1
|
Burnell M, Gaba F, Sobocan M, Desai R, Sanderson S, Loggenberg K, Gessler S, Side L, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Randomised trial of population-based BRCA testing in Ashkenazi Jews: long-term secondary lifestyle behavioural outcomes. BJOG 2022; 129:1970-1980. [PMID: 35781768 PMCID: PMC9796935 DOI: 10.1111/1471-0528.17253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/22/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Ashkenazi-Jewish (AJ) population-based BRCA testing is acceptable, cost-effective and amplifies primary prevention for breast & ovarian cancer. However, data describing lifestyle impact are lacking. We report long-term results of population-based BRCA testing on lifestyle behaviour and cancer risk perception. DESIGN Two-arm randomised controlled trials (ISRCTN73338115, GCaPPS): (a) population-screening (PS); (b) family history (FH)/clinical criteria testing. SETTING North London AJ-population. POPULATION/SAMPLE AJ women/men >18 years. EXCLUSIONS prior BRCA testing or first-degree relatives of BRCA-carriers. METHODS Participants were recruited through self-referral. All participants received informed pre-test genetic counselling. The intervention included genetic testing for three AJ BRCA-mutations: 185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT). This was undertaken for all participants in the PS arm and participants fulfilling FH/clinical criteria in the FH arm. Patients filled out customised/validated questionnaires at baseline/1-year/2-year/3-year follow-ups. Generalised linear-mixed models adjusted for covariates and appropriate contrast tests were used for between-group/within-group analysis of lifestyle and behavioural outcomes along with evaluating factors associated with these outcomes. Outcomes are adjusted for multiple testing (Bonferroni method), with P < 0.0039 considered significant. OUTCOME MEASURES Lifestyle/behavioural outcomes at baseline/1-year/2-year/3-year follow-ups. RESULTS 1034 participants were randomised to PS (n = 530) or FH (n = 504) arms. No significant difference was identified between PS- and FH-based BRCA testing approaches in terms of dietary fruit/vegetable/meat consumption, vitamin intake, alcohol quantity/ frequency, smoking behaviour (frequency/cessation), physical activity/exercise or routine breast mammogram screening behaviour, with outcomes not affected by BRCA test result. Cancer risk perception decreased with time following BRCA testing, with no difference between FH/PS approaches, and the perception of risk was lowest in BRCA-negative participants. Men consumed fewer fruits/vegetables/vitamins and more meat/alcohol than women (P < 0.001). CONCLUSION Population-based and FH-based AJ BRCA testing have similar long-term lifestyle impacts on smoking, alcohol, dietary fruit/vegetable/meat/vitamin, exercise, breast screening participation and reduced cancer risk perception.
Collapse
Affiliation(s)
- Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - Faiza Gaba
- Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Monika Sobocan
- Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Rakshit Desai
- Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Saskia Sanderson
- Behavioural Sciences UnitDepartment Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Kelly Loggenberg
- Department Clinical GeneticsNorth East Thames Regional Genetics UnitGreat Ormond Street HospitalLondonUK
| | - Sue Gessler
- Department of Gynaecological OncologyInstitute for Women's HealthUniversity College LondonLondonUK
| | - Lucy Side
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Angela F. Brady
- Department Clinical GeneticsNorth West Thames Regional Genetics UnitNorthwick Park HospitalLondonUK
| | - Huw Dorkins
- St Peter's CollegeUniversity of OxfordOxfordUK
| | - Yvonne Wallis
- West Midlands Regional Genetics LaboratoryBirmingham Women's NHS Foundation TrustBirminghamUK,Depatment Clinical GeneticsWest Midlands Regional Genetics ServiceBirmingham Women's NHS Foundation TrustBirminghamUK
| | - Chris Jacobs
- Depatment Clinical GeneticsGuy's HospitalLondonUK,University of Technology SydneySydneyNew South WalesAustralia
| | - Rosa Legood
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Uziel Beller
- Department of GynaecologyShaare Zedek Medical CenterJerusalemIsrael
| | - Ian Tomlinson
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Jane Wardle
- Behavioural Sciences UnitDepartment Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Usha Menon
- Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Ian Jacobs
- University of New South WalesSydneyNew South WalesAustralia
| | - Ranjit Manchanda
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK,Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK,Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK,Department of GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
| |
Collapse
|
2
|
Horne J, Madill J, O'Connor C, Shelley J, Gilliland J. A Systematic Review of Genetic Testing and Lifestyle Behaviour Change: Are We Using High-Quality Genetic Interventions and Considering Behaviour Change Theory? Lifestyle Genom 2018; 11:49-63. [PMID: 29635250 DOI: 10.1159/000488086] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours. PURPOSE This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published "call-to-action" paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research. METHODS Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings - primarily the TPB. RESULTS Risk of bias in studies was overall rated to be "fair." Consideration of the TPB was "poor," with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other behaviour change theories, these theories were generally mentioned briefly, and were not thoroughly incorporated into the study design or analyses. The genetic interventions provided to participants were overall of "poor" quality. However, a separate analysis of studies using controlled intervention research methods demonstrated the use of higher-quality genetic interventions (overall rated to be "fair"). The provision of actionable recommendations informed by genetic testing was more likely to facilitate behaviour change than the provision of genetic information without actionable lifestyle recommendations. Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions. The most promising lifestyle changes were changes in nutrition. CONCLUSIONS It is possible to facilitate behaviour change using genetic testing as the catalyst. Future research should ensure that high-quality genetic interventions are provided to participants, and should consider validated theories such as the TPB in their study design and analyses. Further recommendations for future research are provided.
Collapse
Affiliation(s)
- Justine Horne
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada.,School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada
| | - Janet Madill
- School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada
| | - Colleen O'Connor
- School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada
| | - Jacob Shelley
- Faculty of Law, The University of Western Ontario, London, Ontario, Canada.,School of Health Studies, The University of Western Ontario, London, Ontario, Canada.,Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jason Gilliland
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada.,Department of Geography, The University of Western Ontario, London, Ontario, Canada.,Department of Paediatrics, The University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
3
|
Visser A, Vrieling A, Murugesu L, Hoogerbrugge N, Kampman E, Hoedjes M. Determinants of adherence to recommendations for cancer prevention among Lynch Syndrome mutation carriers: A qualitative exploration. PLoS One 2017; 12:e0178205. [PMID: 28570673 PMCID: PMC5453435 DOI: 10.1371/journal.pone.0178205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/09/2017] [Indexed: 01/12/2023] Open
Abstract
Background Lynch Syndrome (LS) mutation carriers are at high risk for various cancer types, particularly colorectal cancer. Adherence to lifestyle and body weight recommendations for cancer prevention may lower this risk. To promote adherence to these recommendations, knowledge on determinants of adherence in LS mutation carriers is needed. Therefore, this study aimed to identify determinants of adherence to lifestyle recommendations for cancer prevention in LS mutation carriers. Methods Five focus groups were conducted with DNA confirmed LS mutation carriers (n = 29). Transcripts were analyzed by thematic analysis, using the Health Belief Model (HBM) as a theoretical framework. Results Tolerance of an unhealthy lifestyle because of the desire to enjoy life and avoidance of LS dominating their life were most frequently reported as important barriers of adherence to the recommendations. Most important facilitators of adherence to the recommendations were enhancement of wellbeing and intolerance of unhealthy foods due to colon surgery. Conclusions This study provided a comprehensive overview of determinants of adherence to recommendations for cancer prevention. These determinants, of which some are typically and unique for LS mutation carriers, can be used to design a lifestyle intervention that meets the needs of LS mutation carriers.
Collapse
Affiliation(s)
- Annemiek Visser
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Laxsini Murugesu
- Department of Health Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ellen Kampman
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Meeke Hoedjes
- Department of Health Sciences, VU University Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| |
Collapse
|
4
|
Paquet L, Simmonds L, Yang C, Verma S. An exploratory study of patients' views about being at high-risk for breast cancer and risk management beliefs and intentions, before and after risk counselling: Preliminary evidence of the influence of beliefs on post-counselling prevention intentions. PATIENT EDUCATION AND COUNSELING 2017; 100:575-582. [PMID: 27756584 DOI: 10.1016/j.pec.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/24/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES 1) To describe how women at high-risk for breast cancer (BC) perceive their at-risk status and the options available to manage this risk, before and after risk counselling; 2) to explore the contributions of pre-counselling demographic, clinical, cognitive and emotional factors to post-counselling risk management intentions. METHODS 58 of 173 eligible patients (34%) enrolled and were asked to fill surveys including measures of 1) subjective risk, 2) illness (being at high-risk for BC) and 3) treatment (surveillance, lifestyle modifications, and chemoprevention) cognitions, 4) BC fear and 5) future risk management intentions, prior to and 3 months after risk consultation. RESULTS 48 of 58 participants (83%) completed both surveys. Beliefs and emotions about their condition and its management were stable over time. Surveillance and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than chemoprevention (all ps <0.001). The strongest predictors of intentions strengths were the women's beliefs about the risk reduction methods, especially for lifestyle and chemoprevention (all ps <0.01). CONCLUSIONS The findings emphasize the importance of patients' beliefs in risk management decisions. PRACTICAL IMPLICATIONS Patients' treatment beliefs appear to influence their choice of BC risk reduction strategies and should be discussed during risk reduction consultations.
Collapse
Affiliation(s)
- Lise Paquet
- Department of Psychology, Carleton University, Ottawa K1S 5B6, Canada.
| | - Lisa Simmonds
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Charles Yang
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Shailendra Verma
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| |
Collapse
|
5
|
Lin JY, Diwanji TP, Snider JW, Knight N, Regine WF. Cancer Screening Patterns and Concerns in Caregivers of Patients Undergoing Radiation Therapy. J Oncol Pract 2016; 12:e405-12. [PMID: 26931401 DOI: 10.1200/jop.2015.009290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evolving cancer screening guidelines can confuse the public. Caregivers of patients undergoing radiation oncology may represent a promising outreach target for disseminating and clarifying screening information. We aimed to: (1) determine the incidence of cancer screening in this cohort, and (2) identify barriers to and deficiencies in screening. METHODS We distributed a 21-item survey on cancer screening history and related concerns to caregivers ≥ 18 years old at one urban and two suburban radiation oncology centers. Reported screening habits were compared with American Cancer Society/American Urological Association guidelines for breast, cervical, colon, and prostate cancer. Statistical analysis included Pearson χ(2) tests. RESULTS A total of 209 caregivers (median age, 55.5 years; 146 women) were surveyed. Although 92% had primary care physicians (PCPs), only 58% reported being informed about recommended screening intervals. Participants ≤ 49 years old were less likely to report PCP discussion of cancer screening than older participants (41% and 66%, respectively; P = .006). Ninety-eight respondents (47%) had one or more screening concern(s). Among screening-eligible caregivers, 23 (18%) reported not undergoing regular colonoscopies. Fourteen women (13%) did not have Papanicolaou smears at recommended intervals, and 21 (18%) did not have annual mammograms. Six men (21%) did not undergo annual prostate screening. Decreased recommended screening with colonoscopy and mammography correlated with younger age. CONCLUSION This survey of relatively unexplored caregivers identified cancer screening deficiencies and concerns that might be addressed by targeted interventions. With approximately 60% of patients with cancer receiving radiation therapy, advice in the radiation oncology setting could positively affect cancer screening behaviors in caregivers.
Collapse
Affiliation(s)
- Jolinta Y Lin
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - Tejan P Diwanji
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - James W Snider
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - Nancy Knight
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - William F Regine
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
6
|
Experiences of Women Who Underwent Predictive BRCA 1/2 Mutation Testing Before the Age of 30. J Genet Couns 2015; 25:90-100. [DOI: 10.1007/s10897-015-9845-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 04/29/2015] [Indexed: 12/16/2022]
|
7
|
Teufel-Shone NI, Cordova-Marks F, Susanyatame G, Teufel-Shone L, Irwin SL. Documenting Cancer Information Seeking Behavior and Risk Perception in the Hualapai Indian Community to Inform a Community Health Program. J Community Health 2015; 40:891-8. [PMID: 25791877 DOI: 10.1007/s10900-015-0009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cancer incidence among American Indians (AIs) is low, yet their 5-year relative survival rate is the second lowest of all U.S. populations. Culturally relevant cancer prevention education is key to achieve health equity. This collaborative project of the Hualapai Tribe and University of Arizona modified the National Cancer Institute's 2003 Health Information National Trends Survey (HINTS) to yield a more culturally relevant cancer information survey to document the health seeking behaviors and perceptions of cancer risks and preventability of AI adults residing in the Hualapai Indian community. A team of health care providers, educators and cancer survivors (six native and three non-natives) completed the adaptation. Four trained native surveyors administered the survey using a random household survey design. The Hualapai HINTS was well accepted (<5% refusal rate) and was completed by 205 adults (20.5% of all adult residents). Respondents reported a preference for and a trust in verbal cancer information and communication with health care professionals (77.1% preference; 57.4% trust) and at workshops (75.2% preference; 45.5% trust). Respondents were aware of some health behaviors associated with a reduced cancer risk, e.g., avoid tobacco use and need for screening. Respondents were less well informed about the role of diet and exercise. These findings were used to inform local cancer prevention education efforts and to develop a series of monthly workshops that engaged local health professionals to reinforce and discuss pathways of the primary role of lifestyle related factors, specifically diet and exercise in reducing cancer risk.
Collapse
Affiliation(s)
- Nicolette I Teufel-Shone
- Family and Child Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA,
| | | | | | | | | |
Collapse
|
8
|
Wright CE, Harvie M, Howell A, Evans DG, Hulbert-Williams N, Donnelly LS. Beliefs about weight and breast cancer: an interview study with high risk women following a 12 month weight loss intervention. Hered Cancer Clin Pract 2015; 13:1. [PMID: 25648828 PMCID: PMC4314794 DOI: 10.1186/s13053-014-0023-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 12/18/2014] [Indexed: 12/20/2022] Open
Abstract
Background Breast cancer is the most common cancer in the UK. Lifestyle factors including excess weight contribute to risk of developing the disease. Whilst the exact links between weight and breast cancer are still emerging, it is imperative to explore how women understand these links and if these beliefs impact on successful behaviour change. Method Overweight/obese premenopausal women (aged 35–45) with a family history of breast cancer (lifetime risk 17–40%) were invited to a semi-structured interview following their participation in a 12 month weight loss intervention aimed at reducing their risk of breast cancer. Interviews were carried out with 9 women who successfully achieved ≥5% weight loss and 11 who were unsuccessful. Data were transcribed verbatim and analysed using thematic analysis. Results Three themes were developed from the analysis. The first theme how women construct and understand links between weight and breast cancer risk is composed of two subthemes, the construction of weight and breast cancer risk and making sense of weight and breast cancer risk. This theme explores women’s understanding of what contributes to breast cancer risk and whether they believe that weight loss could reduce their breast cancer risk. The second theme motivation and adherence to weight loss interventions explains that breast cancer risk can be a motivating factor for adherence to a weight loss intervention. The final theme, acceptance of personal responsibility for health is composed of two subthemes responsibility for one’s own health and responsibility for family health through making sensible lifestyle choices. Conclusion Beliefs about weight and breast cancer risk were informed by social networks, media reports and personal experiences of significant others diagnosed with breast cancer. Our study has highlighted common doubts, anxieties and questions and the importance of providing a credible rationale for weight control and weight loss which addresses individual concerns. Counselling and health education material should be tailored to facilitate understanding of both genetic and modifiable risk factors and should do more help individuals to visualise the weight and breast cancer link.
Collapse
Affiliation(s)
- Claire E Wright
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, CH1 4BJ UK
| | - Michelle Harvie
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Anthony Howell
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester & Central Manchester Foundation Trust, Manchester, M13 9WL UK
| | | | - Louise S Donnelly
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| |
Collapse
|
9
|
Albada A, Vernooij M, van Osch L, Pijpe A, van Dulmen S, Ausems MGEM. Does and should breast cancer genetic counselling include lifestyle advice? Fam Cancer 2013; 13:35-44. [PMID: 23934600 DOI: 10.1007/s10689-013-9672-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To optimally inform counselees about their and their relatives' risks, information about lifestyle risk factors, e.g. physical activity and alcohol consumption, might be discussed in breast cancer genetic counselling. This study explored whether lifestyle was discussed, on whose initiative, whether information and/or advice was given, and whether discussion of lifestyle was related to counselees' characteristics and their causal attributions. First and follow-up consultations with 192 consecutive counselees for breast cancer genetic counselling were videotaped and coded for discussion of lifestyle topics. Counselees completed web-based questionnaires before the initial and after the final consultation. With 52 (27%) counselees lifestyle was discussed, either in the first, or the final consultation, or both. Counselees mostly raised the topic (60%). Counsellors provided information about lifestyle risk factors to 19% and lifestyle advice to 6% of the counselees. Discussion of lifestyle was not associated with counselees' characteristics or causal attributions. Post-counselling, more affected counselees considered lifestyle as a cause of their breast cancer (29%) compared to pre-counselling (15%; p = 0.003). Information and advice about lifestyle risk factors was infrequently provided, both with breast cancer unaffected and affected counselees and with those who did and did not consider their lifestyle as a cause of their breast cancer. Modifiable lifestyle factors could be discussed more frequently to optimally inform counselees about possible ways to reduce their risk. Counsellors should be educated about effects of lifestyle and research should be conducted on how to best integrate lifestyle information in breast cancer genetic counselling.
Collapse
Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands,
| | | | | | | | | | | |
Collapse
|
10
|
Palmquist AEL, Upton R, Lee S, Panter AT, Hadley DW, Koehly LM. Beliefs about cancer and diet among those considering genetic testing for colon cancer. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:150-6. [PMID: 21296025 PMCID: PMC3090483 DOI: 10.1016/j.jneb.2009.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/15/2009] [Accepted: 12/18/2009] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess beliefs about the role of diet in cancer prevention among individuals considering genetic testing for Lynch Syndrome. DESIGN Family-centered, cascade recruitment; baseline assessment of a longitudinal study. SETTING Clinical research setting. PARTICIPANTS Participants were 390 persons, ages 18 and older, including persons with a Lynch Syndrome-associated cancer and suspected of carrying a disease causing mutation, and relatives at risk for inheriting a previously identified mutation. MAIN OUTCOME MEASURES Assess clustering of beliefs about the role of diet in cancer prevention and predictors of class membership. ANALYSIS Confirmatory factor analysis; 2-class factor mixture model with binary indicators; multilevel regression analyses, individuals nested within families. RESULTS Women endorsed a relationship between diet and cancer prevention more often than men (P < .01). A 2-class model was used where Class 1 indicated less likely to link cancer to diet, and Class 2 indicated more likely. Factors associated with increased odds of membership in Class 1 expressed belief that nothing can prevent cancer (P < .01) and fate attribution (P < .01); Class 2 mentioned personal cancer history (P < .05) and genetic knowledge (P < .01). CONCLUSIONS AND IMPLICATIONS Identifying factors associated with a belief in cancer prevention through dietary behaviors can inform targeted interventions.
Collapse
|
11
|
Burton AM, Peterson SK, Marani SK, Vernon SW, Amos CI, Frazier ML, Lynch PM, Gritz ER. Health and lifestyle behaviors among persons at risk of Lynch syndrome. Cancer Causes Control 2010; 21:513-21. [PMID: 20012181 PMCID: PMC8364762 DOI: 10.1007/s10552-009-9482-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 11/20/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate health behaviors among patients with colorectal cancer (CRC) and their at-risk relatives prior to undergoing genetic counseling and testing for Lynch syndrome and to examine associations between health risk behaviors and specific demographic and psychological variables. METHODS Participants included patients with CRC (n = 319) and their cancer-unaffected relatives (n = 110) who were enrolled in studies regarding Lynch syndrome genetic testing. Prior to undergoing genetic counseling or testing, participants completed a questionnaire including measures of demographic characteristics, health behaviors, cancer screening practices (Pap test, clinical breast exam, and mammogram), and psychological distress. RESULTS Unaffected participants scored higher on a risk behavior index (RBI) than patients with CRC (1.7 (SD = 1.0) vs. 1.4 (SD = .09); p < .01). All female participants underwent cancer screening at rates similar to national data. Higher RBI scores were associated with being male, having less education, and age less than 50-years. CONCLUSIONS We identified several health behaviors for potential intervention, including smoking, alcohol use, and diet. Genetic counseling offers a promising avenue for education and risk behavior reduction in persons at increased risk for cancer due to a familial or genetic predisposition, and a teachable moment to introduce lifestyle modifications.
Collapse
Affiliation(s)
- Allison M Burton
- Department of Behavioral Science-Unit 1330, The University of Texas M D Anderson Cancer Center, PO Box 301439, Houston, TX 77230-1439, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Hamilton R, Williams JK, Skirton H, Bowers BJ. Living with genetic test results for hereditary breast and ovarian cancer. J Nurs Scholarsh 2009; 41:276-83. [PMID: 19723276 DOI: 10.1111/j.1547-5069.2009.01279.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine adaptation by nonsymptomatic individuals who knew the results of a genetic test for hereditary breast and ovarian cancer (HBOC) for at least 4 years. DESIGN Longitudinal grounded theory study. METHODS Follow-up interviews after a 3- to 4-year interval were conducted by telephone or e-mail with seven asymptomatic participants originally recruited for an earlier study of genetic testing experiences. A total of 14 interviews, 2 for each participant were conducted. Conceptual analysis on these 14 interviews focused on impact on daily life and health behavior decisions made in the intervening years. FINDINGS Participants described the impact of the result and adaptations made in relationships, sexuality, outlook, and plans for the future. Participants accepted recommended surveillance and preventative measures to maximize a healthy lifestyle and reported both the benefits of knowing their mutation status as well as challenges they had encountered since testing. CONCLUSIONS Adaptation to living with genetic test results indicating a disease-related mutation is an ongoing process of balancing the knowledge of risk with living a normal life. Over time, awareness of genetic risk does not appear to diminish. CLINICAL RELEVANCE Positive and negative long-term consequences of genetic testing for hereditary breast or ovarian cancer may influence many aspects of the personal lives and health care decisions of those tested.
Collapse
Affiliation(s)
- Rebekah Hamilton
- Department of Women, Children and Family Health Science, School of Nursing, University of Illinois at Chicago, IL 60612, USA.
| | | | | | | |
Collapse
|
13
|
Breast cancer risk perception and lifestyle behaviors among White and Black women with a family history of the disease. Cancer Nurs 2009; 32:299-308. [PMID: 19444084 DOI: 10.1097/ncc.0b013e31819deab0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although researchers have investigated the relationships between perceived risk and behavioral risk factors for breast cancer, few qualitative studies have addressed the meaning of risk and its impact on decision making regarding lifestyle behaviors. This qualitative study explored factors involved in the formulation of perceived breast cancer risk and associations between risk perception and lifestyle behaviors in white and black women with a family history of breast cancer. Eligible participants were North Carolina residents in the Sister Study, a nationwide study of risk factors for breast cancer among women who have at least 1 sister diagnosed with breast cancer. Personal interviews were conducted with 32 women. Although most had heightened perceived risk, almost 20% considered themselves below-to-average risk. Participants with moderate-to-high perceived risk were more likely to report an affected sister and mother, a first-degree relative's diagnosis within 4 years, and death of a first-degree relative from breast cancer. Many women were unaware of associations between lifestyle behaviors and breast cancer risk. Only one-third of the women reported healthy lifestyle changes because of family history; dietary change was most frequently reported. Findings may be important for cancer nurses involved in developing breast cancer education programs for women with a family history of breast cancer.
Collapse
|
14
|
Diefenbach M, Turner G, Carpenter KM, Sheldon LK, Mustian KM, Gerend MA, Rini C, von Wagner C, Gritz ER, McQueen A, Prayor-Patterson HM, Miller SM. Cancer and patient-physician communication. JOURNAL OF HEALTH COMMUNICATION 2009; 14 Suppl 1:57-65. [PMID: 19449269 PMCID: PMC2791918 DOI: 10.1080/10810730902814079] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
As patients are increasingly involved in the selection of their care, communication between health care providers and patients takes on new importance. The present article reviews the most common approaches to improve patient communication, distinguishing among patient-directed and provider-directed approaches, as well as introducing multimedia programs designed to enhance communication. We conclude by delineating new critical areas for future research including peer-to-peer patient communication and the challenges brought on by new technologies.
Collapse
|
15
|
Health Behaviors and Psychological Distress in Women Initiating BRCA1/2 Genetic Testing: Comparison with Control Population. J Genet Couns 2008; 17:314-26. [DOI: 10.1007/s10897-008-9150-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
|