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Fenton ATHR, Ornstein KA, Kent EE, Miller-Sonet E, Wright AA, Dionne-Odom JN. A comparison of adult-child and spousal cancer caregivers' participation in medical decisions. PLoS One 2024; 19:e0300450. [PMID: 38870142 PMCID: PMC11175391 DOI: 10.1371/journal.pone.0300450] [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: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Family caregivers often play a key role in medical decision-making for patients with cancer. Adult-children account for nearly half of caregivers, but often have less experience with serious illness care and decision-making and face unique relational challenges as the patient's child. Yet little research explores the potentially distinctive decision-making, involvement in decisions, and support needs of adult-child caregivers. METHODS Analysis of survey data of U.S. cancer caregivers conducted by CancerCare® in 2021. Chi-square tests and multivariable regression models assessed whether adult-child and spousal caregivers differed on the type of medical decisions they participated in (e.g., treatment planning, medication management), who made the decision (e.g., caregiver or joint decision), and the resources that informed decisions (e.g., friends and family, education materials). RESULTS Adult-children (N = 892) were less likely than spouses (N = 314) to participate in treatment planning (beta = -0.41; 95%CI = -0.81,-0.01), but more likely to be involved in decisions about whether to challenge medical authority (e.g., seeking alternative treatment, second opinion) (beta = 0.50; 95%CI = 0.22,0.78). Compared to spouses, adult-children made joint decisions with patients less often (-13.2-percentage points; 95%CI = -19.64,-6.67) and acted as primary decision-maker more frequently (5.60-percentage points; 95%CI = 0.01,10.43). More adult-children than spouses sought help and information regarding decisions from the oncology team (8.42-percentage points; 95%CI = 1.98,14.87) and friends and family (7.91-percentage points; 95%CI = 1.34,14.48). CONCLUSIONS How cancer caregivers and patients are related to each other shapes caregivers' medical decision-making. Adult-children's and spouses' probabilities of participating in and influencing decisions differed for certain types of decisions while adult-children were more likely to seek information and social support regarding decisions. These findings highlight the importance of the patient's and caregiver's relationship type in medical decision-making, suggesting that decision support programs may be more effective if they tailor programs by relationship type.
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Affiliation(s)
- Anny T. H. R. Fenton
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, United States of America
| | - Katherine A. Ornstein
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Erin E. Kent
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Alexi A. Wright
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America
- Division of Gerontology, Geriatrics and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
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2
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Roy S, Gwede CK, Malo TL, Scherr CL, Radlein S, Meade CD, Vadaparampil ST, Park JY. Exploring Prostate Cancer Patients' Interest and Preferences for Receiving Genetic Risk Information About Cancer Aggressiveness. Am J Mens Health 2021; 14:1557988320919626. [PMID: 32436757 PMCID: PMC7243408 DOI: 10.1177/1557988320919626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The number of cases of aggressive prostate cancer is increasing. Differentiating between aggressive and indolent cases has resulted in increased difficulty for the physician and patient to decide on the best treatment option. Due to this challenge, efforts are underway to profile genetic risk for prostate cancer aggressiveness, which may help physicians and patients at risk for developing aggressive prostate cancer to select an appropriate treatment option. This study explores patients’ interest in receiving genetic results, preference for how genetic risk information should be communicated, and willingness to share results with adult male first-degree relatives (FDRs). A nine-item survey was adapted to assess their beliefs and attitudes about genetic testing for prostate cancer aggressiveness. In addition, participants (n = 50) responded to hypothetical scenarios and questions associated with perceived importance of risk disclosure, preferences for receiving genetic risk information, and sharing of results with FDRs. As the hypothetical risk estimate for aggressive prostate cancer increased, patients’ willingness to receive genetic risk information increased. This study found that most patients preferred receiving genetic risk education in the form of a DVD (76%), one-page informational sheet (75%), or educational booklet (70%). Almost all patients (98%) reported that they would be willing to share their test results with FDRs. The results of this study highlight prostate cancer patients’ desire to receive and share genetic risk information. Future research should focus on assessing the long-term benefits of receiving genetic information for prostate cancer patients and implications of sharing this information with FDRs.
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Affiliation(s)
| | | | - Teri L Malo
- University of North Carolina, Chapel Hill, NC, USA
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3
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Bartley N, Best M, Jacobs C, Juraskova I, Newson AJ, Savard J, Meiser B, Ballinger ML, Thomas DM, Biesecker B, Butow P. Cancer patients' views and understanding of genome sequencing: a qualitative study. J Med Genet 2020; 57:671-676. [PMID: 31980566 DOI: 10.1136/jmedgenet-2019-106410] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/03/2019] [Accepted: 12/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about knowledge of, and attitudes towards, genome sequencing (GS) among individuals with a personal history of cancer who decide to undergo GS. This qualitative study aimed to investigate baseline knowledge and attitudes among individuals previously diagnosed with a cancer of likely genetic origin who have consented to GS. METHODS Semistructured interviews were conducted with purposively selected participants (n=20) from the longitudinal Psychosocial Issues in Genomic Oncology study, within a month of consenting to GS and prior to receiving any results. Participants were adults with a cancer of likely genetic aetiology who are undertaking GS as part of a larger genetic study. RESULTS Analysis identified three main themes: limited understanding of genomics; multifactorial motivation; and complex decision making. While motivations such as obtaining health information about self and family appear to be the main drivers for undertaking GS, these motivations are sometimes based on limited knowledge of the accuracy and utility of GS, creating unrealistic expectations. This in turn can prolong the deliberation process and lead to ongoing decisional conflict. CONCLUSION Understanding the degree and nature of patient understanding of GS, as well as their attitudes and decision-making processes, will enable healthcare professionals to better manage patient expectations and appropriately engage and support patients to make an informed decision when pursuing GS.
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Affiliation(s)
- Nicci Bartley
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Megan Best
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ainsley J Newson
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Savard
- School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Mandy L Ballinger
- The Kinghorn Cancer Center and Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - David M Thomas
- The Kinghorn Cancer Center and Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Barbara Biesecker
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - Phyllis Butow
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
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4
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Schreuder K, Kuijer A, Bentum S, van Dalen T, Siesling S. Use and Impact of the 21-Gene Recurrence Score in Relation to the Clinical Risk of Developing Metastases in Early Breast Cancer Patients in the Netherlands. Public Health Genomics 2019; 21:85-92. [PMID: 30650410 DOI: 10.1159/000495742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/23/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The nationwide use of the 21-gene recurrence score (21-RS) and implications regarding chemotherapy administration in relation to clinical risk in early breast cancer patients are investigated. METHODS Breast cancer patients surgically treated between 2014 and 2016 were selected from the Netherlands Cancer Registry and categorized as having a clinical low, intermediate, or high risk of developing metastases. Deployment of the 21-RS is advocated in patients with an intermediate risk of developing metastases. The use and impact of the 21-RS test result on chemotherapy administration were assessed in relation to the clinical risk as well as patient and tumor characteristics; χ2 tests were used for analysis. RESULTS Of all patients, 20,488 were considered as clinical low-, 4,309 as intermediate-, and 15,266 as high-risk patients. The 21-RS was deployed in 0.1% (n = 23), 3.2% (n = 137), and 0.6% (n = 90) of these categories, respectively. In the clinical intermediate-risk group, the 21-RS assigned 73.7, 13.1, and 13.1% of patients to the genomic low-, intermediate-, and high-risk category, respectively. Adherence to the 21-RS was 95.6% in these patients. CONCLUSION In the Netherlands, the 21-RS test is applied both inside and outside the guideline-directed area. In case of discordance between the genomic and clinical risk, patients were treated in line with the result of the 21-RS.
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Affiliation(s)
- Kay Schreuder
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands, .,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands,
| | - Anne Kuijer
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sanne Bentum
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Conflicting Online Health Information and Rational Decision Making: Implication for Cancer Survivors. Health Care Manag (Frederick) 2018; 36:184-191. [PMID: 28383314 DOI: 10.1097/hcm.0000000000000159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although people in the social media age can access health information easier, they have difficulty judging conflicting rational information or summarizing the large amounts of health information available. Conflicting health information occurs when contrary assertions or information about a certain health issue comes from different information sources. This study examined the background knowledge and the current phenomenon of why conflicting health information occurs in real-world conditions. We also reviewed causes and solutions by reviewing the literature. In particular, we recommend a method that solves problems that patients have including cancer survivors who cannot themselves be active in seeking health information. Thus, we categorized the specific types of conflicting health information and analyzed the sociodemographic factors and information carrier factors that have an impact on the health information-seeking behavior of individuals.
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Raoul JL, Maraninchi D. L’autonomie de décision du patient : du concept à la pratique cancérologique. Bull Cancer 2017; 104:695-700. [DOI: 10.1016/j.bulcan.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/12/2017] [Indexed: 11/29/2022]
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7
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Does biomarker information impact breast cancer patients' preferences and physician recommendation for adjuvant chemotherapy? Breast Cancer Res Treat 2017. [PMID: 28646344 DOI: 10.1007/s10549-017-4338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aimed to examine how biomarker information would impact patients' preferences and physicians' recommendations for adjuvant breast cancer therapy. METHODS At the 18-month follow-up, participants in a large, double-blind randomized controlled trial of adjuvant chemotherapy with bevacizumab or placebo (E5103) were surveyed about their preferred treatment (either chemotherapy A alone or chemotherapy A+B) in two hypothetical scenarios: (1) without biomarker information; and (2) after learning that they tested positive for a "B-receptor" which modestly increased both the benefit and toxicity expected with chemotherapy A+B. We performed a cross-sectional analysis of the prospectively collected survey data and used the McNemar's test to examine changes in treatment preferences. A one-time survey of clinical investigators who enrolled patients on the trial evaluated physician recommendations in response to the same biomarker information. RESULTS 439 patients completed both scenarios on 18-month survey. Most participants preferred A+B in both scenario 1 and 2 (77 and 76% respectively). The increase in benefit and toxicity associated with the positive biomarker information in scenario 2 led 60/439 (14%) of patients to switch their treatment preference. The corresponding physician survey revealed that most physicians chose regimen A+B in scenario 1 (77%), and moreso after the biomarker information was available in scenario 2 (84%). CONCLUSIONS Information about a positive biomarker indicating increased benefit and toxicity from additional chemotherapy did not change many participants' preferred treatment. The majority preferred the most effective course in both scenarios. Similarly, most investigators discounted increased toxicity and valued increased benefit. Parent Trial Registration: NCT00433511.
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8
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Hawley ST, Li Y, Jeanpierre LA, Goodell S, Jagsi R, Ward KC, Sabel MS, Katz SJ. Study protocol: A Randomized Controlled Trial of a Comprehensive Breast Cancer Treatment Patient Decision Tool (iCanDecide). Contemp Clin Trials Commun 2017; 5:123-132. [PMID: 29152598 PMCID: PMC5685533 DOI: 10.1016/j.conctc.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patients newly diagnosed with breast cancer face a series of complex decisions regarding locoregional and systemic treatment. There is a need to improve the quality of locoregional and systemic decisions for breast cancer patients, and to help patients understand the role of evaluative tests in this decision process. We are now conducting a randomized controlled trial (RCT) of an online decision tool—called iCanDecide, which we expect will help patients with these difficult decisions. Furthermore, the results of this RCT will be highly relevant to future breast cancer patients making these decisions and to their clinicians. Methods This is a two-arm randomized controlled trial with the target of 222 participants per arm. Participants are recruited from 25 surgical practices (total 40 surgeons) and 2 medical oncology practices (total 2 oncologists) in Michigan, Georgia, Tennessee, and California. Participants are newly-diagnosed female breast cancer patients between 21 and 84 years, with stage I-II invasive breast cancer or ductal carcinoma in situ (DCIS) and who are eligible for and considering either mastectomy or lumpectomy with radiation, and who may be eligible for adjuvant systemic treatment. The RCT tests an interactive, tailored website, called iCanDecide (intervention arm), compared to a static version of the website (control arm). The static control arm is designed to include the same basic content as the intervention version, but without tailoring and interactive features. The primary outcome includes the rate of making a high-quality decision. The hypothesis is that patients randomized to the interactive version of iCanDecide will have higher rates of high quality decisions (informed and values-concordant), and will appraise their decision-making process more positively, for both surgical and systemic treatment. Discussion The goal of this study is to evaluate the impact of the iCanDecide interactive website on decision-making for locoregional and systemic breast cancer treatments. The results of this study will be important for future breast cancer patients and their clinicians as we determine how to better individualize decision making across this complex treatment landscape. Trial registration ClinicalTrials.gov ID NCT01840163.
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Affiliation(s)
- Sarah T Hawley
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA.,University of Michigan, Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.,Veterans Administration Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Yun Li
- University of Michigan, Department of Biostatistics School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - L Alexandra Jeanpierre
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Stefanie Goodell
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, University Hospital, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kevin C Ward
- Emory University, Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road NE, Atlanta, GA 30033, USA
| | - Michael S Sabel
- University of Michigan, Department of Surgery, Comprehensive Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Katz
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA.,University of Michigan, Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
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9
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Wang C, Gordon ES, Norkunas T, Wawak L, Liu CT, Winter M, Kasper RS, Christman MF, Green RC, Bowen DJ. A randomized trial Examining The Impact Of Communicating Genetic And Lifestyle Risks For Obesity. Obesity (Silver Spring) 2016; 24:2481-2490. [PMID: 27891830 PMCID: PMC5127396 DOI: 10.1002/oby.21661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/14/2016] [Accepted: 08/08/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Genetic testing for obesity is available directly to consumers, yet little is understood about its behavioral impact and its added value to nongenetic risk communication efforts based on lifestyle factors. METHODS A randomized trial examined the short-term impact of providing personalized obesity risk information, using a 2 × 2 factorial design. Participants were recruited from the Coriell Personalized Medicine Collaborative (CPMC) and randomized to receive (1) no risk information (control), (2) genetic risk, (3) lifestyle risk, or (4) combined genetic/lifestyle risks. Baseline and 3-month follow-up survey data were collected. Analyses examined the impact of risk feedback on intentions to lose weight and self-reported weight. RESULTS A total of 696 participants completed the study. A significant interaction effect was observed for genetic and lifestyle information on intent to lose weight (P = 0.0150). Those who received genetic risk alone had greater intentions at follow-up, compared with controls (P = 0.0034). The impact of receiving elevated risk information on intentions varied by source and combination of risks presented. Non-elevated genetic risk did not lower intentions. No group differences were observed for self-reported weight. CONCLUSIONS Genetic risk information for obesity may add value to lifestyle risk information depending on the context in which it is presented.
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Affiliation(s)
- Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Tricia Norkunas
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Lisa Wawak
- Coriell Institute for Medical Research, Camden, NJ, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael Winter
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Robert C. Green
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Broad Institute and Harvard Medical School, Boston, MA, USA
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
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Carpenter DM, Geryk LL, Chen AT, Nagler RH, Dieckmann NF, Han PKJ. Conflicting health information: a critical research need. Health Expect 2016; 19:1173-1182. [PMID: 26709206 PMCID: PMC5139056 DOI: 10.1111/hex.12438] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 12/21/2022] Open
Abstract
Conflicting health information is increasing in amount and visibility, as evidenced most recently by the controversy surrounding the risks and benefits of childhood vaccinations. The mechanisms through which conflicting information affects individuals are poorly understood; thus, we are unprepared to help people process conflicting information when making important health decisions. In this viewpoint article, we describe this problem, summarize insights from the existing literature on the prevalence and effects of conflicting health information, and identify important knowledge gaps. We propose a working definition of conflicting health information and describe a conceptual typology to guide future research in this area. The typology classifies conflicting information according to four fundamental dimensions: the substantive issue under conflict, the number of conflicting sources (multiplicity), the degree of evidence heterogeneity and the degree of temporal inconsistency.
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Affiliation(s)
- Delesha M. Carpenter
- Department of Pharmaceutical Outcomes and PolicyUniversity of North Carolina at Chapel HillAshevilleNCUSA
| | - Lorie L. Geryk
- Department of Pharmaceutical Outcomes and PolicyUniversity of North Carolina at Chapel HillAshevilleNCUSA
| | - Annie T. Chen
- Department of Biomedical and Health InformaticsUniversity of WashingtonSeattleWAUSA
| | - Rebekah H. Nagler
- School of Journalism & Mass CommunicationUniversity of MinnesotaMinneapolisMNUSA
| | | | - Paul K. J. Han
- Center for Outcomes Research and EvaluationMaine Medical CenterPortlandMEUSA
- Tufts University Clinical and Translational Sciences InstituteBostonMAUSA
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11
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Bombard Y, Rozmovits L, Trudeau M, Leighl NB, Deal K, Marshall DA. The value of personalizing medicine: medical oncologists' views on gene expression profiling in breast cancer treatment. Oncologist 2015; 20:351-6. [PMID: 25746345 DOI: 10.1634/theoncologist.2014-0268] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/31/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Guidelines recommend gene-expression profiling (GEP) tests to identify early-stage breast cancer patients who may benefit from chemotherapy. However, variation exists in oncologists' use of GEP. We explored medical oncologists' views of GEP tests and factors impacting its use in clinical practice. METHODS We used a qualitative design, comprising telephone interviews with medical oncologists (n = 14; 10 academic, 4 in the community) recruited through oncology clinics, professional advertisements, and referrals. Interviews were analyzed for anticipated and emergent themes using the constant comparative method including searches for disconfirming evidence. RESULTS Some oncologists considered GEP to be a tool that enhanced confidence in their established approach to risk assessments, whereas others described it as "critical" to resolving their uncertainty about whether to recommend chemotherapy. Some community oncologists also valued the test in interpreting what they considered variable practice and accuracy across pathology reports and testing facilities. However, concerns were also raised about GEP's cost, overuse, inappropriate use, and over-reliance on the results within the medical community. In addition, although many oncologists said it was simple to explain the test to patients, paradoxically, they remained uncertain about patients' understanding of the test results and their treatment implications. CONCLUSION Oncologists valued the test as a treatment-decision support tool despite their concerns about its cost, over-reliance, overuse, and inappropriate use by other oncologists, as well as patients' limited understanding of GEP. The results identify a need for decision aids to support patients' understanding and clinical practice guidelines to facilitate standardized use of the test.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Linda Rozmovits
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Trudeau
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Natasha B Leighl
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Deal
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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12
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Martinez KA, Kurian AW, Hawley ST, Jagsi R. How can we best respect patient autonomy in breast cancer treatment decisions? BREAST CANCER MANAGEMENT 2015; 4:53-64. [PMID: 25733982 PMCID: PMC4342843 DOI: 10.2217/bmt.14.47] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care. Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician. Application of this approach in breast cancer decision-making has not been uniform across cancer-specific interventions (e.g., surgery, chemotherapy), and in some circumstances may present challenges to evidence-based care delivery. Increasingly precise estimates of individual patients' risk of recurrence and commensurate predicted benefit from certain therapies hold significant promise in helping patients exercise autonomous decision-making for their breast cancer care, yet will also likely complicate decision-making for certain subgroups of patients.
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Affiliation(s)
- Kathryn A Martinez
- VA Center for Clinical Management Research, 2800 Plymouth Road, Building 16, 3rd Floor, Ann Arbor, MI 48105, USA
| | - Allison W Kurian
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Sarah T Hawley
- VA Center for Clinical Management Research, 2800 Plymouth Road, Building 16, 3rd Floor, Ann Arbor, MI 48105, USA
- Division of General Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor MI, 48105, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
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Leggett LE, Lorenzetti DL, Noseworthy T, Tiwana S, Mackean G, Clement F. Experiences and attitudes toward risk of recurrence testing in women with breast cancer: a systematic review. Breast Cancer Res Treat 2014; 144:457-65. [PMID: 24596049 DOI: 10.1007/s10549-014-2900-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
Recurrence tests, such as Adjuvant! Online and Oncotype DX, can be used to determine an individual's risk of developing recurrent cancer. These technologies are useful for helping health care practitioners make treatment recommendations. With increasing use, it is necessary to consider patients' experience with and attitudes toward risk of recurrence testing. Factors such as anxiety, influence on decision making, confidence in results, and satisfaction with testing are important to consider. To understand experiences and attitudes toward risk of recurrence testing, from the perspective of women who have used these technologies following a breast cancer diagnosis. A systematic review was completed. Eight multidisciplinary electronic databases, including MEDLINE, PsycINFO, CINAHL, and ERIC, were searched from 1950 to December 17, 2012. Abstracts and full-text papers were screened for inclusion, in duplicate, based on established criteria. Recurrent themes and key concepts were identified and analyzed. One-thousand and twenty-two abstracts were retrieved, and fifty-one proceeded to full-text review. Ten studies reporting on eight populations were included in this review. Key themes that emerged from the literature include: experience with the testing process; influence testing has on treatment; and comprehension of results. The literature suggests that testing for breast cancer recurrence can have a negative impact on women; poor comprehension of test results, and anxiety/distress were the most frequently cited reasons for a negative experience. Despite these drawbacks, women consistently reported that they would recommend testing to others. The literature on this topic is limited, and heterogeneous. The available literature suggests that women are generally satisfied with risk of recurrence testing for breast cancer. Potential drawbacks of risk of recurrence testing include anxiety and comprehension of test results. Additional high-quality research on women's experiences with risk of recurrence testing for breast cancer would improve the evidence base, and would allow stronger conclusions to be drawn.
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Affiliation(s)
- Laura E Leggett
- The Department Community Health Sciences, 3D18, Teaching Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Brewer NT, Defrank JT, Chiu WK, Ibrahim JG, Walko CM, Rubin P, Olajide OA, Moore SG, Raab RE, Carrizosa DR, Corso SW, Schwartz G, Peppercorn JM, McLeod HL, Carey LA, Irvin WJ. Patients' understanding of how genotype variation affects benefits of tamoxifen therapy for breast cancer. Public Health Genomics 2014; 17:43-7. [PMID: 24457521 DOI: 10.1159/000356565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/10/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND CYP2D6 is a critical enzyme in the metabolism of tamoxifen and potentially a key determinant in breast cancer outcomes. Our study examined patients' beliefs about how the CYP2D6 genotype would affect their prognoses. METHODS Women enrolled in a pharmacogenomic clinical trial and on tamoxifen for prevention or treatment of breast cancer underwent CYP2D6 genotyping (EM = extensive, IM = intermediate, PM = poor metabolizing alleles). The informed consent said that the purpose of the trial was to examine effects of dose adjustment based on genotype, but that clinical benefits were uncertain. Our embedded sub-study surveyed 320 patients prior to receiving their genotypes. We experimentally manipulated 6 vignettes to describe hypothetical tamoxifen treatment (no or yes) and hypothetical genotype (EM, IM or PM). For each vignette, women gave their perceived recurrence risk (RR; 0-100%). RESULTS Women believed that genotype would not affect their RR if they did not take tamoxifen (p = 0.06). However, women believed that if prescribed tamoxifen, genotype would affect their RR (22% if EM, 30% if IM and 40% if PM, p < 0.001). CONCLUSION Women believed that extensive tamoxifen metabolizers had better prognoses, despite study materials stating uncertainty about any benefit. The rapidly changing nature of genomic science calls for caution when communicating clinical utility.
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Affiliation(s)
- N T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, N.C., USA
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DeFrank JT, Carey LA, Brewer NT. Understanding how breast cancer patients use risk information from genomic tests. J Behav Med 2013; 36:567-73. [PMID: 22878783 PMCID: PMC3535460 DOI: 10.1007/s10865-012-9449-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
We sought to examine how patients' treatment decisions incorporate potentially conflicting information from standard clinical indicators (e.g., tumor size) and genomic tests for breast cancer recurrence risk. Participants were 77 early stage breast cancer survivors who previously received genomic testing. They read six hypothetical vignettes that varied recurrence risk indicated by standard tests (low or high risk) coupled with the genomic test (low, intermediate or high risk). For each vignette, women reported their perceived recurrence risk and treatment preferences. Test results indicating high recurrence risk increased perception of risk and preference for chemotherapy (p < .001 for all). Perceived risk explained (i.e., mediated) the effect of test results on chemotherapy preferences. When test results conflicted, women gave more weight to genomic over standard test results. Hypothetical genomic test results had the intended effect of influencing women's perceptions of recurrence risk and interest in chemotherapy.
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Affiliation(s)
- Jessica T DeFrank
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC, 27599-7440, USA,
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16
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Wang C, Gordon ES, Stack CB, Liu CT, Norkunas T, Wawak L, Christman MF, Green RC, Bowen DJ. A randomized trial of the clinical utility of genetic testing for obesity: design and implementation considerations. Clin Trials 2013; 11:102-13. [PMID: 24216219 DOI: 10.1177/1740774513508029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity rates in the United States have escalated in recent decades and present a major challenge in public health prevention efforts. Currently, testing to identify genetic risk for obesity is readily available through several direct-to-consumer companies. Despite the availability of this type of testing, there is a paucity of evidence as to whether providing people with personal genetic information on obesity risk will facilitate or impede desired behavioral responses. PURPOSE We describe the key issues in the design and implementation of a randomized controlled trial examining the clinical utility of providing genetic risk information for obesity. METHODS Participants are being recruited from the Coriell Personalized Medicine Collaborative, an ongoing, longitudinal research cohort study designed to determine the utility of personal genome information in health management and clinical decision making. The primary focus of the ancillary Obesity Risk Communication Study is to determine whether genetic risk information added value to traditional communication efforts for obesity, which are based on lifestyle risk factors. The trial employs a 2 × 2 factorial design in order to examine the effects of providing genetic risk information for obesity, alone or in combination with lifestyle risk information, on participants' psychological responses, behavioral intentions, health behaviors, and weight. RESULTS The factorial design generated four experimental arms based on communication of estimated risk to participants: (1) no risk feedback (control), (2) genetic risk only, (3) lifestyle risk only, and (4) both genetic and lifestyle risk (combined). Key issues in study design pertained to the selection of algorithms to estimate lifestyle risk and determination of information to be provided to participants assigned to each experimental arm to achieve a balance between clinical standards and methodological rigor. Following the launch of the trial in September 2011, implementation challenges pertaining to low enrollment and differential attrition became apparent and required immediate attention and modifications to the study protocol. Although monitoring of these efforts is ongoing, initial observations show a doubling of enrollment and reduced attrition. LIMITATIONS The trial is evaluating the short-term impact of providing obesity risk information as participants are followed for only 3 months. This study is built upon the structure of an existing personalized medicine study wherein participants have been provided with genetic information for other diseases. This nesting in a larger study may attenuate the effects of obesity risk information and has implications for the generalizability of study findings. CONCLUSIONS This randomized trial examines value of obesity genetic information, both when provided independently and when combined with lifestyle risk assessment, to motivate individuals to engage in healthy lifestyle behaviors. Study findings will guide future intervention efforts to effectively communicate genetic risk information.
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Affiliation(s)
- Catharine Wang
- aDepartment of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Seror V, Marino P, Bertucci F, Mancini J, Extra JM, Ferrero JM, Bachelot T, Viens P, Julian-Reynier C. Breast Cancer Patients' Views on the Use of Genomic Testing to Guide Decisions about Their Postoperative Chemotherapy. Public Health Genomics 2013; 16:110-7. [DOI: 10.1159/000349920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
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Brewer NT, Richman AR, DeFrank JT, Reyna VF, Carey LA. Improving communication of breast cancer recurrence risk. Breast Cancer Res Treat 2012; 133:553-61. [PMID: 21964579 PMCID: PMC3754448 DOI: 10.1007/s10549-011-1791-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 09/15/2011] [Indexed: 12/23/2022]
Abstract
Doctors commonly use genomic testing for breast cancer recurrence risk. We sought to assess whether the standard genomic report provided to doctors is a good approach for communicating results to patients. During 2009-2010, we interviewed 133 patients with stages I or II, node-negative, hormone receptor-positive breast cancer and eligible for the Oncotype DX genomic test. In a randomized experiment, patients viewed six vignettes that presented hypothetical recurrence risk test results. Each vignette described a low, intermediate, or high chance of breast cancer recurrence in 10 years. Vignettes used one of five risk formats of increasing complexity that we derived from the standard report that accompanies the commercial assay or a sixth format that used an icon array. Among women who received the genomic recurrence risk test, 63% said their doctors showed them the standard report. The standard report format yielded among the most errors in identification of whether a result was low, intermediate, or high risk (i.e., the gist of the results), whereas a newly developed risk continuum format yielded the fewest errors (17% vs. 5%; OR 0.23; 95% CI 0.10-0.52). For high recurrence risk results presented in the standard format, women made errors 35% of the time. Women rated the standard report as one of the least understandable and least-liked formats, but they rated the risk continuum format as among the most understandable and most liked. Results differed little by health literacy, numeracy, prior receipt of genomic test results during clinical care, and actual genomic test results. The standard genomic recurrence risk report was more difficult for women to understand and interpret than the other formats. A less complex report, potentially including the risk continuum format, would be more effective in communicating test results to patients.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7440, USA.
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Andrykowski MA, Burris JL, Walsh E, Small BJ, Jacobsen PB. Attitudes toward information about genetic risk for cognitive impairment after cancer chemotherapy: breast cancer survivors compared with healthy controls. J Clin Oncol 2010; 28:3442-7. [PMID: 20498392 DOI: 10.1200/jco.2009.27.8267] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The trend toward personalized medicine will involve cancer treatment increasingly being tailored to the genetic characteristics of individuals. However, the availability of genetic information does not imply this information is desired or would impact treatment decision making. METHODS One hundred sixty breast cancer survivors (BC group) and 205 healthy controls (HC group) were randomly assigned to respond to two different clinical scenarios varying in genetic-related risk of cognitive impairment (CI; little v very likely) and severity of CI (little v moderate problem) after chemotherapy. Ratings of the importance of being told this genetic information (information importance) and the likelihood this information would affect their decision to receive chemotherapy (information impact) were obtained. RESULTS Results indicated the importance ascribed to genetic information was greatest when CI likelihood and severity were both high or low (P < .05). Information impact ratings were not sensitive to differences in CI likelihood or severity; the BC group was less likely to indicate genetic information would affect their decision to receive chemotherapy than the HC group (P < .001). CONCLUSION Results suggest lessened enthusiasm for genetic information that maintains or increases uncertainty about a specific course of action and highlight the importance of including clinically relevant groups in treatment decision-making research that employs hypothetical scenarios. Although women generally believe it is important to receive genetic information, they might benefit from assistance (eg, decision aid) in the difficult task of integrating information about survival and risk for adverse late effects from cancer treatment.
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Affiliation(s)
- Michael A Andrykowski
- Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA.
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