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Brown SL, Fisher P, Hope-Stone L, Damato B, Heimann H, Hussain R, Cherry MG. Fear of cancer recurrence and adverse cancer treatment outcomes: predicting 2- to 5-year fear of recurrence from post-treatment symptoms and functional problems in uveal melanoma survivors. J Cancer Surviv 2023; 17:187-196. [PMID: 34850324 DOI: 10.1007/s11764-021-01129-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The fear of cancer recurrence (FCR) in later survivorship can lead to poorer mental health, quality of life and physical and functional recovery. Later-occurring FCR may be a consequence of late-emerging physical symptoms and functional problems from cancer or its treatment. Based on the self-regulation model, we predicted that persistent or escalating symptoms and functional problems would prospectively predict FCR observed 2-5 years after diagnosis and treatment. METHODS This is a five-year study of 708 uveal melanoma (UM) patients, measuring self-reported visual and ocular symptoms, functional problems and FCR at 6, 12, 24, 36, 48 and 60 months post-diagnosis. A mixed measures design over four levels with observations staggered to represent prospective prediction. Criterion variables were FCR at 24, 36, 48 and 60 months. Predictors were symptom and function scores measured at the previous two observations to FCR. Controls were FCR measured at the previous observation to the criterion FCR measure and demographic, clinical and treatment variables. RESULTS Linear mixed modelling showed that FCR was uniquely predicted by enduring symptoms, those that emerged two observations previously, but not symptoms arising at the previous observation. FCR was predicted by functional problems, which emerged in the observation prior to FCR, but not the observation previous to that. CONCLUSIONS Persistent or emerging post-treatment symptoms and functional limitations are probable risk factors for late-occurring FCR in UM survivors. IMPLICATIONS FOR CANCER SURVIVORS Monitoring symptoms and functional limitations assists in identifying at-risk survivors and targeting preventive interventions. Self-regulation theory suggests that helping survivors to more realistically appraise symptoms and functional problems may prevent FCR.
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Affiliation(s)
- Stephen L Brown
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Peter Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK
| | - Laura Hope-Stone
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Bertil Damato
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Gemma Cherry
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK
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2
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Woof VG, Howell A, McWilliams L, Gareth Evans D, French DP. How do women who are informed that they are at increased risk of breast cancer appraise their risk? A systematic review of qualitative research. Br J Cancer 2022; 127:1916-1924. [PMID: 36002751 PMCID: PMC9681857 DOI: 10.1038/s41416-022-01944-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
This review aimed to synthesise qualitative research on how women notified that they are at increased risk of breast cancer view their risk. Five electronic databases were systematically reviewed for qualitative research investigating how women who have received an increased breast cancer risk estimate appraise their risk status. Fourteen records reporting 12 studies were included and critically appraised. Data were thematically synthesised. Four analytical themes were generated. Women appraise their risk of breast cancer through comparison with their risk of other familial diseases. Clinically derived risk estimates were understood in relation to pre-conceived risk appraisals, with incongruences met with surprise. Family history is relied upon strongly, with women exploring similarities and differences in attributes between themselves and affected relatives to gauge the likelihood of diagnosis. Women at increased risk reported living under a cloud of inevitability or uncertainty regarding diagnosis, resulting in concerns about risk management. Women hold stable appraisals of their breast cancer risk which appear to be mainly formed through their experiences of breast cancer in the family. Healthcare professionals should explore women's personal risk appraisals prior to providing clinically derived risk estimates in order to address misconceptions, reduce concerns about inevitability and increase perceived control over risk reduction.
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Affiliation(s)
- Victoria G. Woof
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Anthony Howell
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.498924.a0000 0004 0430 9101The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ UK
| | - Lorna McWilliams
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - D. Gareth Evans
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.498924.a0000 0004 0430 9101The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ UK
| | - David P. French
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK
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3
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Lacey HP, Lacey SC, Forest C, Blasi D, Dayal P. The role of emotional sensitivity to probability in the decision to choose genetic testing. J Genet Couns 2022; 31:677-688. [PMID: 34873773 DOI: 10.1002/jgc4.1534] [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: 06/16/2021] [Revised: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/08/2022]
Abstract
While the availability of genetic testing is rapidly increasing, many opt out of testing. The decision to test or not is emotionally charged, and both clinical research and theoretical work in psychology show that in emotional decisions, people often struggle to interpret and utilize risk information. Clinical research on genetic testing uptake also shows that feeling overwhelmed by numeric information may be a deterrent to testing. However, recent psychological research indicates that some portion of the population has greater emotional sensitivity to probability, (i.e., the extent to which emotional reactions to risk depend on probabilities) than others. We hypothesize that participants high in emotional sensitivity to probability will be more interested in genetic testing as an opportunity to seek greater precision in risk estimates and that this relationship is moderated by the testing context itself. In an online survey of a nationally representative sample (not recruited as patients), participants were presented with a hypothetical scenario describing a suspected diagnosis with an option for genetic testing. The scenario experimentally varied the pre-test probability estimate of the diagnosis (low or high) and whether the test results would result in certainty (ruling in or ruling out the diagnosis), or reduced uncertainty (providing a more precise individual risk estimate). Results indicated that emotional sensitivity to probability was a strong predictor of intention to test, particularly when the test allowed participants to rule out a diagnosis, reducing an already low probability to zero. These results highlight the way patients' individual characteristics interact with the testing context to guide decision-making and provide important insight into the way patients integrate risk probability information into intensely emotional decisions.
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Affiliation(s)
- Heather P Lacey
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
| | - Steven C Lacey
- Carroll School of Management, Boston College, Massachusetts, USA
| | - Caroline Forest
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
| | - Dana Blasi
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
| | - Prerna Dayal
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
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4
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Brown SL, Fisher PL, Morgan A, Davies C, Olabi Y, Hope-Stone L, Heimann H, Hussain R, Cherry MG. 'I Don't Like Uncertainty, I Like to Know': How and why uveal melanoma patients consent to life expectancy prognostication. Health Expect 2022; 25:1498-1507. [PMID: 35474381 PMCID: PMC9327814 DOI: 10.1111/hex.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Technological advances have led to cancer prognostication that is increasingly accurate but often unalterable. However, a reliable prognosis of limited life expectancy can cause psychological distress. People should carefully consider offers of prognostication, but little is known about how and why they decide on prognostication. Using uveal melanoma (UM) patients, we aimed to identify (i) how and why do people with UM decide to accept prognostication and (ii) alignment and divergence of their decision-making from conceptualizations of a 'well-considered' decision. METHODS UM provides a paradigm to elucidate clinical and ethical perspectives on prognostication, because prognostication is reliable but prognoses are largely nonameliorable. We used qualitative methods to examine how and why 20 UM people with UM chose prognostication. We compared findings to a template of 'well-considered' decision-making, where 'well-considered' decisions involve consideration of all likely outcomes. RESULTS Participants wanted prognostication to reduce future worry about uncertain life expectancy. They spontaneously spoke of hoping for a good prognosis when making their decisions, but largely did not consider the 50% possibility of a poor prognosis. When pressed, they argued that a poor outcome at least brings certainty. CONCLUSIONS While respecting decisions as valid expressions of participants' wishes, we are concerned that they did not explicitly consider the realistic possibility of a poor outcome and how this would affect them. Thus, it is difficult to see their decisions as 'well-considered'. We propose that nondirective preference exploration techniques could help people to consider the possibility of a poor outcome. PATIENT OR PUBLIC CONTRIBUTION This paper is a direct response to a patient-identified and defined problem that arose in therapeutic and conversational discourse. The research was informed by the responses of patient participants, as we used the material from interviews to dynamically shape the interview guide. Thus, participants' ideas drove the analysis and shaped the interviews to come.
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Affiliation(s)
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Morgan
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Cari Davies
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Yasmin Olabi
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Laura Hope-Stone
- School of Psychology, University of Plymouth, Plymouth, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heinrich Heimann
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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5
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Goh MCW, Kelly PJ, Deane FP. Enhancing Type 2 diabetes risk communication with message framing and tailored risk feedback: an online randomised controlled trial. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1997554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melvin C. W. Goh
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Peter J. Kelly
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P. Deane
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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6
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Smith-Uffen M, Bartley N, Davies G, Best M. Motivations and barriers to pursue cancer genomic testing: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1325-1334. [PMID: 33390305 DOI: 10.1016/j.pec.2020.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Single-gene testing is associated with psycho-social challenges for cancer patients. Genomic testing may amplify these. The aim of this study was to understand patients' motivations and barriers to pursue cancer genomic testing, to enable healthcare providers to support their patients throughout the testing process and interpretation of test results. METHODS Five databases were searched for original peer reviewed research articles published between January 2001 and September 2018 addressing motivation for genomic cancer testing. QualSyst was used to assess quality. RESULTS 182 studies were identified and 17 were included for review. Studies were heterogenous. Both somatic and germline testing were included, and 14 studies used hypothetical scenarios. 3249 participants were analyzed, aged 18 to 94. Most were female and white. The most common diagnoses were breast, ovarian, lung and colorectal cancer. Interest in testing was high. Motivations included ability to predict cancer risk, inform disease management, benefit families, and understand cancer. Barriers included concerns about cost, privacy/confidentiality, clinical utility, and psychological harm. CONCLUSIONS Despite concerns, consumers are interested in cancer genomic testing if it can provide actionable results for themselves and their families. PRACTICE IMPLICATIONS Providers must manage understanding and expectations of testing and translate genetic information into health-promoting behaviours.
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Affiliation(s)
- Megan Smith-Uffen
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Nicci Bartley
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Grace Davies
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Megan Best
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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7
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Palmero EI, Campacci N, Schüler-Faccini L, Giugliani R, Rocha JCCD, Vargas FR, Ashton-Prolla P. Cancer-related worry and risk perception in Brazilian individuals seeking genetic counseling for hereditary breast cancer. Genet Mol Biol 2020; 43:e20190097. [PMID: 32325485 PMCID: PMC7210979 DOI: 10.1590/1678-4685-gmb-2019-0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023] Open
Abstract
In Brazil, the population in general has little knowledge about genetic risks, as well as regarding the role and importance of the Cancer Genetic Counseling (CGC). The goal of this study was to evaluate cancer-related worry and cancer risk perception during CGC sessions in Brazilian women at-risk for hereditary breast cancer. This study was performed in 264 individuals seeking CGC for hereditary breast cancer. Both cancer-affected and unaffected individuals were included. As results, individuals with and without cancer reported different motivations for seeking CGC and undergoing genetic testing. A correlation was observed between age at the first CGC session and age at which the closest relative was diagnosed with cancer. Multivariate analysis showed that educational level, cancer risk discussion within the family, and number of deaths by cancer among first-degree relatives influenced positively the cancer risk perception. In conclusion, the results of this study indicate that cancer-related worry and cancer risk perception are significant aspects of morbidity in individuals seeking CGC, whether they are cancer-affected or unaffected. CGC has an important role in health education and cancer prevention for its potential of promoting an accurate perception of the risk.
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Affiliation(s)
- Edenir Inêz Palmero
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | - Natalia Campacci
- Hospital de Câncer de Barretos, Centro de Pesquisa em Oncologia Molecular, Barretos, SP, Brazil
| | - Lavinia Schüler-Faccini
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Roberto Giugliani
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | | | | | - Patricia Ashton-Prolla
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
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8
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Hong SJ. Uncertainty in the Process of Communicating Cancer-related Genetic Risk Information with Patients: A Scoping Review. JOURNAL OF HEALTH COMMUNICATION 2020; 25:251-270. [PMID: 32271688 DOI: 10.1080/10810730.2020.1745963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the era of precision medicine, patients must manage the uncertainty caused by ambiguous genetic information. To aid health practitioners in effectively communicating genetic information, this study classified the types of uncertainty involved in these communication processes. A search of recent literature turned up 64 articles that measured and/or discussed patients' perceptions and/or feelings of uncertainty related to the communication process of cancer-related genetic information. In reviewing these papers, six types of uncertainty regarding cancer-related genetic information were identified: (1) uncertainty about understanding genetic information (n = 25; 39.1%); (2) uncertainty about future cancer risks (n = 34; 53.1%); (3) uncertainty about managing known genetic information or mutation status (n = 33; 51.6%); (4) uncertainty about the utility of genetic information (n = 5; 7.8%); (5) uncertainty about genetic test results before undergoing testing or receiving the results (n = 10; 15.6%); and (6) uncertainty about the impact of genetic results on family and life (n = 11; 17.2%). These six types of uncertainty serve as a helpful taxonomy for developing, validating, and utilizing future measures of uncertainty in the context of cancer-related genetic risk communication.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
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9
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Bayne M, Fairey M, Silarova B, Griffin SJ, Sharp SJ, Klein WMP, Sutton S, Usher-Smith JA. Effect of interventions including provision of personalised cancer risk information on accuracy of risk perception and psychological responses: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:83-95. [PMID: 31439435 PMCID: PMC6919334 DOI: 10.1016/j.pec.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/23/2019] [Accepted: 08/08/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To synthesize the literature on the effect of provision of personalised cancer risk information to individuals at population level risk on accuracy of risk perception and psychological responses. METHODS A systematic review and random effects meta-analysis of articles published from 01/01/2000 to 01/07/2017. RESULTS We included 23 studies. Immediately after provision of risk information 87% of individuals were able to recall the absolute risk estimate. Less than half believed that to be their risk, with up to 71% believing their risk to be higher than the estimate. Provision of risk information increased accuracy of perceived absolute risk immediately after risk information compared with no information (pooled RR 4.16 (95%CI 1.28-13.49), 3 studies). There was no significant effect on comparative risk accuracy (pooled RR 1.39 (0.72-2.69), 2 studies) and either no change or a reduction in cancer worry, anxiety and fear. CONCLUSION These findings highlight the complex cognitive processes involved in the conceptualisation of risk. PRACTICE IMPLICATIONS Individuals who appear to understand and are able to recall risk information most likely do not believe it reflects their own risk.
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Affiliation(s)
- Max Bayne
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Madi Fairey
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge UK
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Stephen Sutton
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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10
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Brown SL, Beesley H, Holcombe C, Saini P, Salmon P. Warranting the decision-maker, not the decision: How healthcare practitioners evaluate the legitimacy of patients' unprompted requests for risk-reducing mastectomy. PATIENT EDUCATION AND COUNSELING 2019; 102:1446-1451. [PMID: 30922623 DOI: 10.1016/j.pec.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Shared decision-making exists to reconcile healthcare practitioners' responsibilities to respect patients' autonomy whilst ensuring well-made decisions. Patients sometimes make unprompted requests for procedures that carry medical and other risks, such as risk-reducing mastectomy (RRM). Faced with pre-formed decisions into which they have had little input, it is unclear how practitioners can reconcile respecting autonomy with ensuring well-made decisions. METHODS Qualitative study of linked patient-practitioner interviews in a breast unit in North-West England. We examined how 10 practitioners addressed 19 patients' unprompted requests for RRM. RESULTS Practitioners empathised with patients' distress about cancer risk, regarded RRM as legitimate to help, but were wary of choices made 'emotionally'. Practitioners did not seek to establish whether choices were well-made but, instead, 'warranted' patients by satisfying themselves that patients were 'sensible' and 'informed' decision-makers, and thus their decisions could be trusted. Practitioners provided information, and tested patients' resolve by delaying decisions and presenting 'what if' scenarios depicting failure or harm from RRM. CONCLUSION Patients who present emotionally and with resolution can receive RRM without evidence of a well-made decision. PRACTICE IMPLICATIONS Argumentation theory proposes an ethically robust and clinically practicable approach, whereby practitioners elicit, examine and, where appropriate, challenge arguments underpinning patients' decisions.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, United Kingdom; School of Psychology, University of Adelaide, Australia.
| | - Helen Beesley
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | - Christopher Holcombe
- Department of Psychological Sciences, University of Liverpool, United Kingdom; Royal Liverpool and Broadgreen University Hospitals Trust, United Kingdom
| | - Pooja Saini
- School of Natural Sciences and Psychology, Liverpool John Moores University, United Kingdom
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, United Kingdom
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11
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Conley CC, Agnese DM, Vadaparampil ST, Andersen BL. Factors associated with intentions for breast cancer risk management: Does risk group matter? Psychooncology 2019; 28:1119-1126. [PMID: 30889627 DOI: 10.1002/pon.5066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE National guidelines provide breast cancer (BC) risk management recommendations based on estimated lifetime risk. Despite this specificity, it is unclear if women's risk management intentions are or are not guideline concordant. To address this knowledge gap, women at varying risk levels reported intentions for risk-reducing behaviors. Factors associated with intentions, informed by the Health Beliefs Model, were also studied. METHODS Women with elevated BC risk (N = 103) were studied and categorized by risk level: moderate (15%-20%), high (greater than or equal to 20%), or very high (BRCA1/2 positive). Participants self-reported BC susceptibility, self-efficacy, and benefits, barriers, and intentions for risk-reducing mastectomy (RRM), risk-reducing salpingo-oophorectomy (RRSO), chemoprevention, improving diet or physical activity, and reducing alcohol use. RESULTS Groups significantly differed in RRSO intentions (P < .01); BRCA1/2 positive women had greater intentions for RRSO. Groups did not differ in intentions for RRM, chemoprevention, or lifestyle changes (Ps > .28). In hierarchical linear regression models examining Health Belief Model (HBM) factors, perceived susceptibility was associated with intentions for RRM (β = .169, P = .08). Perceived benefits was associated with intentions for RRM (β = .237, P = .02) and chemoprevention (β = .388, P < .01). Self-efficacy was associated with intentions for physical activity (β = .286, P < .01). CONCLUSIONS Consistent with guidelines, BRCA1/2 positive women reported greater intentions for RRSO, and risk groups did not differ in intentions for lifestyle changes. Notably, women's intentions for RRM and chemoprevention were guideline discordant; groups did not differ in intentions for these behaviors. Accounting for the effects of risk group, modifiable health beliefs were also associated with risk management intentions; these may represent targets for decision support interventions.
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Affiliation(s)
- Claire C Conley
- Department of Psychology, The Ohio State University, Columbus, Ohio.,Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Doreen M Agnese
- Department of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida
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12
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Hong SJ, Biesecker B, Ivanovich J, Goodman M, Kaphingst KA. Factors affecting breast cancer patients' need for genetic risk information: From information insufficiency to information need. J Genet Couns 2019; 28:543-557. [PMID: 30675956 DOI: 10.1002/jgc4.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/04/2018] [Indexed: 12/28/2022]
Abstract
Information-seeking models typically focus on information-seeking behaviors based on individuals' interest in information, because their current level is perceived to be insufficient. In the context of genetic risk information (GRI), however, information insufficiency is difficult to measure and thus can limit understanding of information behavior in the context of GRI. We propose that an individual's need for information might be a more direct and conceptually clearer alternative to predicting their information-seeking behavior. To test this hypothesis, this study investigates the extent to which previously identified factors affecting interest in GRI are also predictors of need for GRI among women diagnosed with breast cancer at the age of 40 or younger (N = 1,069). As hypothesized, there was a positive association between interest in and need for GRI. Furthermore, hypothesized factors of numeracy, information orientation, and genetic knowledge were significant predictors of increased interest in and need for GRI. In contrast, hypothesized factors of genetic worry and genetic causal belief predicted increased interest in GRI only, while genetic self-efficacy predicted increased need for GRI only. As hypothesized, BRCA status significantly moderated associations between informational norm and both interest in and need for GRI. Collectively, the findings support inclusion of need for GRI in theoretical information-seeking models in the context of genomic risk.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, National University of Singapore, Singapore
| | | | | | | | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Communication, University of Utah, Salt Lake City, Utah
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13
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Brown SL, Salmon P. Reconciling the theory and reality of shared decision-making: A "matching" approach to practitioner leadership. Health Expect 2018; 22:275-283. [PMID: 30478979 PMCID: PMC6543140 DOI: 10.1111/hex.12853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Silarova B, Douglas FE, Usher-Smith JA, Godino JG, Griffin SJ. Risk accuracy of type 2 diabetes in middle aged adults: Associations with sociodemographic, clinical, psychological and behavioural factors. PATIENT EDUCATION AND COUNSELING 2018; 101:43-51. [PMID: 28757303 PMCID: PMC6086332 DOI: 10.1016/j.pec.2017.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify the proportion of individuals with an accurate perception of their risk of type 2 diabetes (T2D) prior to, immediately after and eight weeks after receiving a personalised risk estimate. Additionally, we aimed to explore what factors are associated with underestimation and overestimation immediately post-intervention. METHODS Cohort study based on the data collected in the Diabetes Risk Communication Trial. We included 379 participants (mean age 48.9 (SD 7.4) years; 55.1% women) who received a genotypic or phenotypic risk estimate for T2D. RESULTS While only 1.3% of participants perceived their risk accurately at baseline, this increased to 24.7% immediately after receiving a risk estimate and then dropped to 7.3% at eight weeks. Those who overestimated their risk at baseline continued to overestimate it, whereas those who underestimated their risk at baseline improved their risk accuracy. We did not identify any other characteristics associated with underestimation or overestimation immediately after receiving a risk estimate. CONCLUSION Understanding a received risk estimate is challenging for most participants with many continuing to have inaccurate risk perception after receiving the estimate. PRACTICE IMPLICATIONS Individuals who overestimate or underestimate their T2D risk before receiving risk information might require different approaches for altering their risk perception.
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Affiliation(s)
- Barbora Silarova
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK.
| | - Fiona E Douglas
- School of Clinical Medicine, University of Cambridge, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge, CB1 8RN, UK.
| | - Job G Godino
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK; Center for Wireless and Population Health Systems, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0811, USA.
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK; The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge, CB1 8RN, UK.
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Taber JM, Klein WMP, Suls JM, Ferrer RA. Lay Awareness of the Relationship between Age and Cancer Risk. Ann Behav Med 2017; 51:214-225. [PMID: 27752991 DOI: 10.1007/s12160-016-9845-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cross-sectional studies suggest many people are unaware that cancer risk increases with age, but this misbelief has rarely been studied prospectively, nor are its moderators known. PURPOSE To assess whether people recognize that cancer risk increases with age and whether beliefs differ according to gender, education, smoking status, and family history of cancer. METHODS First, items from the cross-sectional Health Information National Trends Survey (n = 2069) were analyzed to examine the association of age and perceived cancer risk. Second, the prospective National Survey of Midlife Development in the United States (n = 3896) was used to assess whether perceived cancer risk changes over a decade. Third, beliefs about the age at which cancer occurs were analyzed using the US Awareness and Beliefs about Cancer survey (n = 1080). As a comparator, perceived risk of heart disease was also examined. RESULTS Cross-sectionally, older age was associated with lower perceived cancer risk but higher perceived heart disease risk. Prospectively, perceived cancer risk remained stable, whereas perceived heart attack risk increased. Seventy percent of participants reported a belief that cancer is equally likely to affect people of any age. Across three surveys, women and former smokers/smokers who recently quit tended to misunderstand the relationship between age and cancer risk and also expressed relatively higher perceived cancer risk overall. CONCLUSIONS Data from three national surveys indicated that people are unaware that age is a risk factor for cancer. Moreover, those who were least aware perceived the highest risk of cancer regardless of age.
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Affiliation(s)
- Jennifer M Taber
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.
| | - Jerry M Suls
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
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Brown SL, Whiting D, Fielden HG, Saini P, Beesley H, Holcombe C, Holcombe S, Greenhalgh L, Fairburn L, Salmon P. Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests. PLoS One 2017; 12:e0178392. [PMID: 28552971 PMCID: PMC5446175 DOI: 10.1371/journal.pone.0178392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/14/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Contemporary approaches to medical decision-making advise that clinicians should respect patients' decisions. However, patients' decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients' decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. METHODS Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. RESULTS Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do 'all they could' to prevent it. Most therefore perceived RRM to be the 'obvious' option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. CONCLUSION Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients' emotions.
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Affiliation(s)
- Stephen L. Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Hannah G. Fielden
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Pooja Saini
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Helen Beesley
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Christopher Holcombe
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Susan Holcombe
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Lyn Greenhalgh
- Royal Liverpool Women’s Hospital NHS Trust, Liverpool, United Kingdom
| | - Louise Fairburn
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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Padamsee TJ, Wills CE, Yee LD, Paskett ED. Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 2017; 19:34. [PMID: 28340626 PMCID: PMC5366153 DOI: 10.1186/s13058-017-0826-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43220 USA
| | - Celia E. Wills
- College of Nursing, The Ohio State University, Columbus, OH USA
| | - Lisa D. Yee
- College of Medicine, The Ohio State University, Columbus, OH USA
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Fielden HG, Brown SL, Saini P, Beesley H, Salmon P. How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research. Psychooncology 2016; 26:1254-1262. [PMID: 27983769 PMCID: PMC5599983 DOI: 10.1002/pon.4349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Abstract
Objective Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Methods Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception‐June 2015). Results Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk‐reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk‐reducing procedures without such deliberation. Conclusions Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically‐based ethical reflection is required to determine whether and when it is appropriate to provide risk‐reduction procedures to alleviate worry.
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Affiliation(s)
- Hannah G Fielden
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Pooja Saini
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,CLAHRC North West, University of Liverpool, Liverpool, UK
| | - Helen Beesley
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Gamp M, Renner B. Experience-based health risk feedback and lack of reassurance. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1108197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Current directions in behavioral medicine research on genetic testing for disease susceptibility: introduction to the special section. J Behav Med 2015; 38:701-5. [PMID: 26350552 DOI: 10.1007/s10865-015-9674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this special section is to showcase research contributing to our understanding of factors influencing decisions to undergo genetic testing and the impact of the genetic testing process on health-related behaviors of tested individuals. The first two articles report studies investigating factors associated with interest in genetic testing and acceptance of test results (Sherman et al. in J Behav Med doi: 10.1007/s10865-015-9630-9 , 2015; Taber et al. in J Behav Med doi: 10.1007/s10865-015-9642-5 , 2015b). The next two papers address the unique contribution of genetic risk information to understanding risk beyond genetic counseling alone (Heiniger et al. in J Behav Med doi 10.1007/s10865-015-9632-7 , 2015; Taber et al. in J Behav Med doi: 10.1007/s10865-015-9648-z , 2015a). The final three articles investigate the effects of genetic risk information on beliefs about disease control and prevention (Aspinwall et al. in J Behav Med doi: 10.1007/s10865-015-9631-8 , 2015; Kelly et al. in J Behav Med doi 10.1007/s10865-014-9613-2 , 2014; Myers et al. in J Behav Med doi: 10.1007/s10865-015-9626-5 , 2015). Collectively, the special section of papers highlights the diverse ways in which behavioural medicine contributes to our understanding of genetic testing for disease risk, and points to the value of further research to better understand ways in which individuals perceive, interpret and respond to genetic risk information.
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Ribeiro Seabra C, Peuker AC, Armiliato MJ, Alves de Souza ML, Kern de Castro E. Early detection of breast cancer: the role of risk perception and family history. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.55813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Breast cancer is the neoplasm with the highest mortality rates among Brazilian women. Family history plays an important role in tracking the illness because its analysis reveals possible genetic risks. Objective: The aim of this study is to compare the risk perception and self-care for breast cancer among healthy women with and without family history. Method: The study included 211 women (mean age = 59.11 years, SD = 8.54) of which 55 (26.4%) had a family history of the illness. The instruments used were a sociodemographic and health behavior questionnaire and a risk perception questionnaire. Results and Conclusions: The results showed no significant differences in risk perception and self-care behavior among women with and without breast cancer history, signaling the need of guidelines for psychologists to act in breast cancer prevention among women with a family history, encompassing understanding of the risk factors and causes of the illness as well as women’s responsibility in tracking.
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