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Gereis JM, Hetherington K, Robertson EG, Daly R, Donoghoe MW, Ziegler DS, Marshall GM, Lau LMS, Marron JM, Wakefield CE. Parents' and adolescents' perspectives and understanding of information about childhood cancer precision medicine. Cancer 2023; 129:3645-3655. [PMID: 37376781 DOI: 10.1002/cncr.34914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/24/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Precision medicine is projected to become integral to childhood cancer care. As such, it is essential to support families to understand what precision medicine entails. METHODS A total of 182 parents and 23 adolescent patients participating in Precision Medicine for Children with Cancer (PRISM), an Australian precision medicine clinical trial for high-risk childhood cancer, completed questionnaires after study enrollment (time 0 [T0]). Of the parents, 108 completed a questionnaire and 45 completed an interview following return of precision medicine results (time 1 [T1]). We analyzed the mixed-methods data comprising measures exploring families' perceptions and understanding of PRISM's participant information sheet and consent form (PISCF), and factors associated with understanding. RESULTS Most parents were satisfied with the PISCF, rating it as at least "somewhat" clearly presented (n = 160/175; 91%) and informative (n = 158/175; 90%). Many suggested improvements including the use of clearer language and a more visually engaging format. Parents' actual understanding of precision medicine was low on average, but scores improved between T0 and T1 (55.8/100-60.0/100; p = .012). Parents from culturally and/or linguistically diverse backgrounds (n = 42/177; 25%) had lower actual understanding scores than those from a Western/European background whose first language was English (p = .010). There was little correlation between parents' perceived and actual understanding scores (p = .794; Pearson correlation -0.020; 95% CI, -0.169 to 0.116). Most adolescent patients read the PISCF either "briefly" or "not at all" (70%) and had a perceived understanding score of 63.6/100 on average. CONCLUSIONS Our study revealed gaps in families' understanding of childhood cancer precision medicine. We highlighted areas for potential intervention such as through targeted information resources. PLAIN LANGUAGE SUMMARY Precision medicine is projected to become part of the standard of care for children with cancer. Precision medicine aims to give the right treatment to the right patient and involves several complex techniques, many of which may be challenging to understand. Our study analyzed questionnaire and interview data from parents and adolescent patients enrolled in an Australian precision medicine trial. Findings revealed gaps in families' understanding of childhood cancer precision medicine. Drawing on parents' suggestions and the literature, we make brief recommendations about improving information provision to families, such as through targeted information resources.
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Affiliation(s)
- Jessica M Gereis
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Kate Hetherington
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Eden G Robertson
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rebecca Daly
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Mark W Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - David S Ziegler
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Loretta M S Lau
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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Sandhu S, Hickey M, Lew R, Hammarberg K, Braat S, Agresta F, Parle A, Allingham C, Peate M. The development and phase 1 evaluation of a Decision Aid for elective egg freezing. BMC Med Inform Decis Mak 2023; 23:83. [PMID: 37147687 PMCID: PMC10161420 DOI: 10.1186/s12911-023-02178-4] [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: 09/15/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Elective egg freezing decisions are complex. We developed a Decision Aid for elective egg freezing and conducted a phase 1 study to evaluate its acceptability and utility for decision-making. METHODS The online Decision Aid was developed according to International Patient Decision Aid Standards and evaluated using a pre/post survey design. Twenty-six Australian women aged 18-45 years, interested in receiving elective egg freezing information, proficient in English, and with access to the internet were recruited using social media and university newsletters. Main outcomes were: acceptability of the Decision Aid; feedback on the Decision Aid design and content; concern raised by the Decision Aid, and; utility of the Decision Aid as measured by scores on the Decisional Conflict Scale and on a study-specific scale assessing knowledge about egg freezing and age-related infertility. RESULTS Most participants found the Decision Aid acceptable (23/25), balanced (21/26), useful for explaining their options (23/26), and for reaching a decision (18/26). Almost all reported satisfaction with the Decision Aid (25/26) and the level of guidance it provided (25/26). No participant reported serious concerns about the Decision Aid, and most would recommend it to other women considering elective egg freezing (22/26). Median Decisional Conflict Scale score decreased from 65/100 (Interquartile range: 45-80) pre-Decision Aid to 7.5/100 (Interquartile range: 0-37.5) post-Decision Aid review (p < 0.001). Median knowledge score increased from 8.5/14 (Interquartile range: 7-11) pre-Decision Aid to 11/14 (Interquartile range: 10-12) post-Decision Aid review (p = 0.01). CONCLUSION This elective egg freezing Decision Aid appears acceptable and useful for decision-making. It improved knowledge, reduced decisional conflict and did not raise serious concerns. The Decision Aid will be further evaluated using a prospective randomised control trial. STUDY REGISTRATION ACTRN12618001685202 (retrospectively registered: 12 October 2018).
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Anna Parle
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Catherine Allingham
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
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Smith-Lickess SK, Stefanic N, Shaw J, Shepherd H, Naehrig D, Turner RM, Cabrera-Aguas M, Meiser B, Halkett GK, Jackson M, Saade G, Bucci J, Milross C, Dhillon HM. What is the effect of a low literacy talking book on patient knowledge, anxiety and communication before radiation therapy starts? A pilot study. J Med Radiat Sci 2022; 69:463-472. [PMID: 35839313 DOI: 10.1002/jmrs.606] [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: 09/03/2021] [Accepted: 06/29/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Radiation therapy is a common cancer treatment, requiring timely information to help patients prepare for treatment. We pilot tested a low literacy, psycho-educational talking book (written booklet, with accompanying audio recording) to examine (i) the effect of the tool on knowledge, anxiety and communication; (ii) acceptability, and (iii) how it was used in appointments. METHODS A pre-post design was employed. Patients scheduled to receive radiation therapy for any cancer were recruited from two hospitals in Sydney, Australia. Participants were sent the talking book before treatment planning and completed baseline and follow-up surveys, before and after the intervention. RESULTS Forty participants were recruited, and 39 completed all study assessments. Overall, knowledge increased after receiving the talking book by 3.8 points from 13.9 to 17.7/20 (95% confidence interval (CI) 2.7, 4.8, P < 0.001). Anxiety and concerns were significantly lower after receiving the talking book (P = 0.015 and P = 0.004, respectively). Nearly half of participants (s = 17, 48%) reported using the book during appointments. Most reported finding it easier to communicate (n = 31, 89%) and to ask more questions (n = 21, 62%). CONCLUSION The talking book shows promise in improving knowledge, reducing anxiety and enhancing communication. Strategies to support the implementation of the talking book are required. Further studies to translate the book into different languages are also planned.
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Affiliation(s)
- Sian K Smith-Lickess
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Psychology, University of Bath, Bath, UK
| | - Natalie Stefanic
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heather Shepherd
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Radiation Oncology and Medical Services, Sydney, NSW, Australia
| | - Robin M Turner
- Dunedin School of Medicine, Otago University, Wellington, New Zealand
| | - Maria Cabrera-Aguas
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Georgia Kb Halkett
- Faculty of Health Sciences, Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Michael Jackson
- UNSW Sydney, Prince of Wales Clinical School, Randwick, Sydney, NSW, Australia.,Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - George Saade
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Bucci
- St George Hospital Cancer Care, Radiation Oncology Unit, Sydney, NSW, Australia
| | - Christopher Milross
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Radiation Oncology and Medical Services, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Kaur R, McDonald C, Meiser B, Macrae F, Smith SK, Kang YJ, Caruana M, Mitchell G. The Risk-Reducing Effect of Aspirin in Lynch Syndrome Carriers: Development and Evaluation of an Educational Leaflet. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2100046. [PMID: 36618023 PMCID: PMC9744515 DOI: 10.1002/ggn2.202100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Indexed: 01/11/2023]
Abstract
Carriers of germline mutations in genes associated with Lynch syndrome are at increased risk for colorectal, endometrial, ovarian, and other cancers. There is evidence that daily consumption of aspirin may reduce cancer risk in these individuals. There is a need for educational resources to inform carriers of the risk-reducing effects of aspirin or to support decision-making. An educational leaflet describing the risks and benefits of using aspirin as risk-reducing medicine in carriers of Lynch-syndrome-related mutations is developed and pilot tested in 2017. Carriers are ascertained through a familial cancer clinic and surveyed using a mailed, self-administered questionnaire. The leaflet is highly rated for its content, clarity, length, relevance, and visual appeal by more than 70% of the participants. Most participants (91%) report "a lot" or "quite a bit" of improvement in perceived understanding in knowledge about who might benefit from taking aspirin, its benefits, how long to take it, the reduction in bowel cancer risk, and the optimal dosage. A few (14%) participants seek more information on the dosage of aspirin. This leaflet will be useful as an aid to facilitate discussion between patients and their health care professionals about the use of aspirin as a risk-reducing medication.
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Affiliation(s)
- Rajneesh Kaur
- Medical Education OfficeUNSW SydneyNew South WalesAustralia,Medical Education OfficeThe University of SydneyEdward Ford BuildingSydneyNew South Wales2006Australia
| | - Cassandra McDonald
- The Kinghorn Cancer CentreSt Vincent HospitalVictoria StreetDarlinghurstNew South Wales2010Australia
| | - Bettina Meiser
- Psychosocial Research GroupUNSW SydneyHigh StreetSydneyNew South Wales2052Australia
| | - Finlay Macrae
- Department of Colorectal Medicine and Geneticsand Department of MedicineThe Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoria3010Australia
| | - Sian K Smith
- Psychosocial Research GroupUNSW SydneyHigh StreetSydneyNew South Wales2052Australia
| | - Yoon Jung Kang
- Daffodil CentreUniversity of SydneySydneyNew South Wales2006Australia
| | - Michael Caruana
- Daffodil CentreUniversity of SydneySydneyNew South Wales2006Australia
| | - Gillian Mitchell
- Familial Cancer CentrePeter MacCallum Cancer CentreParkvilleVictoria3010Australia,The Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoria3052Australia
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Dahle Ommundsen RM, Strømsvik N, Hamang A. Assessing the relationship between patient preferences for recontact after BRCA1 or BRCA2 genetic testing and their monitoring coping style in a Norwegian sample. J Genet Couns 2021; 31:554-564. [PMID: 34716741 DOI: 10.1002/jgc4.1526] [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] [Received: 04/07/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
Recontacting former patients regarding new genetic information is currently not standard care but might be implemented in the future. Little information is available on the implications of this practice from the point of view of former patients. The aim of this study was to investigate preferences for recontact when new genetic information becomes available among patients tested for BRCA pathogenic variants. We further wanted to investigate whether having a high or low information-seeking coping style (monitoring) impacts preferences. Preferences for recontact were assessed using a self-constructed questionnaire. The Threatening Medical Situations Inventory (TMSI) was used to measure monitoring coping style. The questionnaires were sent to 500 randomly selected patients who had previously been tested for BRCA pathogenic variants within the time frame 2001-2014 at one genetic clinic in Norway. We received 323 completed questionnaires. Most respondents wanted to be recontacted with advances in genetic medicine (81.1%) and to receive highly personalized updates. Genetic counselors/geneticists were believed to be most responsible for recontact. There was a significant relationship between being a high monitor and wanting recontact to learn about own cancer risk and receive ongoing support. Patients have a high interest in being recontacted. The findings indicated a tendency for high monitors to prefer more detailed and personalized information.
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Affiliation(s)
- Randi Marlene Dahle Ommundsen
- Department of Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nina Strømsvik
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Medical Genetics, Northern Norway Familial Cancer Center, University Hospital of North-Norway, Tromsø, Norway
| | - Anniken Hamang
- Department of Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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6
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Tiernan G, Freeman V, Morrow A, Hogden E, Canfell K, Kang YJ, Taylor N. What would I do? Perspectives on the factors underlying Lynch syndrome genetic testing and results sharing decisions for high-risk colorectal cancer patients. Psychooncology 2021; 31:587-596. [PMID: 34698409 PMCID: PMC9298871 DOI: 10.1002/pon.5840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022]
Abstract
Objective Universal tumour testing for Lynch syndrome (LS) in all incident colorectal cancers (CRCs) and sequential diagnostic genetic testing is cost‐effective in Australia. Because of this, our study aimed to understand factors underlying possible decisions faced by tumour test‐positive CRC patients and their at‐risk relatives throughout the LS diagnosis pathway. Methods Semi‐structured telephone interviews were conducted with 23 participants, using four hypothetical scenarios. Vignette‐guided closed‐ and open‐ended questions asked about LS genetic testing uptake, discussing diagnosis with at‐risk relatives, and risk‐reducing interventions. Personal perspectives on genetic testing were collected pre‐post vignette discussion. Inductive thematic analysis was performed on open‐ended questions. Decisional pathway diagrams were developed to convey factors influencing complex decision‐making processes. Results Participant responses incorporated unfolding scenario information, resulting in three decision themes: (1) wanting to know one's LS status; (2) informing family about LS; (3) navigating risk‐reducing interventions. Across all themes, ‘knowledge’ emerged as a facilitator, and ‘negative emotional experience’ as a barrier. Personal supportive views toward genetic testing increased post‐interview. Conclusions When communicating with tumour test‐positive CRC patients or their relatives about LS genetic testing, providing guidance/resources to inform decisions around risk‐reducing interventions and informing family members is critical. Scenario‐driven interviews provide insight into what individuals might do when facing complex healthcare decisions and could aid informed decision‐making. This approach may be applicable in other conditions, particularly with mainstreaming being increasingly introduced into the genetic context.
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Affiliation(s)
- Gabriella Tiernan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Victoria Freeman
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - April Morrow
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Emily Hogden
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Yoon-Jung Kang
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Natalie Taylor
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Lee DSC, Meiser B, Mariapun S, Hassan T, Yip CH, Mohd Taib NA, Teo SH, Thong MK, Yoon SY. Communication about positive BRCA1 and BRCA2 genetic test results and uptake of testing in relatives in a diverse Asian setting. J Genet Couns 2021; 30:720-729. [PMID: 33245177 DOI: 10.1002/jgc4.1360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/05/2022]
Abstract
The vast majority of studies assessing communication of BRCA1/2 results with relatives and family uptake of BRCA1/2 testing have been conducted in Western societies, and a dearth of studies have been conducted in Asia among relatives of diverse carriers of pathogenic BRCA1/2 germline variants. This study aimed to present rates of BRCA1/2 result disclosure by probands and probands' motivators and barriers of family communication and predictive testing uptake among eligible relatives. It also examined patterns of disclosure and testing uptake among different types of relatives. Eighty-seven carriers with either breast or ovarian cancer, who had previously been found to be carriers of a pathogenic variant in BRCA1/2, were interviewed over the phone using a semi-structured interview guide. Fifty-six percent of patients were Chinese, 21% were Indian, and 23% were Malay. It was found that 62.0% of eligible first- and second-degree relatives were informed by the proband about the testing result and that 11.5% of eligible first- and second-degree relatives had genetic testing. First-degree relatives were more likely to have been informed and tested compared to second-degree relatives, as were sisters compared to brothers. The low rates of family communication and testing uptake documented in this study suggest that interventions should focus on encouraging probands to inform male and second-degree relatives and targeting such relatives to increase informed decisions and accessibility to testing. Promotion strategies should be culturally sensitive to optimize outcomes.
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Affiliation(s)
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | | | | | - Nur A Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics, Genetic Medicine Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Freed AS, Gruß I, McMullen CK, Leo MC, Kauffman TL, Porter KM, Muessig KR, Eubanks D, Goddard KAB, Wilfond BS, Liles EG. A decision aid for additional findings in genomic sequencing: Development and pilot testing. PATIENT EDUCATION AND COUNSELING 2021; 104:960-968. [PMID: 33191058 PMCID: PMC8099937 DOI: 10.1016/j.pec.2020.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/29/2020] [Accepted: 10/31/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To describe the development of a web-based, patient-facing decision aid to support patients and research participants to make an informed, values-based decision about whether to receive additional results from genomic sequencing. METHODS We developed the decision aid following the multi-step process described in the International Patient Decision Aids Standards. This utilized literature review, focus groups, and alpha testing with research participants undergoing clinical genomic sequencing. RESULTS The decision aid, the Optional Results Choice Aid (ORCA), includes a seven-question "values clarification exercise," illustrative patient quotes, and summative guidance for the user. The decision aid was found to be highly readable, acceptable and relevant in alpha testing. CONCLUSION We developed a decision aid to support informed, values-based decision making for patients and research participants considering whether to receive additional results from genomic sequencing. ORCA is being implemented in the NHGRI-funded Cancer Health Assessment Reaching Many (CHARM) study, where we are measuring informed values-choice congruence. PRACTICE IMPLICATIONS ORCA was designed to support patients and research participants to make an informed, values-based decision about whether to receive additional results from genomic sequencing.
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Affiliation(s)
- Amanda S Freed
- Department of Medicine, Division of Medical Genetics, University of Washington School of Medicine, Seattle, USA
| | - Inga Gruß
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Carmit K McMullen
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Michael C Leo
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Kathryn M Porter
- Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Donna Eubanks
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, USA
| | - Elizabeth G Liles
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, USA; Northwest Permanente, Kaiser Permanente Northwest, Portland, USA.
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Li H, Chen S, Ma D, Zhao Y, Zhang X, Li Y, Zhang G, Sun J. Effectiveness of patient-targeted interventions to inform decision making and improve uptake of colorectal cancer genetic evaluation for at-risk individuals: A systematic review. Int J Nurs Stud 2021; 118:103928. [PMID: 33848829 DOI: 10.1016/j.ijnurstu.2021.103928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inherited colorectal cancer syndromes increase the risk of contracting colorectal and other cancers. International guidelines recommend the identification of individuals with hereditary colorectal cancer and the supervision of asymptomatic individuals with a family history. However, detection of hereditary colorectal cancer is suboptimal. The prevalence of genetic counselling and testing for individuals with high genetic risk is low. OBJECTIVE To identify, characterize and summarize patient-targeted interventions on improving the uptake of colorectal cancer genetic evaluation for at-risk individuals and enhancing their informed decision making. DESIGN Systematic review. DATA SOURCES Six electronic databases (PubMed, CINAHL, Web of Science, Embase, PsycINFO, and Cochrane library) were searched to identify eligible clinical trials from each database's inception to March 25, 2020. The reference lists of the included studies and reviews were checked for additional articles. REVIEW METHODS Studies were screened and independently appraised by two reviewers using the standardized critical appraisal checklist for randomized controlled trials and quasi-experimental studies from the Joanna Briggs Institute. The results were tabulated and reported in descriptive format. RESULTS Based on the inclusion criteria, 8 articles satisfied the inclusion criteria and were included. The studies examined patient-targeted intervention strategies related to risk assessment, education, and decision aids. Outcomes included (1) informed decisions regarding microsatellite instability testing, (2) informed decisions concerning genetic testing, (3) genetic counselling and testing. Most of the included studies revealed that interventions had positive effects on the uptake of colorectal cancer genetic evaluation for at-risk individuals and their informed decision making. CONCLUSIONS There were few studies included in this review, and the results were inconsistent. Based on this review, the conclusion cannot be made that interventions for risk assessment, education, and decision aids have positive effects on the uptake of colorectal cancer genetic evaluation for at-risk individuals and their informed decision making. However, to our knowledge, this is the first systematic review to summarize the effectiveness of patient-targeted interventions to inform decision making and improve uptake of colorectal cancer genetic evaluation for at-risk individuals. This review provides important evidence for related topics. Future studies with rigorous designs are recommended. Nurses have a crucial role in personalized health care. The involvement of nurses in collaboration with all the stakeholders in the development, implementation and evaluation of cancer genetic screening programs to improve genetic referral of individual at risk.
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Affiliation(s)
- Huanhuan Li
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Si Chen
- Department of Colorectal and Anal Surgery, Bethune First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin 130021, China
| | - Dongfei Ma
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Yingnan Zhao
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xu Zhang
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Yijing Li
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Guanglong Zhang
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
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Hendrix N, Regier DA, Chatterjee J, Dhanda DS, Basu A, Veenstra DL, Carlson JJ. Provider preferences for resolving uncertainty and avoiding harms in precision medicine: a discrete choice experiment. Per Med 2020; 17:389-398. [PMID: 32804043 DOI: 10.2217/pme-2020-0018] [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] [Indexed: 11/21/2022]
Abstract
Background: Substantial uncertainty exists about how providers assess the value of genomic testing. Materials & methods: We developed and administered a discrete choice experiment to a national sample of providers. We analyzed responses using an error components mixed logit model. Results: We received responses from 356 providers. The attributes important to providers were patient health and function, life expectancy, cost, expert agreement, and biomarker prevalence. Providers significantly valued reducing uncertainty only when it eliminated the possibility of decreased life expectancy. Providers valued improving certainty about life expectancy gains from 12 ± 18 to 12 ± 6 months at US$400 (US$200-600) versus US$200 (-US$60-500) for 4 ± 4 to 4 ± 2 years. Conclusion: Providers value resolving uncertainty most when it eliminates the possibility of substantial harm.
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Affiliation(s)
- Nathaniel Hendrix
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA 98195, USA
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada.,School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jagori Chatterjee
- Department of Economics, Furman University, Greenville, SC 29613, USA
| | - Devender S Dhanda
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA 98195, USA
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA 98195, USA
| | - David L Veenstra
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA 98195, USA
| | - Josh J Carlson
- The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA 98195, USA
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11
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Kotwal H, Fleming J, Barlow-Stewart K, Boyle J, Silberbauer L, Leffler M, Murray L, Palmer EE. Pre-genetics clinic resource evaluation for adults with intellectual disability: The pre-genetics clinic aid. J Genet Couns 2020; 29:668-677. [PMID: 32246799 DOI: 10.1002/jgc4.1259] [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] [Received: 11/30/2019] [Revised: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 11/07/2022]
Abstract
People with intellectual disability (PWID) consistently identify the importance of health service information that is accessible and relevant. Resources tailored to the information and support needs of PWID can facilitate inclusivity in their health care (including access to genomic medicine) and improve healthcare outcomes. Despite the fact that PWID are commonly referred to genetics services, there is a lack of appropriate resources to help them prepare for their appointments. We therefore aimed to evaluate the feasibility and acceptability of a booklet for PWID to read with their carers prior to their genetics appointment, to help them prepare for what they may experience. With input from Easy to Read experts and PWID who were members of the New South Wales (NSW) Council for Intellectual Disability, the information booklet 'Getting ready for your visit to the genetics clinic' was produced. Australian healthcare professionals (HCP) familiar with clinical genetics services were invited to complete an anonymous online survey designed to assess perceived relevance, readability, and utility of the resource. Recruitment of HCPs was pursued via affiliated clinical services and email distribution through clinical genetics organizations. Sixty-six HCPs completed and submitted the survey. The results demonstrated that HCPs believed the booklet represented a typical clinical genetics service appointment and that the majority would provide a copy of the resource to clients and their carers. They reported that the booklet was easy to understand and entailed appropriate content and images which were presented clearly and simply. Some minor modifications were recommended and incorporated into the resource. A model of customizable booklets such as this could be transferrable across clinical genetics services and guide development of other resources for PWID. This may help to reduce healthcare disparities, improve client satisfaction, and facilitate involvement of PWID in their own healthcare decisions.
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Affiliation(s)
- Huafrin Kotwal
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jane Fleming
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jackie Boyle
- Genetics of Learning Disability, Waratah, Hunter New England, Sydney, NSW, Australia
| | | | - Melanie Leffler
- Genetics of Learning Disability, Waratah, Hunter New England, Sydney, NSW, Australia
| | - Lucinda Murray
- Genetics of Learning Disability, Waratah, Hunter New England, Sydney, NSW, Australia
| | - Elizabeth E Palmer
- Genetics of Learning Disability, Waratah, Hunter New England, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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12
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"Why and how did this happen?": development and evaluation of an information resource for parents of children with CHD. Cardiol Young 2020; 30:346-352. [PMID: 31920192 DOI: 10.1017/s1047951119003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The causes of CHD are complex and often unknown, leading parents to ask how and why this has happened. Genetic counselling has been shown to benefit these parents by providing information and support; however, most parents currently do not receive this service. This study aimed to develop a brochure to determine whether an information resource could improve parents' knowledge about CHD causation and inheritance and increase psychosocial functioning. METHODS In development, the resource was assessed against several readability scales and piloted. Parents of children attending preadmission clinic for surgery were included. Assessments occurred pre- and post-receiving the information resource using a purpose-designed knowledge measure and validated psychological measures. RESULTS Participant's (n = 52) knowledge scores increased significantly from the pre-questionnaire ( ${\overline x}\, = \,5/10$ , sd = 2.086) to post-questionnaire ( $\overline x\, = \,7.88/10$ , sd = 2.094, p < 0.001), with all aware that CHD can be caused by genetic factors after reading the brochure. Perceived personal control also increased from pre- ( $\overline x\, = \,11.856/18$ , sd = 4.339) to post-brochure ( $\overline x\, = \,14.644/18$ , sd = 3.733, p < 0.001), and many reported reduced feelings of guilt. No negative emotional response to the brochure was reported. The information provided was considered relevant (88%), reassuring (86%), and 88% would recommend the brochure to other parents. However, some wanted more emotional support and assistance in what to tell their child. CONCLUSIONS Use of the information resource significantly enhanced parents' knowledge of CHD causation and increased their psychosocial functioning. It is a valuable resource in the absence of genetic counselling; however, it should not replace formal genetic counselling when required.
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Burns C, Yeates L, Semsarian C, Ingles J. Evaluating a custom-designed aid to improve communication of genetic results in families with hypertrophic cardiomyopathy: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e026627. [PMID: 30782759 PMCID: PMC6361342 DOI: 10.1136/bmjopen-2018-026627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Genetic testing for hypertrophic cardiomyopathy (HCM) in the era of genomics brings unique challenges for genetic counselling. The number of genes routinely included in an HCM gene panel has increased markedly, many with minimal if any robust evidence of gene-disease association. Subsequently, there is a greater chance of uncertain genetic findings. The responsibility of communicating this information with at-risk relatives lies with the index case (proband). We have developed a communication aid to assist with the delivery of genetic results to the proband. We have previously shown the aid is feasible and acceptable and have now developed a study protocol for a randomised controlled trial of a genetic counsellor-led intervention incorporating the communication aid. METHODS AND ANALYSIS This is a prospective randomised controlled trial. We will investigate the impact of a genetic counsellor-led intervention to return proband genetic results using a custom-designed communication aid. We aim to improve knowledge and empowerment. The primary outcome of this trial is the ability and confidence of the proband to communicate genetic results to at-risk relatives. Secondary outcomes will assess genetic knowledge, satisfaction with services, outcomes from genetic counselling and psychological adaptation to genetic information. ETHICS AND DISSEMINATION This study has been approved by and is in strict accordance with the Sydney Local Health District Ethics Review Committee (X16-0030; 22/01/2016; version 1). Results from this trial will be prepared as a manuscript and submitted to peer-reviewed journals for publication as well as submission for presentation at national and international meetings. TRIAL REGISTRATION NUMBER ACTRN12617000706370.
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Affiliation(s)
- Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Laura Yeates
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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14
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Smith SK, Cai A, Wong M, Sousa MS, Peate M, Welsh A, Meiser B, Kaur R, Halliday J, Lewis S, Trevena L, Yanes T, Barlow-Stewart K, Barclay M. Improving women's knowledge about prenatal screening in the era of non-invasive prenatal testing for Down syndrome - development and acceptability of a low literacy decision aid. BMC Pregnancy Childbirth 2018; 18:499. [PMID: 30558569 PMCID: PMC6296052 DOI: 10.1186/s12884-018-2135-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023] Open
Abstract
Background Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs. Methods We developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests). Results Twenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%). Conclusions The DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice. Electronic supplementary material The online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sian Karen Smith
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.
| | - Antonia Cai
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Michelle Wong
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Mariana S Sousa
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.,Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University, Ingham, Sydney, Australia.,South Western Sydney Local Health District, Institute for Applied Medical Research, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Alec Welsh
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tatiane Yanes
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | | | - Margot Barclay
- Women's Services, Liverpool Hospital, Sydney, Australia.,Western Sydney University, Parramatta, Sydney, Australia
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15
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Development and pilot testing of a leaflet informing women with breast cancer about genomic testing for polygenic risk. Fam Cancer 2018; 18:147-152. [DOI: 10.1007/s10689-018-0104-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Grimmett C, Brooks C, Recio-Saucedo A, Armstrong A, Cutress RI, Gareth Evans D, Copson E, Turner L, Meiser B, Wakefield CE, Eccles D, Foster C. Development of Breast Cancer Choices: a decision support tool for young women with breast cancer deciding whether to have genetic testing for BRCA1/2 mutations. Support Care Cancer 2018; 27:297-309. [DOI: 10.1007/s00520-018-4307-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/06/2018] [Indexed: 01/26/2023]
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17
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Grimmett C, Pickett K, Shepherd J, Welch K, Recio-Saucedo A, Streit E, Seers H, Armstrong A, Cutress RI, Evans DG, Copson E, Meiser B, Eccles D, Foster C. Systematic review of the empirical investigation of resources to support decision-making regarding BRCA1 and BRCA2 genetic testing in women with breast cancer. PATIENT EDUCATION AND COUNSELING 2018; 101:779-788. [PMID: 29225062 DOI: 10.1016/j.pec.2017.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/09/2017] [Accepted: 11/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Identify existing resources developed and/or evaluated empirically in the published literature designed to support women with breast cancer making decisions regarding genetic testing for BRCA1/2 mutations. METHODS Systematic review of seven electronic databases. Studies were included if they described or evaluated resources that were designed to support women with breast cancer in making a decision to have genetic counselling or testing for familial breast cancer. Outcome and process evaluations, using any type of study design, as well as articles reporting the development of decision aids, were eligible for inclusion. RESULTS Total of 9 publications, describing 6 resources were identified. Resources were effective at increasing knowledge or understanding of hereditary breast cancer. Satisfaction with resources was high. There was no evidence that any resource increased distress, worry or decisional conflict. Few resources included active functionalities for example, values-based exercises, to support decision-making. CONCLUSION Tailored resources supporting decision-making may be helpful and valued by patients and increase knowledge of hereditary breast cancer, without causing additional distress. PRACTICE IMPLICATIONS Clinicians should provide supportive written information to patients where it is available. However, there is a need for robustly developed decision tools to support decision-making around genetic testing in women with breast cancer.
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Affiliation(s)
- Chloe Grimmett
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Karen Pickett
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Karen Welch
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Alejandra Recio-Saucedo
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) Wessex, University of Southampton, Southampton, UK.
| | - Elke Streit
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Helen Seers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Armstrong
- Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Ramsey I Cutress
- University of Southampton and University Hospital Southampton, Somers Cancer Research Building, Southampton, UK.
| | - D Gareth Evans
- Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK.
| | - Ellen Copson
- University of Southampton and University Hospital Southampton, Somers Cancer Research Building, Southampton, UK.
| | - Bettina Meiser
- Faculty of Medicine, University of New South Wales, New South Wales, 2033, Australia.
| | - Diana Eccles
- University of Southampton and University Hospital Southampton, Somers Cancer Research Building, Southampton, UK.
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
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18
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Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk. J Genet Couns 2018; 27:1055-1066. [DOI: 10.1007/s10897-018-0223-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/25/2018] [Indexed: 01/12/2023]
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19
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Smagarinsky Y, Burns C, Spinks C, Semsarian C, Ingles J. Development of a communication aid for explaining hypertrophic cardiomyopathy genetic test results. Pilot Feasibility Stud 2017; 3:53. [PMID: 29152326 PMCID: PMC5680798 DOI: 10.1186/s40814-017-0205-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/31/2017] [Indexed: 01/10/2023] Open
Abstract
Background Large gene panels are now commonplace for hypertrophic cardiomyopathy (HCM), increasing the yield of uncertain genetic findings. Few resources exist which aim to facilitate communication of HCM genetic test results. We sought to develop, pilot, and refine a communication aid for probands receiving HCM genetic test results. Methods Development was a multi-step process involving expertise of a multidisciplinary team, literature review, and empirical experience. The aid went through an iterative revision process throughout the piloting phase to incorporate feedback. HCM probands attending a specialized multidisciplinary HCM clinic, aged ≥ 18 years and genetic test results available for disclosure between May and August 2016, or recently received their gene results (January–April 2015) were eligible. A purposive sampling strategy was employed, recruiting those attending clinic during the study period or those who could attend without difficulty. Results We developed and pilot tested a genetic counsellor-led communication aid. Based on clinical expertise, the aid addresses (a) what genetic testing is, (b) implications for the patient, (c) reasoning for variant classification, and (d) implications for the family. Pilot data were sought to assess knowledge, feasibility, and acceptability using a self-report survey 2 weeks post-intervention. Twelve of 13 participants completed the follow-up questionnaire. Participants valued the individualised nature of the aid, recommended use of the aid, and indicated genetic knowledge, and family communication was better facilitated. Iterative modification of images helped to more simply depict important genetic concepts. Conclusions We have developed a tool that is feasible, acceptable, and helpful to patients receiving genetic results. This is an important first step, and trial of the aid to assess effectiveness compared to usual care will follow.
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Affiliation(s)
- Yana Smagarinsky
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Catherine Spinks
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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20
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Reducing Decisional Conflict and Enhancing Satisfaction with Information among Women Considering Breast Reconstruction following Mastectomy: Results from the BRECONDA Randomized Controlled Trial. Plast Reconstr Surg 2017; 138:592e-602e. [PMID: 27673530 DOI: 10.1097/prs.0000000000002538] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making. METHODS Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret. RESULTS Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction. CONCLUSIONS Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision.
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Meiser B, Peate M, Levitan C, Mitchell PB, Trevena L, Barlow-Stewart K, Dobbins T, Christensen H, Sherman KA, Dunlop K, Schofield PR. A Psycho-Educational Intervention for People with a Family History of Depression: Pilot Results. J Genet Couns 2016; 26:312-321. [PMID: 27688164 DOI: 10.1007/s10897-016-0011-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/23/2016] [Indexed: 01/02/2023]
Abstract
We developed and pilot-tested the first online psycho-educational intervention that specifically targets people with a family history of depression ('LINKS'). LINKS provides genetic risk information and evidence-rated information on preventive strategies for depression and incorporates a risk assessment tool and several videos using professional actors. LINKS was pilot-tested in the general practitioner (GP) setting. The patient sample included people with a family history of at least one first-degree relative (FDR) with major depressive disorder (MDD) or bipolar disorder (BD). Patients attending participating GP practices were invited to enroll in the study by letter from their GP. Patients who self-identified as having at least one first-degree relative (FDR) with MDD or BD were eligible. Patients completed questionnaires, pre-post viewing LINKS, with measures assessing satisfaction, relevance, emotional impact and perceived improvement of understanding. Six GP practices participated, and 24 patients completed both questionnaires. Of these, all reported that they were satisfied or very satisfied with LINKS, and 74 % reported that LINKS met their expectations, and 21 % that it exceeded their expectations. LINKS was judged highly acceptable by this sample of GP attendees, and results indicate that an assessment of its effectiveness in a larger controlled trial is warranted.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia.
| | - Michelle Peate
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
- Department of Obstetrics and Oncology, Royal Women's Hospital, University of Melbourne, Victoria, Australia
| | - Charlene Levitan
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
| | | | - Lyndal Trevena
- School of Public Health and Community Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Kate Dunlop
- Centre for Genetics Education, NSW Health, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, UNSW, Sydney, NSW, Australia
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22
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Manchanda R, Burnell M, Loggenberg K, Desai R, Wardle J, Sanderson SC, Gessler S, Side L, Balogun N, Kumar A, Dorkins H, Wallis Y, Chapman C, Tomlinson I, Taylor R, Jacobs C, Legood R, Raikou M, McGuire A, Beller U, Menon U, Jacobs I. Cluster-randomised non-inferiority trial comparing DVD-assisted and traditional genetic counselling in systematic population testing for BRCA1/2 mutations. J Med Genet 2016; 53:472-80. [DOI: 10.1136/jmedgenet-2015-103740] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/21/2016] [Indexed: 01/04/2023]
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23
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Family Communication and Cascade Testing for Fragile X Syndrome. J Genet Couns 2016; 25:1075-84. [DOI: 10.1007/s10897-016-9940-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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Witteman HO, Scherer LD, Gavaruzzi T, Pieterse AH, Fuhrel-Forbis A, Chipenda Dansokho S, Exe N, Kahn VC, Feldman-Stewart D, Col NF, Turgeon AF, Fagerlin A. Design Features of Explicit Values Clarification Methods. Med Decis Making 2016; 36:453-71. [DOI: 10.1177/0272989x15626397] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
Background. Values clarification is a recommended element of patient decision aids. Many different values clarification methods exist, but there is little evidence synthesis available to guide design decisions. Purpose. To describe practices in the field of explicit values clarification methods according to a taxonomy of design features. Data Sources. MEDLINE, all EBM Reviews, CINAHL, EMBASE, Google Scholar, manual search of reference lists, and expert contacts. Study Selection. Articles were included if they described 1 or more explicit values clarification methods. Data Extraction. We extracted data about decisions addressed; use of theories, frameworks, and guidelines; and 12 design features. Data Synthesis. We identified 110 articles describing 98 explicit values clarification methods. Most of these addressed decisions in cancer or reproductive health, and half addressed a decision between just 2 options. Most used neither theory nor guidelines to structure their design. “Pros and cons” was the most common type of values clarification method. Most methods did not allow users to add their own concerns. Few methods explicitly presented tradeoffs inherent in the decision, supported an iterative process of values exploration, or showed how different options aligned with users’ values. Limitations. Study selection criteria and choice of elements for the taxonomy may have excluded values clarification methods or design features. Conclusions. Explicit values clarification methods have diverse designs but can be systematically cataloged within the structure of a taxonomy. Developers of values clarification methods should carefully consider each of the design features in this taxonomy and publish adequate descriptions of their designs. More research is needed to study the effects of different design features.
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Affiliation(s)
- Holly O. Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Laura D. Scherer
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Teresa Gavaruzzi
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Arwen H. Pieterse
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Andrea Fuhrel-Forbis
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nicole Exe
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Valerie C. Kahn
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Deb Feldman-Stewart
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nananda F. Col
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Alexis F. Turgeon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Angela Fagerlin
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
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Trait anxiety, information modality, and responses to communications about prenatal genetic testing. J Behav Med 2014; 37:988-99. [PMID: 24481564 DOI: 10.1007/s10865-014-9555-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
Decisions to undergo invasive prenatal diagnostic procedures can be anxiety provoking. Individuals receive information about these procedures in one of three modalities: written text, audio (verbal description), or video. We examined whether modality influences emotional responses and testing decisions, and whether trait anxiety, a disposition linked with heightened sensitivity to threatening information, moderates these effects. New Zealand adults (N = 176) completed a trait anxiety measure before random allocation to view a text, audio, or video message about amniocentesis and chorionic villus sampling. Participants completed measures of child related worry, anticipated emotional distress, anticipated coping efficacy, perceived likelihood of miscarriage, and testing interest. High-anxious individuals reported greater distress and lower coping efficacy in response to the video message compared to the audio message. They also reported greater miscarriage likelihood in response to the video message compared to the text message. These findings suggest that use of video, assumed to be most informative for educating patients, could induce greater distress about prenatal testing in individuals prone to anxiety.
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Dorval M, Bouchard K, Chiquette J. Systematic review of educational tools used during the BRCA1/2 genetic testing process. Per Med 2014; 11:113-124. [DOI: 10.2217/pme.13.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review describes the characteristics of available educational tools used for BRCA1/2 genetic testing. To identify the tools, we conducted a systematic search in electronic databases, and contacted over 1000 cancer genetics professionals. This review is based on 68 tools from the USA, Canada, Australia, the UK, France and Ireland. The tools vary in format and scope depending on the genetic testing phase for which they are intended. We found that a wide diversity of educational materials are available and used for BRCA1/2 genetic testing around the world. However, a substantial number of tools fail to address important aspects of genetic testing.
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Affiliation(s)
- Michel Dorval
- Faculté de Pharmacie et Centre de Recherche sur le Cancer, Université Laval, Québec, QC, G1V 0A6, Canada
- Centre de Recherche du CHU de Québec, Axe Oncologie, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
| | - Karine Bouchard
- Centre de Recherche du CHU de Québec, Axe Oncologie, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
| | - Jocelyne Chiquette
- Centre de Recherche du CHU de Québec, Axe Oncologie, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, G1S 4L8, Canada
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Meiser B, Gleeson M, Watts K, Peate M, Zilliacus E, Barlow-Stewart K, Saunders C, Mitchell G, Kirk J. Getting to the point: what women newly diagnosed with breast cancer want to know about treatment-focused genetic testing. Oncol Nurs Forum 2012; 39:E101-11. [PMID: 22374498 DOI: 10.1188/12.onf.e101-e111] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify young women's information preferences regarding treatment-focused genetic testing (TFGT) and to develop and evaluate a novel educational resource. RESEARCH APPROACH Qualitative interview study and pilot testing of a novel resource. SETTING Two familial cancer services and one outpatient oncology clinic in Sydney and Melbourne, Australia. PARTICIPANTS 26 women with breast cancer aged 50 years and younger who either previously had TFGT (n = 14) or had a diagnosis of breast cancer within the previous 6-12 months. METHODOLOGIC APPROACH Participants were asked about their views of TFGT in semistructured interviews. A brief pamphlet on TFGT then was developed and pilot tested with 17 of the 26 women. MAIN RESEARCH VARIABLES Women's attitudes and preferences with regard to timing, mode of delivery, and amount and format of information regarding TFGT were explored. FINDINGS Most women wanted to be informed about TFGT at or around the time of their cancer diagnosis via a face-to-face consultation. No clear preference existed for which type of healthcare professional should provide information on TFGT. Brief written information about TFGT was viewed as important supporting material. The educational resource developed was well received. CONCLUSIONS The potential for more widespread TFGT in the future indicates a need for patient educational materials that enable women to make informed choices about TFGT. This pilot study has provided timely initial evidence on the efficacy of a brief written resource in preparing women for decision making about TFGT. INTERPRETATION The resource developed in this study will assist oncology nurses to make important genetic risk information available to women newly diagnosed with breast cancer at a stressful time.
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Affiliation(s)
- Bettina Meiser
- Department of Medical Oncology at Prince of Wales Hospital, Prince of Wales Clinical School at University of New South Wales, Sydney, Australia.
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Wakefield CE, Homewood J, Taylor A, Mahmut M, Meiser B. Time Perspective in Hereditary Cancer: Psychometric Properties of a Short Form of the Zimbardo Time Perspective Inventory in a Community and Clinical Sample. Genet Test Mol Biomarkers 2010; 14:617-27. [DOI: 10.1089/gtmb.2009.0185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Claire E. Wakefield
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Judi Homewood
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Alan Taylor
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Mehmet Mahmut
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Bettina Meiser
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Kensington, New South Wales, Australia
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Wakefield CE, Juan AS, Kasparian NA. Men at Increased Risk of Developing Breast Cancer: Language Preferences for Naming a Cancer-Related Mutation. Genet Test Mol Biomarkers 2009; 13:395-8. [DOI: 10.1089/gtmb.2008.0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Claire E. Wakefield
- Faculty of Science, School of Psychology, University of New South Wales, Sydney, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Anne S. Juan
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Nadine A. Kasparian
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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Albada A, van Dulmen S, Otten R, Bensing JM, Ausems MGEM. Development of E-Info Geneca: A Website Providing Computer-Tailored Information and Question Prompt Prior to Breast Cancer Genetic Counseling. J Genet Couns 2009; 18:326-38. [DOI: 10.1007/s10897-009-9221-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 01/29/2009] [Indexed: 11/29/2022]
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Juan AS, Wakefield CE, Kasparian NA, Kirk J, Tyler J, Tucker K. Development and pilot testing of a decision aid for men considering genetic testing for breast and/or ovarian cancer-related mutations (BRCA1/2). ACTA ACUST UNITED AC 2009; 12:523-32. [PMID: 19072564 DOI: 10.1089/gte.2008.0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite the fact that both men and women can carry a breast/ovarian cancer-related mutation, the main emphasis in genetic counseling for breast/ovarian cancer-related risk remains on females. This study aimed to develop and pilot a decision aid specifically designed for men with a strong family history of breast and/or ovarian cancer who are considering genetic testing. The decision aid was developed by a multidisciplinary team of experts and a consumer representative. It was then reviewed by 27 men who had previously undergone genetic testing to identify a mutation in a BRCA1 or BRCA2 gene. All men who reviewed the decision aid indicated that they would recommend the booklet to other men in the same situation, and 96% of the sample (n = 26) reported being "very satisfied" or "satisfied" with the information contained in the decision aid. The decision aid was perceived by all participants as "very relevant" or "quite relevant" for men considering genetic testing. Ninety-three percent of men felt that it was easy to weigh the pros and cons of genetic testing with the help of the decision aid. The perceived impact on participants' emotions and understanding of the genetic testing process was also assessed. Several factors may hinder men from effectively weighing up the potential benefits and risks of genetic testing. A greater understanding of these issues may help health professionals to encourage men with a strong family history of breast and/or ovarian cancer to learn about cancer risk and the appropriate management strategies for themselves and their female relatives.
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Affiliation(s)
- Anne S Juan
- Faculty of Medicine, University of New South Wales , Kensington, New South Wales, Australia
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Wakefield CE, Meiser B, Homewood J, Ward R, O'Donnell S, Kirk J. Randomized trial of a decision aid for individuals considering genetic testing for hereditary nonpolyposis colorectal cancer risk. Cancer 2008; 113:956-65. [PMID: 18618513 DOI: 10.1002/cncr.23681] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite the potential benefits of genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) risk, individuals can find the genetic testing decision-making process complicated and challenging. The goal of the current study was to measure the effectiveness of a tailored decision aid designed specifically to assist individuals to make informed decisions regarding genetic testing for HNPCC risk. METHODS In all, 153 individuals were randomized to receive the decision aid or a control pamphlet at the end of their first genetic counseling consultation. Of these, 109 (71.2%) completed the first questionnaire 1 week after consultation, whereas 95 (62.1%) completed the 6-month follow-up questionnaire. RESULTS Although the decision aid had no significant effect on postdecisional regret or actual genetic testing decision, the trial results demonstrated that participants who received the decision aid had significantly lower levels of decisional conflict (ie, uncertainty) regarding genetic testing (chi-square(1) = 8.97; P = .003) and were more likely to be classified as having made an informed choice concerning genetic testing (chi-square(1) = 4.37; P = .037) than participants who received a control pamphlet. Also, men who received the decision aid had significantly higher knowledge levels regarding genetic testing compared with men who received the control pamphlet, whereas no such differences were found for women (chi-square(2) = 6.76; P = .034). CONCLUSIONS A decision aid for individuals considering genetic testing for HNPCC is an effective intervention to reduce uncertainty and assist individuals to make an informed choice regarding genetic testing for HNPCC after genetic counseling.
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Affiliation(s)
- Claire E Wakefield
- Department of Psychology, Macquarie University, New South Wales, Australia.
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Wakefield CE, Meiser B, Homewood J, Taylor A, Gleeson M, Williams R, Tucker K. A randomized trial of a breast/ovarian cancer genetic testing decision aid used as a communication aid during genetic counseling. Psychooncology 2008; 17:844-54. [DOI: 10.1002/pon.1353] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wakefield CE, Kasparian NA, Meiser B, Homewood J, Kirk J, Tucker K. Attitudes toward genetic testing for cancer risk after genetic counseling and decision support: a qualitative comparison between hereditary cancer types. ACTA ACUST UNITED AC 2008; 11:401-11. [PMID: 18294057 DOI: 10.1089/gte.2007.0013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to qualitatively assess individuals' attitudes toward genetic testing for cancer risk after genetic counseling and decision support. As part of a larger study, 78 women considering genetic testing for hereditary breast/ovarian cancer (HBOC) risk and 22 individuals considering genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) completed an open-ended table of their perceived pros and cons of genetic testing. The most frequently reported pros were "to help manage my risk of developing cancer," "to help my family," and "to know my cancer risk." With regards to risk management, the HBOC group perceived genetic testing as most helpful in informing their general risk management practices, while the HN-PCC group focused on the potential to clarify their need for bowel cancer screening, suggesting that patients' perceptions of the benefits of genetic testing may differ across cancer syndromes. Individuals in both groups expressed concern about the potential psychological impact of genetic testing. We also found that some affected individuals may not fully comprehend the meaning of their potential test results. Eliciting patients' perceived pros and cons during genetic counseling is likely to be a valuable tool for improving patient care. This data also provides an improved evidence base for the development of patient education tools.
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"Are you at risk for hereditary breast cancer?": development of a personal risk assessment tool for hereditary breast and ovarian cancer. J Genet Couns 2008; 17:64-78. [PMID: 18181014 DOI: 10.1007/s10897-007-9125-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 09/19/2007] [Indexed: 12/24/2022]
Abstract
Identification of risk for the hereditary breast and ovarian cancer syndrome (HBOC) is important, as research has demonstrated the benefits of risk-reducing interventions for women with or at risk for this disorder. Knowledge among women regarding risk factors for hereditary breast cancer and the existence of cancer genetics services appears limited. The goal of this project was to develop a tool to broaden women's awareness regarding their potential risk for HBOC. A formal instructional design process was used to develop a brochure to facilitate recognition of HBOC risk among women attending a no-cost breast and cervical cancer screening clinic. Brochure development was guided by gathering feedback from potential users early and often. The resulting brochure included four parts: (1) a brief description of the impact of hereditary breast cancer risk on one's health; (2) a personal and family history collection table; (3) a series of questions enabling the user to self-assess HBOC risk; (4) a list of resources for women at risk for HBOC. User feedback indicated that the brochure was easy to use. The project demonstrated that women can self-evaluate their risk for HBOC. Future work will evaluate this tool among a broader population of women.
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Wakefield CE, Homewood J, Mahmut M, Taylor A, Meiser B. Usefulness of the Threatening Medical Situations Inventory in individuals considering genetic testing for cancer risk. PATIENT EDUCATION AND COUNSELING 2007; 69:29-38. [PMID: 17706910 DOI: 10.1016/j.pec.2007.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/30/2007] [Accepted: 07/01/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To assess the psychometric properties of the Threatening Medical Situations Inventory (TMSI) in a community sample (Study 1), and to examine its usefulness in individuals with a strong family history of cancer (Study 2). METHODS Study 1 participants (N=276) completed 2 online surveys, 14 days apart. Study 2 participants (N=311) completed 2 questionnaires, 6 months apart. RESULTS Both studies revealed the inventory was psychometrically sound, although some concerns were raised about the factor structure. High monitors in Study 1 reported desiring more health-related information and an active role in medical decision-making. High monitors in Study 2 had the greatest knowledge increase when they received a detailed decision aid, compared to a brief pamphlet. CONCLUSION The TMSI is appropriate for use in both community and clinical samples. High monitors in the general community are more likely to prefer receiving as much health-related information as possible and desire an active role in decision-making about their health. PRACTICE IMPLICATIONS Familial cancer clinic patients may benefit from tailoring the amount of information they receive to their coping style, such that patients who are vigilant information-seekers may benefit most from receiving more detailed information about genetic testing.
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Wakefield CE, Meiser B, Homewood J, Peate M, Taylor A, Lobb E, Kirk J, Young MA, Williams R, Dudding T, Tucker K. A randomized controlled trial of a decision aid for women considering genetic testing for breast and ovarian cancer risk. Breast Cancer Res Treat 2007; 107:289-301. [PMID: 17333332 DOI: 10.1007/s10549-007-9539-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 01/30/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure the effectiveness of a tailored decision aid (DA) designed to help women make informed decisions about genetic testing for breast/ovarian cancer risk. METHODS A total of 145 women were randomized to receive the DA or a control pamphlet at the end of their first genetic counseling consultation. Of these, 120 (82.8%) completed two questionnaires, 1 week and 6 months post-consultation. RESULTS While the DA had no effect on informed choice, post-decisional regret or actual genetic testing decision, the trial showed that women who received the DA had higher knowledge levels and felt more informed about genetic testing than women who received the control pamphlet (chi(2)(2) = 6.82; P = 0.033; chi(2)(1) = 4.86; P = 0.028 respectively). The DA also helped women who did not have blood drawn at their first consultation to clarify their values with regards to genetic testing (chi(2)(1) = 5.27; P = 0.022). Women who received the DA were less likely to share the information with other family members than women in the control condition (chi(2)(1) = 8.78; P = 0.003). CONCLUSIONS Decision aids are an effective decision-support strategy for women considering genetic testing for breast/ovarian cancer risk, and are most effective before the patient has made a decision, which is generally at the point of having blood drawn.
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