Multiple endocrine neoplasia type 2a (MEN2a): a call for psycho-social research

Self-Surveillance for Genetic Predisposition to Cancer: Behaviors and Emotions

PURPOSE/OBJECTIVES

To describe the kinds of self-monitoring activities and the emotional responses associated with those activities in patients with a genetic predisposition to multiple endocrine neoplasia type 2a (MEN2a) or familial adenomatous polyposis (FAP).

RESEARCH APPROACH

Thematic analysis of the transcripts of patient interviews conducted for two previous grounded theory investigations of participation in lifelong surveillance for patients with cancer predisposition syndromes and their family members.

SETTING

In the original studies, participants were recruited through a high-risk gastrointestinal cancer clinic (for FAP) and pediatric and adult endocrinology clinics (for MEN2a) at two eastern U.S. medical centers and by patient referral.

PARTICIPANTS

58 transcripts of interviews with 29 patients; 17 diagnosed with FAP or the variants of Gardner syndrome and attenuated FAP and 12 patients diagnosed with MEN2a.

METHODOLOGIC APPROACH

Informants participated in two hour-long, in-depth interviews and completed a self-administered sociodemographic questionnaire.

MAIN RESEARCH VARIABLES

Types of self-surveillance activities.

FINDINGS

Patients engage in an elaborate set of self-surveillance activities that are grouped into five categories of behavior: Medication Appraisal, Phenotype Tracking, Intake and Output Monitoring, Laboratory and Treatment Recording, and Tracking of Visits. Self-surveillance behaviors are grouped independent of type of syndrome, penetrance, age, or gender of the patient. Each category comprises a variety of behaviors that correspond with treatment recommendations and understanding of the disorder.

CONCLUSIONS

Self-surveillance may be driven by a combination of anticipation and the need for control and understanding.

INTERPRETATION

Findings from the study could be used to create an assessment tool to evaluate the extent to which patients are involved in day-to-day self-monitoring. Clinicians may use the categories to better understand patients' knowledge deficits and the emotional impact of enhanced vigilance. Self-surveillance activities performed by patients with MEN2a and FAP also may be performed by patients with other cancer predisposition syndromes.

Bringing threat to the fore: participating in lifelong surveillance for genetic risk of cancer

PURPOSE/OBJECTIVES

To explain how patients with multiple endocrine neoplasia type 2a (MEN2a) and family members conceptualize participation in lifelong surveillance in genetic cancer care.

DESIGN

Qualitative naturalistic inquiry.

SETTING

Northeastern United States. Data were collected during interviews in informants' homes.

SAMPLE

12 adult patients and 9 family members were recruited purposively through endocrinology clinics at two East Coast medical centers.

METHODS

A grounded theory design was used. Subjects completed a demographic questionnaire and were interviewed on two occasions. In-depth interviews were audiotaped. The core concept and process variables emerged through three levels of narrative content analysis, theoretical sampling, and constant comparison. The generated theory was presented to the participants for validation.

MAIN RESEARCH VARIABLES

The basic psychological issue associated with participation in lifelong surveillance and the psychosocial processes used by individuals to deal with the issues.

FINDINGS

MEN2a patients and family members experience surveillance as a (Re)Minding of a threat to health. Once threat is brought to the fore, participants interpret the meaning and negotiate control of the impact of the diagnosis, related events, and consequences. Meaningful information from surveillance activities is incorporated into participants' self-image and daily lives through a process of (Re)Integration. The genetic nature of MEN2a did not emerge as a significant subcategory in relation to the core variable.

CONCLUSIONS

Finding meaning in the outcomes of surveillance events is a psychosocial process that is central to participation in lifelong surveillance. Genetic predisposition to cancer was a peripheral concern to subjects as they dealt with surveillance issues.

IMPLICATIONS FOR NURSING

This investigation provides a model for the development of a grounded theory for understanding how people with other genetic cancer syndromes participate in lifelong surveillance.