1
|
White S, Turbitt E, Rogers K, Tucker K, McEwen A, Best M, Phillips JL, Jacobs C. A survey of genetic and palliative care health professionals' views of integrating genetics into palliative care. Eur J Hum Genet 2024; 32:109-116. [PMID: 37344570 PMCID: PMC10772073 DOI: 10.1038/s41431-023-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/14/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Genetic counselling and testing have utility for people with palliative care needs and their families. However, genetic and palliative care health professionals have described difficulties initiating palliative-genetic discussions. Between March and July 2022, we received n = 73 surveys (6% response rate) from genetic and palliative care health professionals in Australia and New Zealand that assessed and compared barriers and facilitators. The main perceived barrier to both groups was palliative care health professionals' lack of genetic knowledge (44%). Most palliative care health professionals were 'not at all confident' performing several activities, including discussing DNA banking (52%) and knowing their legal responsibilities when sharing genetic information (58%). The most frequently selected facilitator for genetic health professionals was fostering close relationships with palliative care health professionals (52%), while palliative care health professionals indicated a genetic referral template (51%) would be of assistance. Almost all participants agreed genetic discussions do not undermine the central ethos of palliative care (87%). Fewer palliative care health professionals considered themselves well situated to have genetic discussions with a palliative patient's family compared to genetic health professionals (p = 0.014). Our results suggest that genetic and palliative care health professionals support integrating genetics into palliative care, although refinement of the palliative care health professionals' role in this process is required. We have identified intervention targets to overcome barriers related to knowledge and confidence, which ought to be integrated into future interventions designed to support health professionals deliver the benefits of genetic information to people with palliative care needs and their families.
Collapse
Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kathy Tucker
- Hereditary Cancer Centre, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, Division of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
2
|
White S, Turbitt E, Phillips JL, Jacobs C. Approaching discussions about genetics with palliative patients and their families: a qualitative exploration with genetic health professionals. Eur J Hum Genet 2022:10.1038/s41431-022-01179-7. [PMID: 36064787 PMCID: PMC9441822 DOI: 10.1038/s41431-022-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
Genetic information can provide clinical benefits to families of palliative patients. However, integration of genetics into mainstream medicine has not focused on palliative populations. We explored the views and experiences of genetic health professionals in addressing genetics with palliative patients, and their families. We conducted an interpretive descriptive qualitative study with genetic counsellors and clinical geneticists using interviews and focus groups. Findings were generated using reflexive thematic analysis. Three themes were identified: (1) Focusing on the benefit to the family, (2) The discomfort of addressing genetics near end-of-life and (3) "It's always on the back-burner": Challenges to getting genetics on the palliative care agenda. Participants discussed the familial benefit of genetics in palliative care alongside the challenges when patients are near end-of-life. They perceived genetics as low priority for palliative care due to misunderstandings related to the value of genetic information. Acknowledging the challenges in the palliative care context, genetic health professionals want improved service leadership and awareness of the familial benefits of palliative genetic testing. Strong leadership to support genetic health professionals in addressing these barriers is needed for the benefits of genetic information to be realised.
Collapse
Affiliation(s)
- Stephanie White
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
3
|
Buras AL, Barkhurst M, Rutherford TJ, Anderson ML, English DP. The Intersection of Palliative Care and Genetic Counseling in Cancer Care: A Case Discussion. J Palliat Med 2021; 25:167-171. [PMID: 34851746 DOI: 10.1089/jpm.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Up to 10% of cancers have a strong hereditary component. The diagnosis of a hereditary cancer may alter treatment recommendations for the patient. However, the optimal timing and best practices for integrating genetic counseling and testing into the care of women diagnosed with cancer remains unclear. In this study, we demonstrate the potential benefits of discussing genetic testing and counseling in the context of palliative care through two cases. Incorporating referrals for genetic testing into the palliative care context is important. This provides an opportunity to perform previously missed genetic testing. It is also a chance for the patient to leave a legacy while also potentially allowing for alternate targeted treatment possibilities that may be well tolerated and provide a better quality of life for the patients themselves. The benefits of referral to palliative care by the genetics team includes assisting patients with the management of not only physical but also psychological symptoms as well as conducting advanced care planning in patients and families with hereditary mutations.
Collapse
Affiliation(s)
- Andrea L Buras
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Meghan Barkhurst
- Department of Palliative Care, Chesapeake Regional Medical Center, Chesapeake, Virginia, USA
| | - Thomas J Rutherford
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Matthew L Anderson
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Diana P English
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA.,Department of Palliative Medicine, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
4
|
Views and experiences of palliative care clinicians in addressing genetics with individuals and families: a qualitative study. Support Care Cancer 2021; 30:1615-1624. [PMID: 34549349 DOI: 10.1007/s00520-021-06569-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A proportion of people with palliative care needs unknowingly have a genetic predisposition to their disease, placing relatives at increased risk. As end-of-life nears, the opportunity to address genetics for the benefit of their family narrows. Clinicians face numerous barriers addressing genetic issues, but there is limited evidence from the palliative care clinician perspective. Our aims are to (1) explore the views and experiences of palliative care clinicians in addressing genetics with patients and their families and (2) generate suggested strategies that support integration of genetics into palliative care. METHODS An interpretive descriptive qualitative study using semi-structured interviews with palliative care doctors and nurses (N = 14). RESULTS Three themes were identified: (1) Harms and benefits of raising genetics: a delicate balancing act, (2) Navigating genetic responsibility within the scope of palliative care and (3) Overcoming practice barriers: a multipronged approach. Participants described balancing the benefits of addressing genetics in palliative care against potential harms. Responsibility to address genetic issues depends on perceptions of relevance and the scope of palliative care. Suggestions to overcome practice barriers included building genetic-palliative care relationships and multi-layered genetics education, developing clinical resources and increasing organisational support. CONCLUSIONS Integrating aspects of genetics is feasible, but must be balanced against potential harms and benefits. Palliative care clinicians were uncertain about their responsibility to navigate these complex issues to address genetics. There are opportunities to overcome barriers and tailor support to ensure people nearing end-of-life have a chance to address genetic issues for the benefit of their families.
Collapse
|
5
|
Best MC, Bartley N, Jacobs C, Juraskova I, Goldstein D, Newson AJ, Savard J, Meiser B, Ballinger M, Napier C, Thomas D, Biesecker B, Butow P. Patient perspectives on molecular tumor profiling: "Why wouldn't you?". BMC Cancer 2019; 19:753. [PMID: 31366375 PMCID: PMC6670204 DOI: 10.1186/s12885-019-5920-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/10/2019] [Indexed: 12/28/2022] Open
Abstract
Aim This study explored the attitudes of patients with advanced cancer towards MTP and return of results, prior to undergoing genomic testing within a research program. Methods Participants were recruited as part of the longitudinal PiGeOn (Psychosocial Issues in Genomics in Oncology) study involving patients with advanced/metastatic solid cancer who had exhausted therapeutic options and who were offered MTP in order to identify cognate therapies. Twenty patients, selected by purposive sampling, were interviewed around the time they gave consent to MTP. Interviews were audio recorded, transcribed and analysed using thematic analysis. Themes identified in the transcripts were cross-validated via qualitative responses to the PiGeOn study survey (n = 569; 63%). Results All interviewed participants gave consent to MTP without reservation. Three themes were identified and further supported via the survey responses: (1) Obvious agreement to participate, primarily because of desire for new treatments and altruism. (2) The black box – while participant knowledge of genomics was generally poor, faith in their oncologists and the scientific process encouraged them to proceed with testing; and (3) Survival is the priority – receiving treatment to prolong life was the priority for all participants, and other issues such as identification of a germline variant were generally seen as ancillary. Conclusion Having advanced cancer seemed to abrogate any potential concerns about MTP. Participants valued the research for varied reasons, but this was secondary to their priority to survive. While no negative attitudes toward MTP emerged, limitations in understanding of genomics were evident. Electronic supplementary material The online version of this article (10.1186/s12885-019-5920-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Megan C Best
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia.
| | - Nicole Bartley
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia
| | - Chris Jacobs
- University of Technology Sydney, Graduate School of Health, Broadway NSW, Sydney, 2007, Australia
| | - Ilona Juraskova
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of NSW, High Street, Kensington, NSW, 2032, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney Health Ethics, University of Sydney, 92/94 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Jacqueline Savard
- School of Medicine, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, HighStreet, Kensington, NSW, 2032, Australia
| | - Mandy Ballinger
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria street, Darlinghurst, NSW, 2010, Australia
| | - Christine Napier
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria street, Darlinghurst, NSW, 2010, Australia
| | - David Thomas
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria street, Darlinghurst, NSW, 2010, Australia
| | | | - Phyllis Butow
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia
| | | |
Collapse
|
6
|
Cleophat JE, Pelletier S, Joly Y, Gagnon P, Déry A, Marin A, Chiquette J, Gagnon B, Roy L, Bitzas V, Nabi H, Dorval M. Addressing cancer family history at the end of life: How frequent, relevant, and feasible is it? A survey of palliative care providers. Palliat Med 2019; 33:856-858. [PMID: 31023160 DOI: 10.1177/0269216319845826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jude E Cleophat
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.,2 Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.,3 Laval University Cancer Research Center, Quebec City, QC, Canada
| | - Sylvie Pelletier
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | - Yann Joly
- 4 Center of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Pierre Gagnon
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.,3 Laval University Cancer Research Center, Quebec City, QC, Canada.,5 Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Alberte Déry
- 6 Association Québécoise de Soins Palliatifs, Granby, QC, Canada
| | - Ana Marin
- 7 Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC, Canada.,8 CHU de Québec-Laval University, Quebec City, QC, Canada.,9 CISSS de Chaudière-Appalaches Research Center, Lévis, QC, Canada
| | - Jocelyne Chiquette
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.,3 Laval University Cancer Research Center, Quebec City, QC, Canada.,5 Faculty of Medicine, Laval University, Quebec City, QC, Canada.,8 CHU de Québec-Laval University, Quebec City, QC, Canada
| | - Bruno Gagnon
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.,3 Laval University Cancer Research Center, Quebec City, QC, Canada.,5 Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Louis Roy
- 8 CHU de Québec-Laval University, Quebec City, QC, Canada
| | - Vasiliki Bitzas
- 10 Palliative Care Unit, Jewish General Hospital, Montreal, QC, Canada
| | - Hermann Nabi
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.,3 Laval University Cancer Research Center, Quebec City, QC, Canada.,5 Faculty of Medicine, Laval University, Quebec City, QC, Canada.,11 French National Institute of Health and Medical Research Institute, Epidemiology and Population Health Research Center, INSERM U.1018, Villejuif, France
| | - Michel Dorval
- 1 Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.,2 Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.,3 Laval University Cancer Research Center, Quebec City, QC, Canada.,9 CISSS de Chaudière-Appalaches Research Center, Lévis, QC, Canada
| |
Collapse
|
7
|
Abstract
People with an inherited condition who receive palliative care may be missing out on the opportunity to store a DNA sample for future use by their families and offspring. A DNA sample from a family member affected with an inherited condition can help at-risk relatives to access accurate risk assessment and, where relevant, enhanced surveillance and risk-reducing measures. As genetic and genomic testing becomes increasingly important in all aspects of healthcare, health professionals specialising in palliative care will be asked to communicate about family history risk and testing. This article highlights the importance of discussing genetics and genomics issues for people receiving palliative care, their families and the health professionals caring for them.
Collapse
Affiliation(s)
- Chris Jacobs
- Senior Lecturer, Genetic Counselling, University of Technology Sydney (UTS) Ultimo, NSW Australia
| | - Stephanie White
- Associate Genetic Counsellor, Familial Cancer Service, Royal North Shore Hospital, Sydney, NSW Australia
| | - Jane Phillips
- Professor of Palliative Nursing, Director of IMPACCT, University of Technology Sydney (UTS) Ultimo, NSW Australia
| |
Collapse
|
8
|
D’Angelo A, Ormond KE, Magnus D, Tabor HK. Assessing genetic counselors’ experiences with physician aid-in-dying and practice implications. J Genet Couns 2019; 28:164-173. [DOI: 10.1002/jgc4.1047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Abby D’Angelo
- Department of Genetics; Stanford School of Medicine; Stanford California
| | - Kelly E. Ormond
- Stanford Center for Biomedical Ethics; Stanford University; Stanford California
- Department of Pediatrics; Stanford University; Stanford California
| | - David Magnus
- Stanford Center for Biomedical Ethics; Stanford University; Stanford California
- Department of Pediatrics; Stanford University; Stanford California
- Department of Medicine; Stanford University; Stanford California
| | - Holly K. Tabor
- Stanford Center for Biomedical Ethics; Stanford University; Stanford California
- Department of Medicine; Stanford University; Stanford California
| |
Collapse
|