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Abad PJB, Shah LL, Daack-Hirsch S. Family Information Management in the Context of Inherited Conditions: An Integrative Review. JOURNAL OF FAMILY NURSING 2024:10748407241272196. [PMID: 39194163 DOI: 10.1177/10748407241272196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
This review aimed to develop a framework to understand the process of information management in families with inherited conditions. Electronic databases were searched for relevant peer-reviewed articles. Articles were included if they were original research on families affected by any confirmed inherited condition, described how a family accesses, interprets, conveys, and/or uses information about the disease, included the recruitment of more than one family member, and used family as the unit of analysis. Data were analyzed through directed content analysis. Thirty-four articles from 27 studies were analyzed. We propose a framework for family information management consisting of the following domains: contextual influences, family information management behaviors, and family information management outcomes. This proposed framework expands the understanding of how families manage their genetic information in making health care decisions for their affected and at-risk relatives.
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Affiliation(s)
- Peter James B Abad
- The University of Iowa, USA
- University of the Philippines Manila, Philippines
| | - Lisa L Shah
- Virginia Commonwealth University, Richmond, USA
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Cragun D, Dean M, Baker D, Kelley M, Hooker G, Weidner A, Hunt P, Pal T. The Development and Evaluation of Novel Patient Educational Material for a Variant of Uncertain Significance (VUS) Result in Hereditary Cancer Genes. Curr Oncol 2024; 31:3361-3378. [PMID: 38920739 PMCID: PMC11202617 DOI: 10.3390/curroncol31060256] [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: 04/25/2024] [Revised: 05/30/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
A Variant of Uncertain Significance (VUS) is a difference in the DNA sequence with uncertain consequences for gene function. A VUS in a hereditary cancer gene should not change medical care, yet some patients undergo medical procedures based on their VUS result, highlighting the unmet educational needs among patients and healthcare providers. To address this need, we developed, evaluated, and refined novel educational materials to explain that while VUS results do not change medical care, it remains important to share any personal or family history of cancer with family members given that their personal and family medical history can guide their cancer risk management. We began by reviewing the prior literature and transcripts from interviews with six individuals with a VUS result to identify content and design considerations to incorporate into educational materials. We then gathered feedback to improve materials via a focus group of multidisciplinary experts and multiple rounds of semi-structured interviews with individuals with a VUS result. Themes for how to improve content, visuals, and usefulness were used to refine the materials. In the final round of interviews with an additional 10 individuals with a VUS result, materials were described as relatable, useful, factual, and easy to navigate, and also increased their understanding of cancer gene VUS results.
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Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL 33620, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL 33620, USA
- Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - David Baker
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Meghan Kelley
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Gillian Hooker
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Anne Weidner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Paige Hunt
- College of Public Health, University of South Florida, Tampa, FL 33620, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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Aceti M, Caiata-Zufferey M, Pedrazzani C, Schweighoffer R, Kim SY, Baroutsou V, Katapodi MC, Kim S. Modes of responsibility in disclosing cancer genetic test results to relatives: An analysis of Swiss and Korean narrative data. PATIENT EDUCATION AND COUNSELING 2024; 123:108202. [PMID: 38395023 DOI: 10.1016/j.pec.2024.108202] [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: 08/12/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE We examined how responsibility (the "duty to inform relatives about genetic testing results") is understood and enacted among Swiss and Korean women carrying BRCA1 or BRCA2 pathogenic variants. METHODS In-depth interviews and/or focus groups with 46 Swiss and 22 Korean carriers were conducted, using an identical interview guide. Data were analyzed inductively and translated into English for cross-country comparisons. RESULTS We identified five modes of responsibility in both samples: Persuader, Enabler, Relayer, Delayer, and Decliner. The Enabler and Relayer modes were the most common in both countries. They followed the rational imperative of health and norms of competence and self-determination, respectively. The Relayer mode transmitted information without trying to influence relatives' decisions. The Delayer and Decliner modes withheld information, deeming it the best way to safeguard the family during that specific moment of its trajectory. Responsibility to disclose testing results was influenced by culturally diverging conceptions of the family unit and socio-contextual norms. CONCLUSION Responsibility primarily reflects the imperative of health prevention; findings demonstrate various interpretations, including the sense of family caring achieved through controlled disclosure of genetic information. PRACTICE IMPLICATIONS Findings offer healthcare providers socio-anthropological insights to assist probands navigate the disclosure of genetic information within their families. TRIAL REGISTRATION NUMBER NCT04214210 (registered Nov 2, 2020), KCT 0005643 (registered Nov 23, 2020).
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Affiliation(s)
- Monica Aceti
- Laboratory Sport and Social Sciences, University of Strasbourg, Strasbourg, France; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care at the University of Applied Science and Arts of Southern Switzerland, Manno, Switzerland.
| | - Carla Pedrazzani
- Department of Business Economics, Health and Social Care at the University of Applied Science and Arts of Southern Switzerland, Manno, Switzerland.
| | - Reka Schweighoffer
- Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Soo Yeon Kim
- Korea Armed Forces Nursing Academy, Daejeon, South Korea; College of Nursing, Yonsei University, Seoul, South Korea.
| | - Vasiliki Baroutsou
- Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Maria C Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Sue Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
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Currey M, Solomon I, McGraw S, Shen J, Munoz F, Sosa E, Puello-Lozano V, Wing S, Lopez L, Afkhami M, LoBello J, Szelinger S, Gray SW. Preparing for the unexpected: Recommendations for returning secondary findings in late-stage cancer care. Genet Med 2024; 26:100991. [PMID: 37791544 DOI: 10.1016/j.gim.2023.100991] [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: 03/23/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE We conducted qualitative interviews with patients with cancer and providers to identify gaps in clinical care and highlight care delivery solutions for the return of secondary germline findings. METHODS Twelve patients and 19 cancer providers from the United States were interviewed between January 2019 and May 2021. Interviews elicited feedback about patient information needs, emotional responses to secondary findings, and recommendations for improving pre-test education. RESULTS Patients' responses ranged from gratitude to regret, depending on how much pre-test counseling they received before tumor testing. Providers cited insufficient clinic time as a major barrier to pretest education, favoring online support tools and standardized pre-test education models. Providers had differing perspectives on how pre-test education should be integrated into clinical workflows but agreed that it should include the differences between somatic and germline testing, the likelihood of medically actionable findings, and the possibility of being referred to a genetics provider. CONCLUSION The spectrum of participants' responses to their secondary findings underscores the importance of adequate pre-test discussions before somatic sequencing. Although educational interventions could address patients' information needs and augment traditional pre-test counseling, health care systems, labs, and genetic providers may be called on to play greater roles in pre-test education.
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Affiliation(s)
| | - Ilana Solomon
- Department of Population Sciences, City of Hope, Duarte, CA
| | | | - Jenny Shen
- Department of Psychology, The State University of New York at Stony Brook, Stony Brook, NY
| | | | | | | | - Sam Wing
- Intuitive Surgical, Health Economics and Outcomes Research, Sunnyvale, CA
| | - Lisa Lopez
- School of Nursing, University of Texas at Austin, Austin, TX
| | | | | | | | - Stacy W Gray
- Department Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA.
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Cragun DL, Hunt PP, Dean M, Weidner A, Shields AK, Tezak A, Pal T. Applying the framework for developing and evaluating complex interventions to increase family communication about hereditary cancer. PEC INNOVATION 2023; 2:100133. [PMID: 37214492 PMCID: PMC10194404 DOI: 10.1016/j.pecinn.2023.100133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 05/24/2023]
Abstract
Objective Evaluate an intervention to increase family communication (FC) of positive hereditary cancer test results using the Framework for Developing and Evaluating Complex Interventions (FDECI). Methods We developed 'programme theory' during the FDECI development phase by aligning intervention components with behavior change techniques (BCTs) and theoretical factors expected to improve FC. During the feasibility phase, we obtained feedback from 12 stakeholder interviews. Results Intervention components aligned with a total of 14 unique BCTs for which prior evidence links the BCT to theoretical factors that influence behavior change. Constructive stakeholder feedback included: more information desired, rewording to support autonomy by highlighting options, and improvements to navigation, visuals, and audio. Positive comments included: comprehensiveness of materials, modeling of conversations, and usefulness of the materials for helping a person prepare to share positive test results. Conclusion The first FDECI phases were helpful for improving the intervention and planning our ongoing effectiveness and future implementation phases. Innovation Our application of the FDECI is novel, including plans to test our 'programme theory' using coincidence analysis (CNA) to determine who accesses which intervention materials, how utilizing certain materials impact the aligned theoretical factors, and whether these in turn make a difference in the behavioral outcome.
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Affiliation(s)
- Deborah L. Cragun
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Paige Phillips Hunt
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Marleah Dean
- University of South Florida, Department of Communication, Tampa, FL; Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, FL, United States of America
- Moffitt Cancer Center, Health Outcomes & Behavior Program, Tampa, FL, United States of America
| | - Anne Weidner
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| | - Andrea K. Shields
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Ann Tezak
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| | - Tuya Pal
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
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Allen CG, McBride CM, Escoffery C, Guan Y, Hood C, Zaho J, Brody G, An W. Developing and assessing a kin keeping scale with application to identifying central influencers in African American family networks. J Community Genet 2023; 14:593-603. [PMID: 37648941 PMCID: PMC10725405 DOI: 10.1007/s12687-023-00665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
Promoting family communication about inherited disease risk is an arena in which family systems theory is highly relevant. One family systems' construct that can support promotion of family communication regarding inherited disease risk is the notion of "kin keeping." However, kin keeping and whether it might be capitalized on to encourage family communication about inherited risk has been understudied. The goal of this report was to propose a broadened conceptualization of kin keeping that distinguishes between a structural functional perspective (role conceptualization) and transitional behaviors (skill conceptualization), and to develop and evaluate a scale that would enable this assertion to be tested among a sample of African American community health workers. We developed a scale using four steps: item development using concept analysis and content validity, scale development among a national sample (n = 312), scale evaluation using exploratory factor analysis (n = 52), and scale reduction. We then posed suppositions of associations that would indicate whether the developed kin keeping measure was assessing a specific family role or set of behaviors. Our results included the development of the first quantitative measure of kin keeping (9- and 15-item scales). Model fit for 9-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.09, SMRM = 0.06) and model fit for 15-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.06, SMRM = 0.05). These findings allow us to move toward more rigorous research about the role of kin keeping on information sharing and health decision making. Results also suggest that, contrary to the historical structural functional conceptualization of kin keeping as a role, kin keeping might also be conceptualized as a behavior or set of modifiable behaviors. Ultimately, the kin keeping scale could be used to operationalize kin keeping in various theoretical models and frameworks, guide intervention development to encourage or train for kin keeping behaviors, and test assumptions of whether families vary in the density of kin keeping.
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Affiliation(s)
- Caitlin G Allen
- Medical University of South Carolina, Charleston, SC, USA.
- Emory University, Atlanta, GA, USA.
| | | | | | - Yue Guan
- Emory University, Atlanta, GA, USA
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Hunter JE, Riddle L, Joseph G, Amendola LM, Gilmore MJ, Zepp JM, Shuster E, Bulkley JE, Muessig KR, Anderson KP, Goddard KAB, Wilfond BS, Leo MC. Most people share genetic test results with relatives even if the findings are normal: Family communication in a diverse population. Genet Med 2023; 25:100923. [PMID: 37421176 PMCID: PMC10766857 DOI: 10.1016/j.gim.2023.100923] [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: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
PURPOSE With increasing utilization of genetic testing, sharing genetic information can become part of general family health communication while providing biological relatives with important information about their own genetic risk. Importantly, little is known about motivations for and barriers to family communication of genetic information in historically underserved populations. METHODS Using mixed methods, we explored patient experiences with family communication in a study population of English- and Spanish-speaking adults aged 18 to 49 years, enriched for participants from historically underserved backgrounds. Risk screening for hereditary cancer guided genetic testing for cancer risk genes and other medically actionable findings. RESULTS Most participants overall (91%), including most with normal findings (89%), shared or planned to share their results with relatives. Common motivations for sharing results were to give relatives information about their genetic risk and because the participant thought the results were interesting. Reasons for not sharing were limited contact with relatives, perceptions of limited clinical utility for relatives, and concern that discussion of genetic information was stigmatized or taboo. CONCLUSION Results demonstrate high rates of sharing genetic information, indicate motivations for sharing go beyond facilitating genetic testing for relatives, and suggest general willingness to share genetic information as part of family health communication.
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Affiliation(s)
- Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, NC; Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR.
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Katherine P Anderson
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
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Zhao J, McBride CM, Campbell GP, Pentz RD, Escoffery C, Konomos M, Bellcross C, Ward K, Shepperd JR, Guan Y. Your Family Connects: A Theory-Based Intervention to Encourage Communication about Possible Inherited Cancer Risk among Ovarian Cancer Survivors and Close Relatives. Public Health Genomics 2023; 26:77-89. [PMID: 37487468 PMCID: PMC10614520 DOI: 10.1159/000531772] [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: 12/16/2022] [Accepted: 06/26/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Encouraging family communication about possible genetic risk has become among the most important avenues for achieving the full potential of genomic discovery for primary and secondary prevention. Yet, effective family-wide risk communication (i.e., conveying genetic risk status and its meaning for other family members) remains a critical gap in the field. We aim to describe the iterative process of developing a scalable population-based communication outreach intervention, Your Family Connects, to reach ovarian cancer survivors and close relatives to communicate the potential for inherited risk and to consider genetic counseling. METHODS Relational-level theories (e.g., interdependence theory) suggest that interventions to promote family cancer risk communication will be most effective if they consider the qualities of specific relationships and activate motives to preserve the relationship. Informed by these theories, we collaborated with 14 citizen scientists (survivors of ovarian cancer or relatives) and collected 261 surveys and 39 structured interviews over 12 weeks of citizen science activities in 2020. RESULTS The citizen science findings and consideration of relational-level theories informed the content and implementation of Your Family Connects (www.yourfamilyconnects.org). CS results showed survivors favor personal contact with close relatives, but relatives were open to alternative contact methods, such as through health professionals. Recognizing the need for varied approaches based on relationship dynamics, we implemented a relative contact menu to enable survivors identify at-risk relatives and provide multiple contact options (i.e., survivor contact, health professional contact, and delayed contact). In line with relational autonomy principles, we included pros and cons for each option, assisting survivors in choosing suitable contact methods for each relative. DISCUSSION Our developed intervention represents a novel application of relational-level theories and partnership with citizen scientists to expand genetic services reach to increase the likelihood for fair distribution of cancer genomic advances. The Your Family Connects intervention as part of a randomized trial in collaboration with the Georgia Cancer Registry compared with standard outreach.
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Affiliation(s)
- Jingsong Zhao
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA,
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Gavin P Campbell
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Rebecca D Pentz
- Department of Hematology and Oncology, Emory School of Medicine, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | | | | | - Kevin Ward
- Georgia Center for Cancer Statistics, Emory University, Atlanta, Georgia, USA
| | - James R Shepperd
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
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Wells I, Zemedikun DT, Simons G, Stack RJ, Mallen CD, Raza K, Falahee M. Predictors of the likelihood that patients with rheumatoid arthritis will communicate information about rheumatoid arthritis risk to relatives: A quantitative assessment. PATIENT EDUCATION AND COUNSELING 2023; 112:107713. [PMID: 37003160 DOI: 10.1016/j.pec.2023.107713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/10/2023] [Accepted: 03/17/2023] [Indexed: 05/09/2023]
Abstract
First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) are increasingly recruited to prediction and prevention studies. Access to FDRs is usually via their proband with RA. Quantitative data on predictors of family risk communication are lacking. RA patients completed a questionnaire assessing likelihood of communicating RA risk information to their FDRs, demographic variables, disease impact, illness perceptions, autonomy preferences, interest in FDRs taking a predictive test for RA, dispositional openness, family functioning, and attitudes towards predictive testing. Ordinal regression examined associations between patients' characteristics and their median likelihood of communicating RA risk to FDRs. Questionnaires were completed by 482 patients. The majority (75.1%) were likely/extremely likely to communicate RA risk information to FDRs, especially their children. Decision-making preferences, interest in FDRs taking a predictive test, and beliefs that risk knowledge would increase people's empowerment over their health increased patients' odds of being likely to communicate RA risk information to FDRs. Beliefs that risk information would cause stress to their relatives decreased odds that patients would be likely to communicate RA risk. These findings will inform the development of resources to support family communication about RA risk.
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Affiliation(s)
- Imogen Wells
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dawit T Zemedikun
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rebecca J Stack
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, United Kingdom
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom; Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, United Kingdom
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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Phillips A, Dewitte I, Debruyne B, Vears DF, Borry P. Disclosure of genetic risk in the family: A survey of the Flemish general population. Eur J Med Genet 2023:104800. [PMID: 37336289 DOI: 10.1016/j.ejmg.2023.104800] [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: 02/03/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Results from genomic sequencing often have implications not just for patients but also for their relatives. To date, there are no studies in Belgium exploring whether potential relatives would want to be informed of a genetic risk in the family and their preferences on different approaches to disclosure. METHODS We surveyed the attitudes of the Flemish general population (n = 407) towards receiving genetic information from their family members, including attitudes towards breaches in confidentiality, preferences for who communicates genetic risk and how the information is communicated, and policy approaches to nondisclosure. RESULTS Most participants wanted to be informed of their genetic risk and receive genetic testing to confirm their diagnosis. Most preferred to be informed of genetic risk by a close family member, but that when given the choice between a distant family member and a clinician, most participants preferred to be contacted by a clinician. CONCLUSION In Belgium there is currently no clear legal pathway for clinicians to directly initiate contact with at-risk relatives, but the responses from members of the Flemish population analyzed in this study indicate that this approach to disclosure of genetic risk deserves further consideration. Our findings indicate that the general population would support legislation allowing clinicians to inform relatives even in cases where the patient did not want to inform them. As this is not currently allowed in Belgium, policy alternatives should be considered.
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Affiliation(s)
- Amicia Phillips
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Iris Dewitte
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bo Debruyne
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Danya F Vears
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Melbourne Law School, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Harrison C, Bartley N, Jacobs C, Best M, Vatter S, Meiser B, Ballinger ML, Thomas DM, Butow P. Family communication and results disclosure after germline sequencing: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2023; 114:107800. [PMID: 37210765 DOI: 10.1016/j.pec.2023.107800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Research on family communication of germline genome sequencing (GS) results (versus of genetic results after targeted genetic testing) is still emerging, yet potentially complex results increase the importance of communicating risk to relatives. Promoting equity by ensuring patients have sufficient health literacy to interpret results is important in this context. This study aimed to identify cancer patients' perceived importance of result disclosure, predictors of perceptions, and perspectives on family communication. METHODS This explanatory-sequential, cross-sectional mixed-methods study involved participants (n = 246) completing a questionnaire and (n = 20) a semi-structured interview. Ordinal logistic regressions determined associations between potential predictors and perceived importance of result disclosure. Interview transcripts were analysed thematically using a constant-comparative approach. RESULTS More participants intended disclosing to nuclear (77.4%) than to extended family (42.7%). More than half (59.3%) felt results were family information; 62.7% believed it was important to disclose results to family members. Nuclear and extended family communication scores and education level were significantly positively associated with perceived importance of disclosure (p < 0.05). Six qualitative themes were identified: i) Responsibility to inform, ii) Choice, iii) Autonomy, iv) Family Communication, v) Significance of results, and vi) Health professional role. CONCLUSION Low health literacy and family conflict can complicate communication of GS results. Patients seek clear, interpretable information in a format they can easily communicate. PRACTICE IMPLICATIONS Healthcare professionals can facilitate discussion of GS results by offering written information, encouraging disclosure, exploring existing family dynamics and communication patterns, and offering strategies to improve family communication. Centralised genetic communication offices and chatbots can also be helpful.
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Affiliation(s)
- Camelia Harrison
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Nicci Bartley
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Megan Best
- Institute for Ethics and Society, The University of Notre Dame, Sydney, Australia
| | - Sabina Vatter
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Bettina Meiser
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, Australia
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia; School of Psychology, Centre of Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, Australia.
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Makhnoon S, Yu R, Peterson SK, Shete S. Clinical Cancer and Direct-to-Consumer Genetic Test Result-Sharing Behavior: Findings from HINTS 2020. J Pers Med 2022; 13:jpm13010018. [PMID: 36675679 PMCID: PMC9866851 DOI: 10.3390/jpm13010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Sharing genetic test results with different stakeholders such as family members, healthcare providers and genetic counselors (HCP/GCs), spouses/partners, and friends is a health behavior of clinical importance in genomic medicine. METHODS Using nationally representative population-based data collected from the Health Information National Trends Survey (HINTS 5, cycle 4), we identified the prevalence and factors associated with genetic test result-sharing behavior for high-risk cancer tests, genetic health risk tests, and ancestry tests within four groups: HCP/GCs, first-degree relatives (FDRs), spouse/partner, and friend/other. RESULTS Overall, 68.4% of those who underwent high-risk cancer genetic testing shared their results with FDRs, whereas 89.9% shared with HCP/GCs. In adjusted multivariable analyses, women were nine times more likely than men to share (p = 0.006), and those with a personal history of cancer were less likely to share with HCP/GCs (OR = 0.025, p ≤ 0.001). Of those tested for genetic health risk, 66.5% shared with HCP/GCs, 38.7% with FDRs, 66.6% with a spouse/partner, 12.8% with a friend, and 14.1% did not share results with anyone. Of those who underwent ancestry testing, very few shared results with HCP/GCs (2.6%), whereas modest sharing was reported with FDRs, spouses/partners, and friends. DISCUSSION These data add empirical evidence about the population prevalence of genetic information sharing and serve as a metric for public engagement with genetic testing.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Robert Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(713)-745-2483
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13
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Silva E, Gomes P, Matos PM, Silva ER, Silva J, Brandão C, Castro F, Neves MC, Sales CMD. “I have always lived with the disease in the family”: family adaptation to hereditary cancer-risk. BMC PRIMARY CARE 2022; 23:93. [PMID: 35461227 PMCID: PMC9034526 DOI: 10.1186/s12875-022-01704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
Background Hereditary cancer syndromes have been conceptualized as a family level process. The present study explores the complexity and challenges of family adaptation to the hereditary cancer syndrome, in the context of genetic counseling and long-term cancer risk management and follow-up surveillance. Methods We performed semi-structured interviews with 13 participants with one of the following hereditary cancer syndromes: Lynch Syndrome, Hereditary Diffuse Gastric Cancer Syndrome, Hereditary Breast and Ovarian Cancer Syndrome, or Familial Adenomatous Polyposis. The interview was developed through a participatory approach with the involvement of healthcare professionals and individuals with first-hand experience of living with the hereditary cancer syndromes. Results The family is the main source of information and emotional support to deal with hereditary cancer syndromes. Multiple individual adaptation processes and communal coping networks interact, influencing the emotional and health-related behavior of family members. This is affected and affects the family’s communication and its’ members reactions to disclosure, with consequent changes in relationships. Conclusions The systemic interdependent dynamics of family adaptation calls for family-centered care of genetic cancer syndromes.
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Rising CJ, Wilsnack C, Boyd P, Sleight AG, Hutson SP, Khincha PP, Werner-Lin A. Family communication challenges of adolescents and young adults with Li-Fraumeni syndrome: Implications for psychosocial care. PATIENT EDUCATION AND COUNSELING 2022; 105:3259-3266. [PMID: 35918231 PMCID: PMC9529832 DOI: 10.1016/j.pec.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This qualitative-descriptive study explored adolescent and young adult (AYA) perspectives, experiences, and challenges with openness and closedness in family communication about Li-Fraumeni syndrome (LFS). METHODS We conducted interviews with AYAs (aged 15-39 years) with LFS enrolled in the National Cancer Institute's LFS study (NCT01443468). An interprofessional clinician-researcher team analyzed transcribed data using the constant comparative method and interpretive description. RESULTS AYAs (N = 38; 26 females, 12 males, mean age=29 years) reported navigating openness and closedness about LFS in their families, which varied by LFS topic, relationship, disease trajectory, and developmental phase. AYAs described communication challenges, including broaching difficult topics (e.g., reproductive decision-making, end-of-life), balancing information-sharing with emotionally protecting family and self, and struggling with interactions that cause relational tensions. CONCLUSIONS AYAs reported experiencing LFS family communication challenges that disrupted their psychosocial well-being. LFS-related stressors and life transitions complicated and were complicated by these challenging family interactions. PRACTICE IMPLICATIONS Clinicians may support AYAs with LFS by inquiring about family communication, responding empathically to communication concerns, providing resources to support difficult conversations, and engaging mental health providers as needed. Researchers could partner with AYAs to develop tailored communication skills training and social support tools.
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Affiliation(s)
- Camella J Rising
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
| | - Catherine Wilsnack
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA.
| | - Patrick Boyd
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
| | - Alix G Sleight
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, USA.
| | - Sadie P Hutson
- College of Nursing, The University of Tennessee, Knoxville, USA.
| | - Payal P Khincha
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
| | - Allison Werner-Lin
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA.
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15
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The Communication Chain of Genetic Risk: Analyses of Narrative Data Exploring Proband–Provider and Proband–Family Communication in Hereditary Breast and Ovarian Cancer. J Pers Med 2022; 12:jpm12081249. [PMID: 36013197 PMCID: PMC9409642 DOI: 10.3390/jpm12081249] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Low uptake of genetic services among members of families with hereditary breast and ovarian cancer (HBOC) suggests limitations of proband-mediated communication of genetic risk. This study explored how genetic information proceeds from healthcare providers to probands and from probands to relatives, from the probands’ perspectives. Using a grounded-theory approach, we analyzed narrative data collected with individual interviews and focus groups from a sample of 48 women identified as carriers of HBOC-associated pathogenic variants from three linguistic regions of Switzerland. The findings describe the “communication chain”, confirming the difficulties of proband-mediated communication. Provider–proband communication is impacted by a three-level complexity in the way information about family communication is approached by providers, received by probands, and followed-up by the healthcare system. Probands’ decisions regarding disclosure of genetic risk are governed by dynamic and often contradictory logics of action, interconnected with individual and family characteristics, eventually compelling probands to engage in an arbitrating process. The findings highlight the relevance of probands’ involvement in the communication of genetic risk to relatives, suggesting the need to support them in navigating the complexity of family communication rather than replacing them in this process. Concrete actions at the clinical and health system levels are needed to improve proband-mediated communication.
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16
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Zhao J, Guan Y, McBride CM. A systematic review of theory-informed strategies used in interventions fostering family genetic risk communication. PATIENT EDUCATION AND COUNSELING 2022; 105:1953-1962. [PMID: 35304074 PMCID: PMC9203975 DOI: 10.1016/j.pec.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Inherited risk is a family issue. Identifying family members who carry a pathogenic genetic variant that increases risk of cancers and other chronic diseases can be lifesaving for those affected. OBJECTIVE The research questions are: (1) which family communication frameworks have been applied, (2) how do intervention strategies employed map to these theories, and (3) to what extent were families receptive to these strategies and communication increased? METHODS Manuscripts published between January 2010 and August 2020 were searched in three databases: PubMed, PsycINFO, and Web of Science. RESULTS Nine intervention trials were identified. All interventions were evaluated in clinical genetic counseling contexts using at least one individual-level strategy (e.g. increase knowledge). Only three focused on dyadic conversations such as preparing for relatives' information needs. CONCLUSIONS This systematic review posed the question whether theoretically based approaches have been applied to foster family genetic risk communication. Greater attention needs to be paid to the utilization of dyadic level and family system level theories to guide intervention developments. PRACTICAL IMPLICATIONS We conclude by calling for accelerating and broadening the development of interventions to enable family communication about inherited risk that are theory-based, incorporate family-systems thinking, and are conducted outside of specialty clinic settings.
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Affiliation(s)
- Jingsong Zhao
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA.
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
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17
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Winchester B, Cragun D, Redlinger-Grosse K, Walters ST, Ash E, Baldry E, Zierhut H. Application of motivational interviewing strategies with the extended parallel process model to improve risk communication for parents of children with familial hypercholesterolemia. J Genet Couns 2022; 31:847-859. [PMID: 35150174 DOI: 10.1002/jgc4.1554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Current genetic counseling practice has not been found to significantly increase risk communication between family members. A more diverse set of genetic counseling approaches may be needed. A genetic counseling intervention based on motivational interviewing principles and the extended parallel process model was utilized to increase cascade outcomes within families with familial hypercholesterolemia, a common, underdiagnosed, and treatable condition. Parents of children with familial hypercholesterolemia were invited to participate in an online pre-survey, single-session genetic counseling intervention, and post-intervention surveys as a part of the CHEERS (Cholesterol Evaluation to Explore Risk Screening) intervention. This study investigated the efficacy of a genetic counselor delivered motivational interviewing intervention and how parents of children with familial hypercholesterolemia react by assessing family member cholesterol screening and risk communication to at-risk relatives. Transcripts were audio-recorded, transcribed, and analyzed for change talk using the Motivational Interviewing Skill Code version 2.1. Participant surveys were analyzed for self-reported extended parallel process constructs and motivations. Coincidence analysis was conducted to explore differences between those with and without positive cascade outcomes within 12 months after the intervention. On average, change talk increased during the session in order of the extended parallel process constructs (perceived severity, susceptibility, response efficacy, self-efficacy). Coincidence analysis revealed that 6 of the 7 cases with positive cascade outcomes were explained by either the presence of high change talk during the intervention or presence of positive motivations shortly after, while 5 of the 5 cases without a positive outcome lacked both of these key factors that were associated with cascade outcomes. Results of this study suggest that incorporating motivational interviewing and the extended parallel process model increases change talk and that the presence of either high levels of change talk or positive motivations is associated with positive cascade outcomes.
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Affiliation(s)
- Bridget Winchester
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Scott T Walters
- School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erin Ash
- Genetic Counseling Program, Sarah Lawrence College, Bronxville, New York, USA
| | - Emma Baldry
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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18
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A tailored approach to informing relatives at risk of inherited cardiac conditions: results of a randomised controlled trial. Eur J Hum Genet 2022; 30:203-210. [PMID: 34815540 PMCID: PMC8821591 DOI: 10.1038/s41431-021-00993-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023] Open
Abstract
If undetected, inherited cardiac conditions can lead to sudden cardiac death, while treatment options are available. Predictive DNA testing is therefore advised for at-risk relatives, and probands are currently asked to inform relatives about this. However, fewer than half of relatives attend genetic counselling. In this trial, we compared a tailored approach to informing relatives, in which probands were asked whether they preferred relatives to be informed by themselves or by the genetic counsellor, with current practice. Our primary outcome was uptake of genetic counselling in relatives in the first year after test result disclosure. Secondary outcomes were evaluation of the approach and impact on psychological/family functioning measured 3 (T1) and 9 (T2) months post-disclosure via telephone interviews and questionnaires. We included 96 probands; 482 relatives were eligible for counselling and genetic testing. We observed no significant difference in uptake of genetic counselling between the control (38%) and the intervention (37%) group (p = 0.973). Nor were there significant differences between groups in impact on family/psychological functioning. Significantly more probands in the tailored group were satisfied (p = 0.001) and felt supported (p = 0.003) by the approach, although they also felt somewhat coerced to inform relatives (p < 0.001) and perceived room for improvement (p < 0.001). To conclude, we observed no differences in uptake and impact on family/psychological functioning between the current and tailored approach, but probands in the tailored group more often felt satisfied. Further research on barriers to relatives attending genetic counselling and on how to optimize the provision of a tailored approach is needed.
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19
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Hawranek C, Hajdarevic S, Rosén A. A Focus Group Study of Perceptions of Genetic Risk Disclosure in Members of the Public in Sweden: "I'll Phone the Five Closest Ones, but What Happens to the Other Ten?". J Pers Med 2021; 11:jpm11111191. [PMID: 34834542 PMCID: PMC8622605 DOI: 10.3390/jpm11111191] [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: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
This study explores perceptions and preferences on receiving genetic risk information about hereditary cancer risk in members of the Swedish public. We conducted qualitative content analysis of five focus group discussions with participants (n = 18) aged between 24 and 71 years, recruited from various social contexts. Two prominent phenomena surfaced around the interplay between the three stakeholders involved in risk disclosure: the individual, healthcare, and the relative at risk. First, there is a genuine will to share risk information that can benefit others, even if this is difficult and causes discomfort. Second, when the duty to inform becomes overwhelming, compromises are made, such as limiting one’s own responsibility of disclosure or projecting the main responsibility onto another party. In conclusion, our results reveal a discrepancy between public expectations and the actual services offered by clinical genetics. These expectations paired with desire for a more personalized process and shared decision-making highlight a missing link in today’s risk communication and suggest a need for developed clinical routines with stronger healthcare–patient collaboration. Future research needs to investigate the views of genetic professionals on how to address these expectations to co-create a transparent risk disclosure process which can realize the full potential of personalized prevention.
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Affiliation(s)
- Carolina Hawranek
- Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden;
- Correspondence: ; Tel.: +46-76-89-34-504
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden;
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20
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Cragun D, Beckstead J, Farmer M, Hooker G, Dean M, Matloff E, Reid S, Tezak A, Weidner A, Whisenant JG, Pal T. IMProving care After inherited Cancer Testing (IMPACT) study: protocol of a randomized trial evaluating the efficacy of two interventions designed to improve cancer risk management and family communication of genetic test results. BMC Cancer 2021; 21:1099. [PMID: 34645413 PMCID: PMC8513202 DOI: 10.1186/s12885-021-08822-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Implementing genetic testing for inherited cancer predisposition into routine clinical care offers a tremendous opportunity for cancer prevention and early detection. However, genetic testing itself does not improve outcomes; rather, outcomes depend on implemented follow-up care. The IMPACT study is a hybrid type I randomized effectiveness-implementation trial to simultaneously evaluate the effectiveness of two interventions for individuals with inherited cancer predisposition focused on: 1) increasing family communication (FC) of genetic test results; and 2) improving engagement with guideline-based cancer risk management (CRM). METHODS This prospective study will recruit a racially, geographically, and socioeconomically diverse population of individuals with a documented pathogenic/likely pathogenic (P/LP) variant in an inherited cancer gene. Eligible participants will be asked to complete an initial trial survey and randomly assigned to one of three arms: A) GeneSHARE, a website designed to increase FC of genetic test results; B) My Gene Counsel's Living Lab Report, a digital tool designed to improve understanding of genetic test results and next steps, including CRM guidelines; or C) a control arm in which participants continue receiving standard care. Follow-up surveys will be conducted at 1, 3, and 12 months following randomization. These surveys include single-item measures, scales, and indices related to: 1) FC and CRM behaviors and behavioral factors following the COM-B theoretical framework (i.e., capability, opportunity, and motivation); 2) implementation outcomes (i.e., acceptability, appropriateness, exposure, and reach); and 3) other contextual factors (i.e., sociodemographic and clinical factors, and uncertainty, distress, and positive aspects of genetic test results). The primary outcomes are an increase in FC of genetic test results (Arm A) and improved engagement with guideline-based CRM without overtreatment or undertreatment (Arm B) by the 12-month follow-up survey. DISCUSSION Our interventions are designed to shift the paradigm by which individuals with P/LP variants in inherited cancer genes are provided with information to enhance FC of genetic test results and engagement with guideline-based CRM. The information gathered through evaluating the effectiveness and implementation of these real-world approaches is needed to modify and scale up adaptive, stepped interventions that have the potential to maximize FC and CRM. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (NCT04763915, date registered: February 21, 2021). PROTOCOL VERSION September 17th, 2021 Amendment Number 04.
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Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Meagan Farmer
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Gillian Hooker
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, 4202 East Fowler Avenue, CIS 3043, Tampa, FL, 33620, USA
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Ellen Matloff
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Sonya Reid
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Ann Tezak
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Anne Weidner
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Jennifer G Whisenant
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA.
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21
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Sapp JC, Facio FM, Cooper D, Lewis KL, Modlin E, van der Wees P, Biesecker LG. A systematic literature review of disclosure practices and reported outcomes for medically actionable genomic secondary findings. Genet Med 2021; 23:2260-2269. [PMID: 34433902 PMCID: PMC9017985 DOI: 10.1038/s41436-021-01295-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose: Secondary findings (SF) are present in 1–4% of individuals undergoing genome/exome sequencing. A review of how SF are disclosed and what outcomes result from their receipt is urgent and timely. Methods: We conducted a systematic literature review of SF disclosure practices and outcomes after receipt including cascade testing, family and provider communication, and healthcare actions. Of the 1,184 non-duplicate records screened we summarize findings from 27 included research articles describing SF disclosure practices, outcomes after receipt, or both. Results: The included articles reported 709 unique SF index recipients/families. Referrals and/or recommendations were provided 647 SF recipients and outcome data were available for 236. At least one recommended evaluation was reported for 146 SF recipients; 16 reports of treatment or prophylactic surgery were identified. We found substantial variations in how the constructs of interest were defined and described. Conclusion: Variation in how SF disclosure and outcomes were described limited our ability to compare findings. We conclude the literature provided limited insight into how the ACMG guidelines have been translated into precision health outcomes for SF recipients. Robust studies of SF recipients are needed and should be prioritized for future research.
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Affiliation(s)
- Julie C Sapp
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA. .,Translational Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Flavia M Facio
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Diane Cooper
- National Institutes of Health Library, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Katie L Lewis
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Emily Modlin
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Philip van der Wees
- Translational Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Radboud University Medical Center, IQ Healthcare and Rehabilitation, Nijmegen, Netherlands
| | - Leslie G Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
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22
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Makhnoon S, Bowen DJ, Shirts BH, Fullerton SM, Meischke HW, Larson EB, Ralston JD, Leppig K, Crosslin DR, Veenstra D, Jarvik GP. Relationship between genetic knowledge and familial communication of CRC risk and intent to communicate CRCP genetic information: insights from FamilyTalk eMERGE III. Transl Behav Med 2021; 11:563-572. [PMID: 32579152 DOI: 10.1093/tbm/ibaa054] [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] [Indexed: 01/19/2023] Open
Abstract
Successful translation of genetic information into patient-centered care and improved outcomes depends, at least in part, on patients' genetic knowledge. Although genetic knowledge is believed to be an important facilitator of familial communication of genetic risk information, empirical evidence of this association is lacking. We examined whether genetic knowledge was related to frequency of current familial communication about colorectal cancer and polyp (CRCP) risk, and future intention to share CRCP-related genomic test results with family members in a clinical sample of patients. We recruited 189 patients eligible for clinical CRCP sequencing to the eMERGE III FamilyTalk randomized controlled trial and surveyed them about genetic knowledge and familial communication at baseline. Participants were primarily Caucasian, 47% male, average age of 68 years, mostly well educated, and with high-income levels. Genetic knowledge was positively associated with future-intended familial communication of genetic information (odds ratio = 1.11, 95% confidence interval: 1.02-1.23), but not associated with current communication of CRC risk (β = 0.01, p = .58). Greater current communication of CRC risk was associated with better family functioning (β = 0.04, p = 8.2e-5). Participants' genetic knowledge in this study was minimally associated with their intended familial communication of genetic information. Although participants have good intentions of communication, family-level factors may hinder actual follow through of these intentions. Continued focus on improving proband's genetic knowledge coupled with interventions to overcome family-level barriers to communication may be needed to improve familial communication rates.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - James D Ralston
- Genetic Services, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kathleen Leppig
- Genetic Services, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - David R Crosslin
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - David Veenstra
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington Medical Center, Seattle, WA, USA
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23
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Stuttgen Finn K, Pacyna JE, Tsou C, Samadder NJ, Sharp RR. Factors that Influence Intent to Share Genetic Information Related to Cancer Risk with Family Members. JOURNAL OF HEALTH COMMUNICATION 2021; 26:545-552. [PMID: 34473010 PMCID: PMC10869109 DOI: 10.1080/10810730.2021.1968078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We describe factors influencing patient decisions to share positive cancer genetic test results with family members. We focused on patients who were diagnosed with several different cancer types but did not have a family history that was suggestive of an inherited risk. Participants were recruited from Mayo Clinic and had been recently diagnosed with cancer. An 80+ gene panel was performed. Before receiving genetic test results, patients completed a 49-item survey on their intent to share their results with relatives. 1,721 (57.7%) of 2,984 individuals who elected to pursue genetic testing completed the survey. Most patients planned to share cancer-related genetic results with a spouse or partner (97.0%), at least one adult child (92.2%), at least one sibling (86.2%), and with at least one parent (70.3%). Familial support scores and familial communication scores were predictive of intent to share cancer-related genetic test results. Our data highlight differences in family communication capacity and support that are important for clinicians to consider when supporting patients who wish to share cancer-related genetic test results with family members. Our data point to several potential interventional strategies that might increase the likelihood of cancer-related genetic test results being shared with family members at risk.
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Affiliation(s)
- Kelsey Stuttgen Finn
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Cindy Tsou
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Niloy J Samadder
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Smit AK, Bartley N, Best MC, Napier CE, Butow P, Newson AJ, Tucker K, Ballinger ML, Thomas DM, Jacobs C, Meiser B, Goldstein D, Savard J, Juraskova I. Family communication about genomic sequencing: A qualitative study with cancer patients and relatives. PATIENT EDUCATION AND COUNSELING 2021; 104:944-952. [PMID: 33129629 DOI: 10.1016/j.pec.2020.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study explored family communication about undertaking genomic sequencing, and intentions to communicate pertinent heritable results to family members. METHODS Semi-structured interviews were conducted with cancer patients (n = 53) and their relatives (n = 20) who underwent germline genome sequencing or molecular tumor testing. Interviews were audio-recorded, transcribed and analyzed using thematic analysis. RESULTS Key themes relevant to family communication about undertaking sequencing included: perceiving family member interest, delaying discussion until results were received, having shared capacity to understand and cope, and having open communication in the family. Intended communication subsequent to receiving results was affected by: disease severity, risk management options, degree of closeness in the family, sense of responsibility, and potential adverse impacts on family. Resource and support needs varied based on the complexity of test results, health professionals' availability, and disease severity. Unique subthemes were identified for specific subgroups. CONCLUSION Current findings support the need to assess the impact and resource needs specific to each clinical application of genomic sequencing. PRACTICE IMPLICATIONS Increasingly sophisticated and complex clinical genomic sequencing warrants development of family-centered interventions and resources to facilitate preference-sensitive communication about genomic sequencing, including disseminating relevant information to family members.
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Affiliation(s)
- Amelia K Smit
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, Sydney, Australia; The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia; The University of Sydney, Melanoma Institute Australia, Australia.
| | - Nicci Bartley
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
| | - Megan C Best
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
| | - Christine E Napier
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
| | - Ainsley J Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Mandy L Ballinger
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Clinical School, University of NSW, Sydney, Australia
| | - David M Thomas
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Clinical School, University of NSW, Sydney, Australia
| | - Chris Jacobs
- University of Technology Sydney, Graduate School of Health, Sydney, Australia; Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | | | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
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25
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Haas CB, Scrol A, Jujjavarapu C, Jarvik GP, Henrikson NB. Usefulness of mobile apps for communication of genetic test results to at-risk family members in a U.S. integrated health system: a qualitative approach from user-testing. HEALTH POLICY AND TECHNOLOGY 2021; 10. [PMID: 34040952 DOI: 10.1016/j.hlpt.2021.100511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To assess the usefulness a mobile based application to send genetic test results to at-risk family members in a U.S. integrated health system. Methods We conducted semi-structured in-person interviews with members of Kaiser Permanente Washington who had enrolled in a prospective study and received genetic test results. Participants were given the task to use the app and comment on the experience. The moderator asked participants to share perspectives on the usefulness of a mobile based app and their lived experiences of sharing their test results with family members. Results Fourteen study participants who had undergone genetic testing were interviewed. Four primary themes emerged as relevant to the use of mobile-based apps as a tool for communicating genetic test results to at-risk family members: (i) Participants felt a sense of obligation to share positive test results with relatives; (ii) Participants felt that the advantages of using email were similar to those of the app; (iii) Participants felt that younger individuals would be more comfortable with an app; and, (iv) Participants felt they could use the app independently and in their own time. Conclusion A mobile based app could be used as a tool to improve cascade screening for pathogenic/likely pathogenic test results. The benefits of such a tool are likely greatest among relatives still at the stage of family planning, as well as among family members with strained relationships. There would be minimal burden on the system to offer a mobile based app as a tool.
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Affiliation(s)
- Cameron B Haas
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Aaron Scrol
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Chethan Jujjavarapu
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington School of Medicine, Seattle, WA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Grill K, Rosén A. Healthcare professionals' responsibility for informing relatives at risk of hereditary disease. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106236. [PMID: 33246998 PMCID: PMC8639958 DOI: 10.1136/medethics-2020-106236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 05/10/2023]
Abstract
Advances in genetic diagnostics lead to more patients being diagnosed with hereditary conditions. These findings are often relevant to patients' relatives. For example, the success of targeted cancer prevention is dependent on effective disclosure to relatives at risk. Without clear information, individuals cannot take advantage of predictive testing and preventive measures. Against this background, we argue that healthcare professionals have a duty to make actionable genetic information available to their patients' at-risk relatives. We do not try to settle the difficult question of how this duty should be balanced against other duties, such as the duty of confidentiality and a possible duty not to know one's genetic predisposition. Instead, we argue for the importance of recognising a general responsibility towards at-risk relatives, to be discharged as well as possible within the limits set by conflicting duties and practical considerations. According to a traditional and still dominant perspective, it is the patient's duty to inform his or her relatives, while healthcare professionals are only obliged to support their patients in discharging this duty. We argue that this perspective is a mistake and an anomaly. Healthcare professionals do not have a duty to ensure that their patients promote the health of third parties. It is often effective and desirable to engage patients in disseminating information to their relatives. However, healthcare professionals should not thereby deflect their own moral responsibility.
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Affiliation(s)
- Kalle Grill
- Radiation Sciences, Umeå university, Umeå, Sweden
| | - Anna Rosén
- Radiation Sciences, Umeå university, Umeå, Sweden
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27
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Studwell CM, Kelley EG, Sinsheimer JS, Palmer CGS, LeBlanc K. Family genetic result communication in rare and undiagnosed disease communities: Understanding the practice. J Genet Couns 2020; 30:439-447. [PMID: 33108040 DOI: 10.1002/jgc4.1329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/05/2022]
Abstract
Genetic results have implications not only for the individual, but also for their family members. Research on family communication of genetic results has primarily focused on families affected by adult-onset, dominant conditions as well as more common genetic conditions such as familial hypercholesterolemia, cardiomyopathies, and genetic hearing loss. This study therefore aimed to characterize genetic result communication in families with rare and undiagnosed conditions and identify factors that influence communication. One hundred and forty-two individuals who received a diagnosis from the Undiagnosed Diseases Network (UDN), a study focused on providing diagnoses to individuals with undiagnosed conditions, were eligible to complete a survey assessing genetic results communication. Survey items assessed if communication was discussed with healthcare providers, with whom participants communicated genetic testing, why they chose to communicate with these family members, and what information they communicated. All respondents (5 adult UDN participants, 38 parents/guardians of UDN participants, and 2 identifying as both) shared genetic results with at least one family member. Individuals who identified as both were considered exclusively adult participants for the purpose of these analyses. Adult participants and parents/guardians of participants reported high levels of understanding (96%), utility (96%), and comfort communicating genetic results (89%). Additionally, parents/guardians were more likely to disclose genetic results due to a general desire to share (60% of parents/guardians vs. 14% adult participants), while adult participants reported that they shared results to communicate risk to family members (86% of adult participants vs. 24% of parents/guardians). Many respondents did not recall discussing with a healthcare provider how (64%) or what (42%) to communicate about results. The results of this study provide insight into the practice of result communication by individuals with rare and previously undiagnosed conditions, which can ideally inform development of more effective counseling strategies and guidelines to aid family communication.
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Affiliation(s)
- Courtney M Studwell
- Department of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily G Kelley
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | | | - Janet S Sinsheimer
- Departments of Human Genetics and Computational Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Christina G S Palmer
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.,Department of Human Genetics, UCLA, Los Angeles, CA, USA.,Institute for Society and Genetics, UCLA, Los Angeles, CA, USA
| | - Kimberly LeBlanc
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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28
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From Probands to Relatives: Communication of Genetic Risk for Hereditary Breast-Ovarian Cancer and Its Influence on Subsequent Testing. Cancer Nurs 2020; 45:E91-E98. [PMID: 32804756 DOI: 10.1097/ncc.0000000000000876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The genetic risk communication from proband to relatives varies from family to family, and patients often need support with the communication of genetic test results and making decisions to manage hereditary cancer risks. OBJECTIVE The aim of this study was to characterize the communication of BRCA1 or BRCA2 (BRCA1/2) genetic risk from proband to first-degree relatives (FDRs) using a social network framework. METHODS We characterized network and nonnetwork factors to explore their association with which FDRs were told about the genetic risk and whether or not relatives underwent genetic testing. Ninety-two female probands with hereditary breast and ovarian cancer who have confirmed BRCA1/2 mutations participated in the study. Communication of hereditary breast and ovarian cancer risk was assessed between 92 probands and their 417 FDRs. RESULTS Of 92 probands, 94.5% (n = 87) communicated their genetic test result to at least one of their FDRs. Of FDRs older than 18 years, 19.9% (n = 72) have genetic testing. Emotional closeness, educational level of the proband, and relative's age were significantly associated with communicating test results with FDRs. CONCLUSION Communication of genetic risk with the FDRs after having a BRCA1/2 gene-mutation-positive test result was high in this group of cancer patients. However, the rate of genetic testing among FDRs was low. IMPLICATIONS FOR PRACTICE Probands' educational level and age of relatives for cascade genetic screening should be considered during counseling. Interventions to support women with BRCA1/2 mutations during the communication process and their family members' engagement in testing and risk-reducing strategies are needed.
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Pollard S, Kalloger S, Weymann D, Sun S, Nuk J, Schrader KA, Regier DA. Genetic testing for hereditary cancer syndromes: patient recommendations for improved risk communication. Health Expect 2020; 23:884-892. [PMID: 32338425 PMCID: PMC7495068 DOI: 10.1111/hex.13062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/18/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Background Multi‐gene panel testing is replacing single‐gene testing for patients with suspected hereditary cancer syndromes. The detection of a hereditary cancer syndrome allows tested individuals to initiate enhanced primary and secondary prevention efforts—where available—with a view to reduce disease burden. Current policy prevents testing programmes from communicating genetic test results with potentially affected family members, yet it is well documented that tested individuals face multiple challenges in initiating such discussions with relatives. Objective In response to this challenge, we sought patient recommendations about how to improve genetic risk communication to enhance interfamilial discussions about primary and secondary disease prevention. Design We conducted 25 semi‐structured interviews with individuals who received genetic testing through British Columbia’s Hereditary Cancer Program between 2017 and 2018. Interviews were professionally transcribed and analysed using a constant comparative approach. Results Participants described difficulty engaging in conversations with relatives who were resistant to receiving genetic risk information, when communicating with younger relatives and where participants reported strained familial relationships. Participants recommended that testing facilities provide a summary of results and implications and that resources be made available to prepare patients for challenging discussions with family members. Discussion Our study demonstrates that individuals undergoing genetic testing for suspected hereditary cancer syndromes would benefit from additional supportive resources alongside genetic counselling. Providing this on‐going support will enhance the accurate and transparent communication of risk to facilitate the uptake of cascade testing and enhanced prevention strategies.
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Affiliation(s)
- Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Steve Kalloger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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30
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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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31
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Mazzella JM, Adham S, Frank M, Legrand A, Lahlou-Laforêt K, Jeunemaitre X. Communication of genetic information to at-risk relatives during the multidisciplinary monitoring of vascular Ehlers-Danlos syndrome in a French referral clinic. J Genet Couns 2020; 29:828-837. [PMID: 31903687 DOI: 10.1002/jgc4.1211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022]
Abstract
Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited disorder leading to arterial, digestive, and uterine complications due to pathogenic COL3A1 variants. Identification of causal variants allows family screening, provided that relatives have previously been informed, according to a 2013 French Decree. The aims of our study were to assess the communication of genetic information to at-risk relatives, the impact of diagnosis disclosure and to highlight a possible link between the experience of vEDS patients and ability to communicate about genetic information. A total of n = 51 vEDS adult probands answered a questionnaire during a clinical visit. Communication to relatives was considered effective if the proband gave information to some or all first-degree relatives and considered easily achieved if it was disclosed to all relatives less than a month after the diagnosis and without difficulty. Personal and family vEDS experiences of probands were also assessed. Effective communication of information to relatives was remarkably high (98%). Siblings were the most frequently informed relatives (82%). Women informed their at-risk relatives of genetic family screening faster (p = .006) and easier (p = .004) than men. There was no difference in the disclosure of information to relatives before and after 2013 in our multidisciplinary clinic. Regarding the lived experience of vEDS patients, they felt anxious (78%) at diagnosis disclosure but also considered this diagnosis as an opportunity to start a medical follow-up (82%) putting an end to diagnosis delay. Our findings highlight for the first time that the ability to easily inform at-risk first-degree relatives is related to the relief felt during vEDS-positive diagnosis disclosure (p = .04). In order to improve the communication of genetic information to relatives, we believe that psychological support should systematically be part of the multidisciplinary monitoring, just as medical follow-up and genetic counseling.
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Affiliation(s)
- Jean-Michaël Mazzella
- Centre de Référence des Maladies Vasculaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Salma Adham
- Centre de Référence des Maladies Vasculaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Michael Frank
- Centre de Référence des Maladies Vasculaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, U970, Paris centre de Recherche Cardiovasculaire - PARCC, Paris, France
| | - Anne Legrand
- Centre de Référence des Maladies Vasculaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM, U970, Paris centre de Recherche Cardiovasculaire - PARCC, Paris, France
| | - Khadija Lahlou-Laforêt
- Centre de Référence des Maladies Vasculaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Unité de Psychologie et Psychiatrie de Liaison et d'Urgence, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Xavier Jeunemaitre
- Centre de Référence des Maladies Vasculaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM, U970, Paris centre de Recherche Cardiovasculaire - PARCC, Paris, France
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32
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Marleen van den Heuvel L, Stemkens D, van Zelst-Stams WAG, Willeboordse F, Christiaans I. How to inform at-risk relatives? Attitudes of 1379 Dutch patients, relatives, and members of the general population. J Genet Couns 2019; 29:786-799. [PMID: 31889383 PMCID: PMC7649718 DOI: 10.1002/jgc4.1206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/17/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
The uptake of predictive DNA testing in families with a hereditary disease is <50%. Current practice often relies on the proband to inform relatives about the possibility of predictive DNA testing, but not all relatives are informed adequately. To enable informed decision-making concerning predictive DNA testing, the approach used to inform at-risk relatives needs to be optimized. This study investigated the preferences of patients, relatives, and the general population from the Netherlands on how to inform relatives at risk of autosomal dominant diseases. Online surveys were sent to people with autosomal dominant neuro-, onco-, or cardiogenetic diseases and their relatives via patient organizations (n = 379), and to members of the general population via a commercial panel (n = 1,000). Attitudes of the patient and population samples generally corresponded. A majority believed that initially only first-degree relatives should be informed, following the principles of a cascade screening approach. Most participants also thought that probands and healthcare professionals (HCPs) should be involved in informing relatives, and a large proportion believed that HCPs should contact relatives directly in cases where patients are unwilling to inform, both for untreatable and treatable conditions. Participants from the patient sample were of the opinion that HCPs should actively offer support. Our findings show that both patients and HCPs should be involved in informing at-risk relatives of autosomal dominant diseases and suggest that relatives' 'right to know' was considered a dominant issue by the majority of participants. Further research is needed on how to increase proactive support in informing of at-risk relatives.
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Affiliation(s)
- Lieke Marleen van den Heuvel
- Department of Clinical Genetics, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Daphne Stemkens
- VSOP Dutch Patient Alliance for Rare and Genetic Diseases, Soest, The Netherlands
| | - Wendy A G van Zelst-Stams
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center/Radboud University, Nijmegen, The Netherlands
| | | | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands.,Department of Genetics, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands
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33
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Ballard LM, Horton RH, Fenwick A, Lucassen AM. Genome sequencing in healthcare: understanding the UK general public's views and implications for clinical practice. Eur J Hum Genet 2019; 28:155-164. [PMID: 31527856 DOI: 10.1038/s41431-019-0504-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022] Open
Abstract
Technological advances have seen the offer of genome sequencing becoming part of mainstream medical practice. Research has elicited patient and health professional views on the ethical issues genome sequencing raises, however, we know little about the general public's views. These views offer an insight into people's faith in such technologies, informing discussion regarding the approach to consent in clinic. We aimed to garner public views regarding genome sequencing, incidental findings (IFs), and sharing genetic information with relatives. Participants (n = 1954) from the British general public completed a survey, distributed via email. Overall, the public had a positive view of genomic sequencing, choosing 'informative' as the most popular word (52%) and 'family legacy' as the most popular analogy (33%) representing genomic sequencing for them. Fifty-three percent agree that their relative had the right to be told about genetic information relevant to them. Fifty-four percent would expect to be told about IFs whether they had asked for them or not. Clinical practice needs to acknowledge these perspectives and expectations in order to facilitate meaningful discussion during the consent process for genomic tests. We suggest that: (a) optimistic perspectives on the usefulness of genomic tests need to be tempered by discussion in clinic about the likelihood that genomic results might be uninformative, uncertain or unexpected; (b) discussions regarding the familial nature of results are needed before testing: the majority of patients will welcome this and any concerns can be explored further; and (c) a wider discussion is required regarding the consent approach for genomic testing.
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Affiliation(s)
- Lisa M Ballard
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK.
| | - Rachel H Horton
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK
| | - Anneke M Lucassen
- Clinical Ethics and Law at Southampton (CELS), Centre for Cancer Immunology, University of Southampton, School of Medicine, Southampton, UK
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34
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Harris S, Cirino AL, Carr CW, Tafessu HM, Parmar S, Greenberg JO, Szent-Gyorgyi LE, Ghazinouri R, Glowny MG, McNeil K, Kaynor EF, Neumann C, Seidman CE, MacRae CA, Ho CY, Lakdawala NK. The uptake of family screening in hypertrophic cardiomyopathy and an online video intervention to facilitate family communication. Mol Genet Genomic Med 2019; 7:e940. [PMID: 31482667 PMCID: PMC6825857 DOI: 10.1002/mgg3.940] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Individuals with hypertrophic cardiomyopathy (HCM), even when asymptomatic, are at‐risk for sudden cardiac death and stroke from arrhythmias, making it imperative to identify individuals affected by this familial disorder. Consensus guidelines recommend that first‐degree relatives (FDRs) of a person with HCM undergo serial cardiovascular evaluations. Methods We determined the uptake of family screening in patients with HCM and developed an online video intervention to facilitate family communication and screening. Family screening and genetic testing data were collected through a prospective quality improvement initiative, a standardized clinical assessment and management plan (SCAMP), utilized in an established cardiovascular genetics clinic. Patients were prescribed an online video if screening of their FDRs was incomplete and a pilot study on video utilization and family communication was conducted. Results Two‐hundred and sixteen probands with HCM were enrolled in SCAMP Phase I and 190 were enrolled in SCAMP Phase II. In both phases, probands reported that 51% of FDRs had been screened (382/749 in Phase I, 258/504 in Phase II). Twenty patients participated in a pilot study on video utilization and family communication. Nine participants reported watching the video and six participants reported sharing the video with relatives; however only one participant reported sharing the video with relatives who were not yet aware of the diagnosis of HCM in the family. Conclusion Despite care in a specialized cardiovascular genetics clinic, approximately one half of FDRs of patients with HCM remained unscreened. Online interventions and videos may serve as supplemental tools for patients communicating genetic risk information to relatives.
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Affiliation(s)
- Stephanie Harris
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christina W Carr
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hiwot M Tafessu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Siddharth Parmar
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Roya Ghazinouri
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle G Glowny
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kara McNeil
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Efthalia F Kaynor
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine Neumann
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine E Seidman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Calum A MacRae
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neal K Lakdawala
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
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35
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Gauna Cristaldo FB, Touzani R, Apostolidis T, Mouret-Fourme E, Stoppa-Lyonnet D, Lasset C, Fricker JP, Berthet P, Julian-Reynier C, Mancini J, Noguès C, Bouhnik AD. Uptake of genetic counseling among adult children of BRCA1/2 mutation carriers in France. Psychooncology 2019; 28:1894-1900. [PMID: 31276266 DOI: 10.1002/pon.5169] [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: 03/22/2019] [Revised: 06/05/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Genetic counseling in at-risk families is known to improve cancer prevention. Our study aimed to determine the rate of uptake of genetic counseling among adult children of BRCA1/2 mutation carriers and to identify the potential psychosocial factors associated with uptake of genetic counseling. METHODS A self-reported questionnaire was mailed to 328 BRCA1/2 mutation carriers 10 years after BRCA1/2 test disclosure. Of the 233 carriers who returned the questionnaire (response rate = 71%), 135 reported having children over age 18 years and were therefore included in the analysis. Generalized estimating equations models were used to identify the factors associated with uptake of genetic counseling among adult children of mutation carriers. RESULTS Data were gathered for a total of 296 children (46% male, 54% female). The vast majority were informed about the familial mutation (90.9%) and 113 (38%; 95% CI, 32%-44%) underwent genetic counseling. This percentage exceeded 80% in women over 40 years. In the multivariate model, female sex, advanced age, mutation in the father, diagnosis of cancer in the mutation-carrying parent after genetic testing, and good family relationships were all factors associated with higher uptake of genetic counseling. CONCLUSIONS Adult children of BRCA1/2 mutation carriers in France do not undergo genetic counseling sufficiently often. Further studies should be conducted on the psychosocial factors that hinder the uptake of genetic counseling among adult children of BRCA1/2 mutation carriers.
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Affiliation(s)
- Fatima Belén Gauna Cristaldo
- LPS EA 849, Aix-Marseille Université, Aix-en-Provence, France.,Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Rajae Touzani
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,UMR1252, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, Paris, France.,INSERM U830, Institut Curie, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Lasset
- Département de Santé Publique, Centre Léon Bérard, Lyon, France.,CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Pierre Fricker
- Service d'Oncogénétique, prévention, dépistage, CLCC Paul Strauss, Strasboug, France
| | - Pascaline Berthet
- Service d'oncologie génétique, Centre François Baclesse, Caen, France
| | - Claire Julian-Reynier
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,UMR1252, Institut Paoli-Calmettes, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, HopTimone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| | - Catherine Noguès
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,Département d'Anticipation et de Suivi des Cancers, Oncogénétique clinique, Institut Paoli-Calmettes, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
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36
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Alegre N, Perre PV, Bignon YJ, Michel A, Galibert V, Mophawe O, Corsini C, Coupier I, Chiesa J, Robert L, Bernhard L, Picot M, Bertet H, Macioce V, Bastide N, Solassol J, Rey JM, Thomas F, Carton S, Pujol P. Psychosocial and clinical factors of probands impacting intrafamilial disclosure and uptake of genetic testing among families with
BRCA1/2
or MMR gene mutations. Psychooncology 2019; 28:1679-1686. [DOI: 10.1002/pon.5142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Nathalie Alegre
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Pierre Vande Perre
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
- Université Toulouse III Paul Sabatier Toulouse France
| | - Yves Jean Bignon
- Laboratoire d'Oncologie moléculaire, CLCC Jean Perrin Clermont‐Ferrand France
| | - Aude Michel
- Département de PsychologieUniversité Montpellier III Montpellier France
| | - Virginie Galibert
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Ornellia Mophawe
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Carole Corsini
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Isabelle Coupier
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Jean Chiesa
- Département de Génétique médicale et cytogénétiqueCentre Hospitalier Universitaire Nîmes Nîmes France
| | - Laura Robert
- Laboratoire d'Oncologie moléculaire, CLCC Jean Perrin Clermont‐Ferrand France
| | - Lydie Bernhard
- Département de Génétique médicale et cytogénétiqueCentre Hospitalier Universitaire Nîmes Nîmes France
| | - Marie‐Christine Picot
- Unité de Recherche Clinique & Epidémiologie, DIMCentre Hospitalier Universitaire Montpellier Montpellier France
- Clinical Investigation Centre, INSERM U1411 Montpellier France
| | - Héléna Bertet
- Unité de Recherche Clinique & Epidémiologie, DIMCentre Hospitalier Universitaire Montpellier Montpellier France
| | - Valérie Macioce
- Unité de Recherche Clinique & Epidémiologie, DIMCentre Hospitalier Universitaire Montpellier Montpellier France
| | | | - Jérôme Solassol
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Jean Marc Rey
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Frédéric Thomas
- Centre de Recherches Écologiques et Évolutives sur le Cancer Montpellier France
| | - Solange Carton
- Département de PsychologieUniversité Montpellier III Montpellier France
| | - Pascal Pujol
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
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37
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Heuvel L, Smets E, Tintelen J, Christiaans I. How to inform relatives at risk of hereditary diseases? A mixed‐methods systematic review on patient attitudes. J Genet Couns 2019; 28:1042-1058. [DOI: 10.1002/jgc4.1143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L.M. Heuvel
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - J.P. Tintelen
- Department of Genetics University Medical Centre Utrecht, University of Utrecht Utrecht The Netherlands
| | - I. Christiaans
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
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38
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Henrikson NB, Blasi PR, Fullerton SM, Grafton J, Leppig KA, Jarvik GP, Larson EB. "It would be so much easier": health system-led genetic risk notification-feasibility and acceptability of cascade screening in an integrated system. J Community Genet 2019; 10:461-470. [PMID: 30843145 PMCID: PMC6754469 DOI: 10.1007/s12687-019-00412-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/04/2019] [Accepted: 02/07/2019] [Indexed: 11/02/2022] Open
Abstract
Assess the feasibility and acceptability of health system-led genetic risk notification in a US integrated health system. We conducted semi-structured phone interviews with individuals age 40-64 years who had undergone genetic sequencing, but had not yet received their results, assessing attitudes to direct outreach to relatives. During each interview, we collected contact information for adult relatives identified as members of the same system and attempted to identify each relative in administrative data. We conducted 20 interviews. Most participants expressed support for Kaiser Permanente Washington involvement in familial risk notification. Direct outreach to relatives received the most unqualified support; outreach to the relatives' physician or interaction with the relatives' electronic medical record received more tempered support. Support was motivated by the desire to have risk communicated accurately and quickly. The most common caveat was a desire to alert relatives before the health system contacted them. Of 57 named relatives who were members of the same health system, we retrieved a single match for 40 (70.2%) based on name or birthdate. Health system involvement in familial risk notification received support in a sample of patients in a US integrated health system, and identification of relatives is feasible.
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Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Paula R Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jane Grafton
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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39
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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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40
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Yanes T, Willis AM, Meiser B, Tucker KM, Best M. Psychosocial and behavioral outcomes of genomic testing in cancer: a systematic review. Eur J Hum Genet 2019; 27:28-35. [PMID: 30206354 PMCID: PMC6303287 DOI: 10.1038/s41431-018-0257-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/23/2023] Open
Abstract
Psychosocial and behavioral outcomes of genetic testing in oncology are well known, however, it is unclear how these findings will generalize to more complex genomic testing. The aim of this systematic review was to assess the psychosocial and behavioral outcomes of cancer genomic testing. Studies were selected for inclusion if they were published from January 2003 to January 2017 and addressed psychological and behavioral outcomes of cancer genomic testing in adults. A review of four databases identified 9620 abstracts, with 22 publications meeting the inclusion criteria. Of the included articles, 11 studies reported on outcomes of germline testing, with three articles assessing panel testing and eight SNP testing. No studies assessed the outcomes of WGS or WES. Eleven articles assessed the outcomes of somatic testing, including testing for cancer prognosis and for personalized therapies. Studies were biased toward breast cancer and Caucasian women with high education and socioeconomic status. While studies demonstrated limited adverse psychological outcomes associated with genomic testing, a lack of consistency in psychosocial measures precluded any meta-analysis. Changes in health behavior following positive results were limited, and in some cases risk perception was not altered following genomic testing. There is limited evidence of adverse psychosocial outcomes and changes in health behavior following genomic testing to assess cancer risk. Findings from this review highlight the need for longitudinal research with superior methodological and theoretical design.
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Affiliation(s)
- Tatiane Yanes
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia.
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, Australia.
| | - Amanda M Willis
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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41
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Shah LL, Daack-Hirsch S, Ersig AL, Paik A, Ahmad F, Williams J. Family Relationships Associated With Communication and Testing for Inherited Cardiac Conditions. West J Nurs Res 2018; 41:1576-1601. [PMID: 30539690 DOI: 10.1177/0193945918817039] [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] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to identify characteristics of family relationships associated with communication of genetic risk and testing behaviors among at-risk relatives in families with an inherited cardiac condition. Data were collected from 53 patients and parents of children with an inherited cardiac condition through interviews, pedigrees, and surveys. Associations were examined among family relationship characteristics and whether at-risk relatives were informed about their risk and tested for disease. Of 1,178 at-risk relatives, 52.5% were informed about their risk and 52.1% of those informed were tested. Emotional closeness, relationship quality, and communication frequency had significant bivariate associations with genetic risk communication. Communication frequency was associated with genetic risk communication and testing in multivariate models. This study provides new insight into the extent of genetic risk communication and testing in families with inherited cardiac conditions. Family relationships, especially communication frequency, are critical factors in family communication of genetic risk.
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42
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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Family functioning integrated with diabetes self-management: a concept analysis. FRONTIERS OF NURSING 2018. [DOI: 10.1515/fon-2018-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Although the concept of family functioning has gained recent popularity, the terms "family functioning" and "family resilience" are sometimes confused and used interchangeably. The aim of this concept analysis was to clarify what is meant by family functioning in the context of diabetes self-management by assessing specific attributes, antecedents, and consequences. A concept analysis model by Walker and Avant was applied. The Identified attributes of family functioning in a diabetes self-management context Included problem-solving, communication, roles, affective responsiveness, affective involvement, and behavioral control. Antecedents Included family structure, socloeconomic status, family functioning relationships, family stage, and life events. Consequences Included family satisfaction, family cohesion, and family relationships. This analysis provided a deeper understanding of a family functioning concept within a diabetes self-management context. It is recommended that health care providers should be aware of antecedent factors that could inhibit outcome improvement. Further research is needed to explain family functioning attributes in relation to antecedents and potential consequences.
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[Prevention of genetic diseases : the return of the family practitioner ?]. Rev Epidemiol Sante Publique 2018; 69:30-38. [PMID: 30219572 DOI: 10.1016/j.respe.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 06/14/2018] [Accepted: 07/16/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Information to kin is one of the major ethical problems of the new genetics. In France, the revised bioethics law in 2011 created the possibility for patients to authorize professionals, under certain conditions, to directly contact their relatives at risk. Beyond this, other actors, such as GPs, could however play a role in this process. METHODS Our article is based on an ethnographic-type sociological study by observations and semi-structured interviews with patients (n=59) and genetic professionals (n=16) that took place from 2014 to 2016 in three genetic hospital wards in France and Canada. It focuses particularly on genetic predispositions to breast and ovarian cancers as well as genetic hemochromatosis. RESULTS Because of its position as a primary care specialist, the general practitioner can play a decisive role in the process of informing relatives about genetic disorders. Upstream of the genetic test, the generalist, thanks to his knowledge of the family context of his patients, can play a referral role towards a specialized consultation. Downstream, it can also ensure a more effective follow-up of the information procedures undertaken by its patients thanks to the medical follow-up that it carries out. CONCLUSION The data collected during our study highlight the unprecedented place that could be that of the general practitioner in the field of prevention in genetics. At the articulation between primary care and highly specialized care, it is the figure of the "family" doctor who seems to be called here to be renewed by genetics.
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Eijzenga W, de Geus E, Aalfs CM, Menko FH, Sijmons RH, de Haes HCJM, Smets EMA. How to support cancer genetics counselees in informing at-risk relatives? Lessons from a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2018; 101:1611-1619. [PMID: 29789176 DOI: 10.1016/j.pec.2018.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/18/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In hereditary and familial cancer, counselees are requested to inform their at-risk relatives. We developed an intervention to support counselees in this task. METHODS A randomized controlled trial was conducted aimed at improving cancer genetic counselees' i) knowledge, ii) motivation to disclose information, and ii) self-efficacy in this regard. Eligible participants were randomized to telephonic counseling (n = 148), or standard care (n = 157) and assessed at baseline, 1 week post-intervention, and 4 months after study enrolment. RESULTS No between-group differences were found in participants' knowledge, motivation, and self-efficacy. Knowledge concerning which second-degree relatives to inform was lower compared to first-degree relatives. About 60% of the participants was of the opinion that they needed to inform more relatives than stated in their summary letter and only about 50% were correctly aware of which information to disclose. Of note, at baseline, almost 80% of the participants had already correctly informed their at-risk relatives. CONCLUSIONS Since, unexpectedly, counselees already informed most of their relatives before the intervention was offered, efficacy of the intervention could not convincingly be determined. Counselees' knowledge about whom to inform about what is suboptimal. PRACTICE IMPLICATIONS Future interventions should target a more homogeneous sample and address counselees' understanding and recall.
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Affiliation(s)
- Willem Eijzenga
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Eveline de Geus
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Fred H Menko
- Cancer Family Clinic, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rolf H Sijmons
- Department of Clinical Genetics, University Medical Centre Groningen, University Groningen, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Cragun DL, Kechik J, Pal T. Complexities of genetic screening and testing in hereditary colorectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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Petersen HV, Frederiksen BL, Lautrup CK, Lindberg LJ, Ladelund S, Nilbert M. Unsolicited information letters to increase awareness of Lynch syndrome and familial colorectal cancer: reactions and attitudes. Fam Cancer 2018; 18:43-51. [DOI: 10.1007/s10689-018-0083-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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48
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Family Communication About Genetic Risk of Hereditary Cardiomyopathies and Arrhythmias: an Integrative Review. J Genet Couns 2018; 27:1022-1039. [PMID: 29492742 DOI: 10.1007/s10897-018-0225-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022]
Abstract
Screening for hereditary cardiomyopathies and arrhythmias (HCA) may enable early detection, treatment, targeted surveillance, and result in effective prevention of debilitating complications and sudden cardiac death. Screening at-risk family members for HCA is conducted through cascade screening. Only half of at-risk family members are screened for HCA. To participate in screening, at-risk family members must be aware of their risk. This often relies on communication from diagnosed individuals to their relatives. However, family communication is not well understood and is ripe for developing interventions to improve screening rates. Until very recently, family communication of genetic risk has been mostly studied in non-cardiac disease. Using this non-cardiac literature, we developed the family communication of genetic risk (FCGR) conceptual framework. The FCGR has four main elements of the communication process: influential factors, communication strategies, communication occurrence, and reaction to communication. Using the FCGR, we conducted an integrated review of the available literature on genetic risk communication in HCA families. Descriptive analysis of 12 articles resulted in the development of categories describing details of the FCGR elements in the context of HCA. This review synthesizes what is known about influential factors, communication strategies, communication occurrence, and outcomes of communication in the context of HCA.
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Derbez B. Is there a "right time" for bad news? Kairos in familial communication on hereditary breast and ovarian cancer risk. Soc Sci Med 2018; 202:13-19. [PMID: 29500986 DOI: 10.1016/j.socscimed.2018.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 10/18/2022]
Abstract
Time has long been considered as an important dimension of the process of disclosure of information about genetic risk to kin. The question of the "right time to tell" has been frequently noticed but seldom placed at the centre of the analyses of social scientists. Based on an ethnographical fieldwork in a French cancer genetics clinic, this article aims to show that many dimensions of the practical issues of disclosure to family can be fruitfully addressed through the temporal lens of kairos. Relying on the case of hereditary breast and ovarian cancer risk, it firstly highlights the existence of a mismatch between the "chronological" time of prevention proposed by professionals and the "kairological" time of disclosure lived by informants. Secondly, it emphasizes the problematic nature of the pragmatic approach of time associated with kairos. On the one hand one can draw some benefits from seeking the right time to inform relatives, but on the other hand waiting on uncertain opportunities to disclose such information can make communication even more difficult.
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Affiliation(s)
- Benjamin Derbez
- LABERS, Université de Bretagne Occidentale, 22 boulevard Camille Desmoulins, 29238 Brest, France.
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Intentions to share exome sequencing results with family members: exploring spousal beliefs and attitudes. Eur J Hum Genet 2018; 26:735-739. [PMID: 29476166 DOI: 10.1038/s41431-018-0118-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 11/08/2022] Open
Abstract
Given familial implications of genetic information, it is important to understand intentions to share carrier results with family members. To our knowledge, no studies among individuals undergoing exome sequencing have used dyadic data analysis to examine the effect of spousal perceptions and beliefs. Survey responses from 136 individuals (68 couples) undergoing exome sequencing in a research study were analyzed using dyadic analysis (the actor-partner interdependence model). Intention to share carrier results with family members was correlated between spouses (ICC = 0.43; 95% CI: 0.21-0.61; p = 0.004), as was worry about risk of a genetic condition in the family (ICC = 0.45; 95% CI: 0.24-0.62; p < 0.001). Perceived value of result and worry about risk of a genetic condition in the family were associated with one's own intentions to share carrier results. However, spousal status on these variables did not explain additional variance in an individual's intentions. Although we found no partner effects on intentions, spouses have comparable intentions to share carrier results, suggesting it may be important to account for non-independence in other research studies.
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