). Psychologic distress and perceived comparative mutation risk moderated the effect of counseling and testing. Uptake between IPC versus TC did not differ at low levels of distress and risk, but differed at high distress (26.3% TC vs. 44.3% IPC) and high perceived comparative risk (33.9% TC vs. 50.5% IPC).Conclusions: Cost concerns are a strong determinant of testing. Differences in testing uptake by counseling mode may depend on precounseling distress and risk perceptions.Impact: Cost concerns may contribute to low testing in population-based samples of at-risk cancer survivors. Precounseling psychosocial characteristics should be considered when offering in-person versus telephone counseling. Cancer Epidemiol Biomarkers Prev; 26(12); 1772-80. ©2017 AACR.
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Affiliation(s)
- Laurie E Steffen
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruofei Du
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Wendy K Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ji-Hyun Lee
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Rebecca A Campo
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kristina G Flores
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Belinda Vicuña
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Marc D Schwartz
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. .,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
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25
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Referrals to Mental Health Services: Exploring the Referral Process in Genetic Counseling. J Genet Couns 2017; 27:289-300. [DOI: 10.1007/s10897-017-0147-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
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Bouhnik AD, N’Diaye K, Evans DG, Harris H, Tibben A, van Asperen C, Schmidtke J, Nippert I, Mancini J, Julian-Reynier C. Validation of a scale for assessing attitudes towards outcomes of genetic cancer testing among primary care providers and breast specialists. PLoS One 2017; 12:e0178447. [PMID: 28570656 PMCID: PMC5453525 DOI: 10.1371/journal.pone.0178447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/12/2017] [Indexed: 01/31/2023] Open
Abstract
Objective To develop a generic scale for assessing attitudes towards genetic testing and to psychometrically assess these attitudes in the context of BRCA1/2 among a sample of French general practitioners, breast specialists and gyneco-obstetricians. Study design and setting Nested within the questionnaire developed for the European InCRisC (International Cancer Risk Communication Study) project were 14 items assessing expected benefits (8 items) and drawbacks (6 items) of the process of breast/ovarian genetic cancer testing (BRCA1/2). Another item assessed agreement with the statement that, overall, the expected health benefits of BRCA1/2 testing exceeded its drawbacks, thereby justifying its prescription. The questionnaire was mailed to a sample of 1,852 French doctors. Of these, 182 breast specialists, 275 general practitioners and 294 gyneco-obstetricians completed and returned the questionnaire to the research team. Principal Component Analysis, Cronbach’s α coefficient, and Pearson’s correlation coefficients were used in the statistical analyses of collected data. Results Three dimensions emerged from the respondents’ responses, and were classified under the headings: “Anxiety, Conflict and Discrimination”, “Risk Information”, and “Prevention and Surveillance”. Cronbach’s α coefficient for the 3 dimensions was 0.79, 0.76 and 0.62, respectively, and each dimension exhibited strong correlation with the overall indicator of agreement (criterion validity). Conclusions The validation process of the 15 items regarding BRCA1/2 testing revealed satisfactory psychometric properties for the creation of a new scale entitled the Attitudes Towards Genetic Testing for BRCA1/2 (ATGT-BRCA1/2) Scale. Further testing is required to confirm the validity of this tool which could be used generically in other genetic contexts.
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Affiliation(s)
- Anne-Deborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- * E-mail:
| | - Khadim N’Diaye
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - D. Gareth Evans
- Department of Genomic Medicine, The University of Manchester, Manchester, United Kingdom
| | - Hilary Harris
- GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Christi van Asperen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joerg Schmidtke
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Irmgard Nippert
- Women’s Health Research, Münster Medical School, Münster, Germany
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
| | - Claire Julian-Reynier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- Institut Paoli-Calmettes, UMR_S 912, Marseille, France
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Kohler JN, Turbitt E, Biesecker BB. Personal utility in genomic testing: a systematic literature review. Eur J Hum Genet 2017; 25:662-668. [PMID: 28295040 DOI: 10.1038/ejhg.2017.10] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Researchers and clinicians refer to outcomes of genomic testing that extend beyond clinical utility as 'personal utility'. No systematic delineation of personal utility exists, making it challenging to appreciate its scope. Identifying empirical elements of personal utility reported in the literature offers an inventory that can be subsequently ranked for its relative value by those who have undergone genomic testing. A systematic review was conducted of the peer-reviewed literature reporting non-health-related outcomes of genomic testing from 1 January 2003 to 5 August 2016. Inclusion criteria specified English language, date of publication, and presence of empirical evidence. Identified outcomes were iteratively coded into unique domains. The search returned 551 abstracts from which 31 studies met the inclusion criteria. Study populations and type of genomic testing varied. Coding resulted in 15 distinct elements of personal utility, organized into three domains related to personal outcomes: affective, cognitive, and behavioral; and one domain related to social outcomes. The domains of personal utility may inform pre-test counseling by helping patients anticipate potential value of test results beyond clinical utility. Identified elements may also inform investigations into the prevalence and importance of personal utility to future test users.
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Affiliation(s)
- Jennefer N Kohler
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erin Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Biesecker B, Austin J, Caleshu C. Theories for Psychotherapeutic Genetic Counseling: Fuzzy Trace Theory and Cognitive Behavior Theory. J Genet Couns 2016; 26:322-330. [PMID: 27812918 DOI: 10.1007/s10897-016-0023-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
Psychotherapeutic genetic counseling is an increasingly relevant practice description. In this paper we aim to demonstrate how psychotherapeutic genetic counseling can be achieved by using psychological theories to guide one's approach to working with clients. We describe two illustrative examples, fuzzy trace theory and cognitive behavior theory, and apply them to two challenging cases. The theories were partially derived from evidence of beneficial client outcomes using a psychotherapeutic approach to patient care in other settings. We aim to demonstrate how these two specific theories can inform psychotherapeutic genetic counseling practice, and use them as examples of how to take a psychological theory and effectively apply it to genetic counseling.
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Affiliation(s)
- Barbara Biesecker
- National Human Genome Research Institute, National Institutes of Health, NHGRI/NIH, 31 Center Drive, Rm B1 B36, Bethesda, MD, 20897-2073, USA.
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Abstract
An increasing demand for genetic testing has moved the procedure from highly selected at-risk individuals, now also including cancer patients for treatment associated testing. The heritable fraction of ovarian cancer is more than 10%, and our department has offered BRCA testing to such patients irrespective of family history since 2002. This study examined potential psychosocial distress associated with this procedure using The Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire and other patient-rated generic distress instruments. Patients were divided into four groups according to cancer risk: mutation carriers, own history of breast cancer and ovarian cancer, family history of breast cancer and/or ovarian cancer, and patients without family history. In a postal survey, 354 patients responded. Good acceptance of the MICRA was observed, and previously described good psychometric properties were confirmed. A significant association between MICRA total score and receiving a positive BRCA test result was found. No significant between-group differences were observed with generic distress instruments. Time since cancer diagnosis, test result, and survey showed no significant associations with MICRA scores. Internal consistencies of instruments were adequate. Exploratory and confirmatory factor analyses showed adequate fit indices for a three factor solution of the MICRA, but further refinement of the items should be considered. In conclusion, the specific types of worry and distress most relevant to receiving genetic testing irrespective of family history were not captured by the generic distress instruments. The MICRA was supported as a useful tool for detection of mental distress related to genetic testing and risk evaluation.
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Ringwald J, Wochnowski C, Bosse K, Giel KE, Schäffeler N, Zipfel S, Teufel M. Psychological Distress, Anxiety, and Depression of Cancer-Affected BRCA1/2 Mutation Carriers: a Systematic Review. J Genet Couns 2016; 25:880-91. [PMID: 27074860 DOI: 10.1007/s10897-016-9949-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/18/2016] [Indexed: 12/12/2022]
Abstract
Understanding the intermediate- and long-term psychological consequences of genetic testing for cancer patients has led to encouraging research, but a clear consensus of the psychosocial impact and clinical routine for cancer-affected BRCA1 and BRCA2 mutation carriers is still missing. We performed a systematic review of intermediate- and long-term studies investigating the psychological impact like psychological distress, anxiety, and depression in cancer-affected BRCA mutation carriers compared to unaffected mutation carriers. This review included the screening of 1243 studies. Eight intermediate- and long-term studies focusing on distress, anxiety, and depression symptoms among cancer-affected mutation carriers at least six months after the disclosure of genetic testing results were included. Studies reported a great variety of designs, methods, and patient outcomes. We found evidence indicating that cancer-affected mutation carriers experienced a negative effect in relation to psychological well-being in terms of an increase in symptoms of distress, anxiety, and depression in the first months after test disclosure. In the intermediate- and long-term, no significant clinical relevant symptoms occurred. However, none of the included studies used specific measurements, which can clearly identify psychological burdens of cancer-affected mutation carriers. We concluded that current well-implemented distress screening instruments are not sufficient for precisely identifying the psychological burden of genetic testing. Therefore, future studies should implement coping strategies, specific personality structures, the impact of genetic testing, supportive care needs and disease management behaviour to clearly screen for the possible intermediate- and long-term psychological impact of a positive test disclosure.
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Affiliation(s)
- Johanna Ringwald
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.
- Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany.
| | - Christina Wochnowski
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany
| | - Kristin Bosse
- Institute of Medical Genetics and Applied Genomics, University Hospital Tuebingen, Tuebingen, Germany
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany
- Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany
- Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany
- Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
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31
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Eijzenga W, Bleiker EMA, Hahn DEE, Van der Kolk LE, Sidharta GN, Aaronson NK. Prevalence and detection of psychosocial problems in cancer genetic counseling. Fam Cancer 2015; 14:629-36. [PMID: 25968807 PMCID: PMC4630247 DOI: 10.1007/s10689-015-9809-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Only a minority of individuals who undergo cancer genetic counseling experience heightened levels of psychological distress, but many more experience a range of cancer genetic-specific psychosocial problems. The aim of this study was to estimate the prevalence of such psychosocial problems, and to identify possible demographic and clinical variables associated significantly with them. Consenting individuals scheduled to undergo cancer genetic counseling completed the Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) prior to or immediately following their counseling session. More than half of the 137 participants reported problems on three or more domains of the PAHC, most often in the domains 'living with cancer' (84%), 'family issues' (46%), 'hereditary predisposition' (45%), and 'child-related issues' (42%). Correlations between the PAHC, the HADS and the DT were low. Previous contact with a psychosocial worker, and having a personal history of cancer were associated significantly with HADS scores, but explained little variance (9%). No background variables were associated significantly with the DT. Previous contact with a psychosocial worker, and having children were significantly associated with several PAHC domains, again explaining only a small percentage of the variance (2-14%). The majority of counselees experience specific cancer genetic counseling-related psychosocial problems. Only a few background variables are associated significantly with distress or psychosocial problems. Thus we recommend using the PAHC or a similar problem-oriented questionnaire routinely in cancer genetic counseling to identify individuals with such problems.
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Affiliation(s)
- W Eijzenga
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E M A Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D E E Hahn
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Psychosocial Counseling, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L E Van der Kolk
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G N Sidharta
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Prognostic Factors for Distress After Genetic Testing for Hereditary Cancer. J Genet Couns 2015; 25:495-503. [PMID: 26475052 PMCID: PMC4868861 DOI: 10.1007/s10897-015-9894-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 09/23/2015] [Indexed: 10/27/2022]
Abstract
The psychological impact of an unfavorable genetic test result for counselees at risk for hereditary cancer seems to be limited: only 10-20 % of counselees have psychological problems after testing positive for a known familial mutation. The objective of this study was to find prognostic factors that can predict which counselees are most likely to develop psychological problems after presymptomatic genetic testing. Counselees with a 50 % risk of BRCA1/2 or Lynch syndrome completed questionnaires at three time-points: after receiving a written invitation for a genetic counseling intake (T1), 2-3 days after receiving their DNA test result (T2), and 4-6 weeks later (T3). The psychological impact of the genetic test result was examined shortly and 4-6 weeks after learning their test result. Subsequently, the influence of various potentially prognostic factors on psychological impact were examined in the whole group. Data from 165 counselees were analyzed. Counselees with an unfavorable outcome did not have more emotional distress, but showed significantly more cancer worries 4-6 weeks after learning their test result. Prognostic factors for cancer worries after genetic testing were pre-existing cancer worries, being single, a high risk perception of getting cancer, and an unfavorable test result. Emotional distress was best predicted by pre-existing cancer worries and pre-existing emotional distress. The psychological impact of an unfavorable genetic test result appears considerable if it is measured as "worries about cancer." Genetic counselors should provide additional guidance to counselees with many cancer worries, emotional distress, a high risk perception or a weak social network.
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Eijzenga W, Bleiker EMA, Ausems MGEM, Sidharta GN, Van der Kolk LE, Velthuizen ME, Hahn DEE, Aaronson NK. Routine assessment of psychosocial problems after cancer genetic counseling: results from a randomized controlled trial. Clin Genet 2014; 87:419-27. [PMID: 25130962 DOI: 10.1111/cge.12473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
Abstract
Approximately 70% of counselees undergoing cancer genetic counseling and testing (CGCT) experience some degree of CGCT-related psychosocial problems. We evaluated the efficacy of an intervention designed to increase detection and management of problems 4 weeks after completion of CGCT. In this randomized, controlled trial, 118 participants completed a CGCT-related problem questionnaire prior to an - audiotaped - telephone session with their counselor 1 month after DNA-test disclosure. For those randomized to the intervention group (n = 63), a summary of the questionnaire results was provided to the counselor prior to the telephone session. Primary outcomes were discussion of the problems, counselors' awareness of problems, and problem management. Secondary outcomes included self-reported distress, cancer worries, CGCT-related problems, and satisfaction. Counselors who received a summary of the questionnaire were more aware of counselees' problems in only one psychosocial domain (practical issues). No significant differences in the number of problems discussed, in problem management, or on any of the secondary outcomes were observed. The prevalence of problems was generally low. The telephone session, combined with feedback on psychosocial problems, has minimal impact. The low prevalence of psychosocial problems 1 month post-CGCT recommends against its use as a routine extension of the CGCT procedure.
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Affiliation(s)
- W Eijzenga
- Division of Psychosocial Research and Epidemiology
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34
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Eijzenga W, Aaronson NK, Kluijt I, Sidharta GN, Hahn DE, Ausems MG, Bleiker EM. The efficacy of a standardized questionnaire in facilitating personalized communication about problems encountered in cancer genetic counseling: design of a randomized controlled trial. BMC Cancer 2014; 14:26. [PMID: 24428912 PMCID: PMC3898090 DOI: 10.1186/1471-2407-14-26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background Individuals with a personal or family history of cancer, can opt for genetic counseling and DNA-testing. Approximately 25% of these individuals experience clinically relevant levels of psychosocial distress, depression and/or anxiety after counseling. These problems are frequently left undetected by genetic counselors. The aim of this study is to evaluate the efficacy of a cancer genetics-specific screening questionnaire for psychosocial problems, the ‘Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire’ together with the Distress Thermometer, in: (1) facilitating personalized counselor-counselee communication; (2) increasing counselors’ awareness of their counselees’ psychosocial problems; and (3) facilitating the management of psychosocial problems during and after genetic counseling. Methods This multicenter, randomized controlled trial will include 264 individuals undergoing cancer genetic counseling in two family cancer clinics in the Netherlands. Participants will be randomized to either: (1) an intervention group that completes the PAHC questionnaire, the results of which are made available to the genetic counselor prior to the counseling session; or (2) a control group that completes the PAHC questionnaire, but without feedback being given to the genetic counselor. The genetic counseling sessions will be audiotaped for content analysis. Additionally, study participants will be asked to complete questionnaires at baseline, three weeks after the initial counseling session, and four months after a telephone follow-up counseling session. The genetic counselors will be asked to complete questionnaires at the start of and at completion of the study, as well as a checklist directly after each counseling session. The questionnaires/checklists of the study include items on communication during genetic counseling, counselor awareness of their clients’ psychosocial problems, the (perceived) need for professional psychosocial support, cancer worries, general distress, specific psychosocial problems, satisfaction with care received, and experience using the PAHC questionnaire. Discussion This study will provide empirical evidence regarding the efficacy of a relatively brief psychosocial screening questionnaire in terms of facilitating personalized communication, increasing counselors’ awareness, and optimizing management of psychosocial problems in the cancer genetic counseling setting. Trial registration This study is registered at the Netherlands Trial Register (NTR3205) and ClinicalTrials.gov (NCT01562431).
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Affiliation(s)
| | | | | | | | | | | | - Eveline Ma Bleiker
- The Netherlands Cancer Institute, Dept, of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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