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Silva E, Gomes P, Matos PM, Silva ER, Silva J, Brandão C, Castro F, Neves MC, Sales CMD. “I have always lived with the disease in the family”: family adaptation to hereditary cancer-risk. BMC PRIMARY CARE 2022; 23:93. [PMID: 35461227 PMCID: PMC9034526 DOI: 10.1186/s12875-022-01704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
Background Hereditary cancer syndromes have been conceptualized as a family level process. The present study explores the complexity and challenges of family adaptation to the hereditary cancer syndrome, in the context of genetic counseling and long-term cancer risk management and follow-up surveillance. Methods We performed semi-structured interviews with 13 participants with one of the following hereditary cancer syndromes: Lynch Syndrome, Hereditary Diffuse Gastric Cancer Syndrome, Hereditary Breast and Ovarian Cancer Syndrome, or Familial Adenomatous Polyposis. The interview was developed through a participatory approach with the involvement of healthcare professionals and individuals with first-hand experience of living with the hereditary cancer syndromes. Results The family is the main source of information and emotional support to deal with hereditary cancer syndromes. Multiple individual adaptation processes and communal coping networks interact, influencing the emotional and health-related behavior of family members. This is affected and affects the family’s communication and its’ members reactions to disclosure, with consequent changes in relationships. Conclusions The systemic interdependent dynamics of family adaptation calls for family-centered care of genetic cancer syndromes.
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Warner N, Groarke A, Gleeson C, Fahey P, Horgan R. Experiences of living with Lynch Syndrome: A reflexive thematic analysis. Eur J Oncol Nurs 2022; 58:102117. [DOI: 10.1016/j.ejon.2022.102117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/03/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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Gomes P, Pietrabissa G, Silva ER, Silva J, Matos PM, Costa ME, Bertuzzi V, Silva E, Neves MC, Sales CMD. Family Adjustment to Hereditary Cancer Syndromes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1603. [PMID: 35162625 PMCID: PMC8834948 DOI: 10.3390/ijerph19031603] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Abstract
Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to hereditary cancer syndromes has been mainly studied at an individual level, and research about familial adjustment remains dispersed and disorganized. To overcome this gap, this review aims to understand how families adjust to genetic testing and risk management, and to what extent the family's adjustment influences the psychological response and risk management behaviors of mutation carriers. We conducted searches on the PubMed/Med Line, PsycInfo, SCOPUS, and Google Scholar databases and used the Mixed Methods Appraisal Tool (MMAT-v2018) to assess the methodological quality of each selected study. Thirty studies met the inclusion criteria. Most results highlighted the interdependent nature of adjustment of pathogenic variant carriers and their families. The way carriers adjust to the syndrome is highly dependent on family functioning and related to how family members react to the new genetic information, particularly partners and siblings. Couples who share their worries and communicate openly about cancer risk present a better long-term adjustment than couples who use protective buffering (not talking about it to avoid disturbing the partner) or emotional distancing. Parents need help dealing with disclosing genetic information to their children. These findings reinforce the importance of adopting a family-centered approach in the context of genetic counseling and the necessity of involving family members in research.
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Affiliation(s)
- Pedro Gomes
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, 20123 Milan, Italy; (G.P.); (V.B.)
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20122 Milan, Italy
| | - Eunice R. Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Psychology Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - João Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Medical Genetics Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Paula Mena Matos
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Maria Emília Costa
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Vanessa Bertuzzi
- Department of Psychology, Catholic University of the Sacred Heart, 20123 Milan, Italy; (G.P.); (V.B.)
| | - Eliana Silva
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Maria Carolina Neves
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Célia M. D. Sales
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
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Campbell-Salome G, Buchanan AH, Hallquist MLG, Rahm AK, Rocha H, Sturm AC. Uncertainty management for individuals with Lynch Syndrome: Identifying and responding to healthcare barriers. PATIENT EDUCATION AND COUNSELING 2021; 104:403-412. [PMID: 32782180 DOI: 10.1016/j.pec.2020.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/24/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine the uncertainty management process of individuals with Lynch syndrome (LS). METHODS 19 phone interviews were conducted with individuals with LS. The interview guide included questions on family communication, risk perceptions, and uncertainty management. Data were analyzed using the constant comparison method to code for emergent themes. RESULTS Qualitative analysis found individuals with LS tried to manage their uncertainty through preventive care, but were often confounded by healthcare barriers. Healthcare barriers included cost and insurance issues, absence of coordinated care, insufficient provider knowledge, and lack of patient-centered communication. Participants reported increased uncertainty and anxiety due to these barriers and used alternative uncertainty management strategies such as advocating for themselves with providers, seeking information online, and communicating with family for emotional support. CONCLUSION Healthcare barriers identified in this study exacerbated uncertainty and anxiety for individuals with LS and challenged their ability to engage in preventive care. In response, participants used alternative uncertainty management strategies to reduce their uncertainty, which may have unintended negative consequences. PRACTICE IMPLICATIONS Findings support the need for providers to partner with specialists in genetics and/or LS to better care for individuals with LS. Findings highlight opportunities for interventions in healthcare to better support individuals with LS.
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Affiliation(s)
| | | | | | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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Heuvel L, Smets E, Tintelen J, Christiaans I. How to inform relatives at risk of hereditary diseases? A mixed‐methods systematic review on patient attitudes. J Genet Couns 2019; 28:1042-1058. [DOI: 10.1002/jgc4.1143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L.M. Heuvel
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - J.P. Tintelen
- Department of Genetics University Medical Centre Utrecht, University of Utrecht Utrecht The Netherlands
| | - I. Christiaans
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
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Albiani JJ, McShane KE, Holter S, Semotiuk K, Aronson M, Cohen Z, Hart TL. The impact of health anxiety on perceptions of personal and children's health in parents with Lynch syndrome. J Genet Couns 2019; 28:495-506. [PMID: 30638287 DOI: 10.1002/jgc4.1043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/15/2018] [Accepted: 11/01/2018] [Indexed: 11/05/2022]
Abstract
This study examined the differences in perceptions of one's health and one's child's health between parents with Lynch syndrome (LS) characterized with high versus low health anxiety. Twenty-one parents completed semistructured telephone interviews about their perceptions of their own health and the health of their children. Qualitative content analysis using a template coding approach examined the differences between parents with high and low health anxiety. Findings revealed that the most prevalent difference emerged on perceptions of personal health, showing individuals with high health anxiety reported more extreme worries, were more hypervigilant about physical symptoms, experienced the emotional and psychological consequences of LS as more negative and severe, and engaged in more dysfunctional coping strategies than those with low health anxiety. Unexpectedly, with regards to perceptions of their children, parents in the high and low health anxiety groups exhibited similar worries. However, high health anxiety parents reported using dysfunctional coping about their children's health more frequently than those with low health anxiety. The findings suggest that health anxiety is of clinical significance for individuals with LS. Accurately identifying and treating health anxiety among this population may be one avenue to reduce the distress experienced by LS carriers.
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Affiliation(s)
- Jenna J Albiani
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Kelly E McShane
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Spring Holter
- Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada
| | - Zane Cohen
- Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada
| | - Tae L Hart
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Reproductive Decision-Making in MMR Mutation Carriers After Results Disclosure: Impact of Psychological Status in Childbearing Options. J Genet Couns 2015; 25:432-42. [PMID: 26392361 DOI: 10.1007/s10897-015-9888-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/08/2015] [Indexed: 01/13/2023]
Abstract
Reproductive techniques such as prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD), although debated, are legally forbidden in France in case of Lynch syndrome. The preference of mutation carriers about their reproductive options is not systematically considered in France. We aimed to prospectively assess the reproductive preferences of mismatch repair mutation carriers consulting in our institution (2003-2010, n = 100). We also considered the short- and long-term post-disclosure psychological impact using the Impact of Events Scale-Revised questionnaire to measure the prevalence of posttraumatic stress disorder (PTSD) in those patients. Complete data were obtained for 34 respondents (17 males, 17 females, median age of 33.5 years [22-59]). Seventeen respondents (57 %) preferred spontaneous natural conception versus 28 % and 35 % choosing PND and PGD, respectively. At results disclosure, respondents mainly explained their distress by fear of premature death (43 %) and transmitting mutated genes (42 %). One year later, this last fear remained predominant in 55 % of subjects. None of the main socio-demographical, psychological or medical variables (including fear of transmitting mutations) was significantly associated with the reproductive preferences. Results disclosure had a real and time-decreasing psychological impact on mutation carriers. Reproductive techniques, expected to decrease the hereditary risk, were not significantly preferred to natural conception.
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Galiatsatos P, Rothenmund H, Aubin S, Foulkes WD. Psychosocial Impact of Lynch Syndrome on Affected Individuals and Families. Dig Dis Sci 2015; 60:2246-50. [PMID: 25786861 DOI: 10.1007/s10620-015-3626-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 03/03/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Lynch syndrome is the most common hereditary colorectal cancer syndrome, conferring a heightened risk not only of colon cancer but also of various extracolonic tumors. Studies in hereditary breast cancer have shown a negative psychological impact for patients testing positive for BRCA1 or BRCA2 mutations, but there is a paucity of literature looking at psychosocial impact of LS testing for probands and families. METHODS A literature search of PubMed English-language articles was performed using the keywords "Lynch syndrome" combined with "psychological impact," "depression," and "anxiety." RESULTS Lynch syndrome mutation carriers, whether or not they have had cancer, suffer a transient increase in depression and anxiety scores post-disclosure, which seem to normalize by 6-12 months. Younger patients with higher colorectal cancer risk perception, higher education level, married, and employed are more likely to accept genetic testing. Major motivators for testing are predicting one's own risk of cancer and risk to offspring. Carrier status influences family planning, and there is growing interest for preimplantation genetic diagnosis. CONCLUSIONS Psychosocial ramifications of LS mutation positivity need to be explored further.
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Affiliation(s)
- Polymnia Galiatsatos
- Division of Gastroenterology, Department of Medicine, Room E-110, Jewish General Hospital, McGill University, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada,
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Heiniger L, Butow PN, Charles M, Price MA. Intuition versus cognition: a qualitative exploration of how women understand and manage their increased breast cancer risk. J Behav Med 2015; 38:727-39. [PMID: 25820809 DOI: 10.1007/s10865-015-9632-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/18/2015] [Indexed: 01/05/2023]
Abstract
Risk comprehension in individuals at increased familial risk of cancer is suboptimal and little is known about how risk is understood and managed by at-risk individuals who do not undergo genetic testing. We qualitatively studied these issues in 36 unaffected women from high-risk breast cancer families, including both women who had and had not undergone genetic testing. Data were collected through semi-structured interviews and data analysis was guided by Grounded Theory. Risk comprehension and risk management were largely influenced by the individual's experience of coming from a high-risk family, with both tested and untested women relying heavily on their intuition. Although women's cognitive understanding of their risk appeared generally accurate, this objective risk information was considered of secondary value. The findings could be used to guide the development and delivery of information about risk and risk management to genetically tested and untested individuals at increased risk of hereditary cancer.
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Affiliation(s)
- Louise Heiniger
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia. .,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Margaret Charles
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Melanie A Price
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
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Hirschberg AM, Chan-Smutko G, Pirl WF. Psychiatric implications of cancer genetic testing. Cancer 2014; 121:341-60. [PMID: 25234846 DOI: 10.1002/cncr.28879] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022]
Abstract
As genetic testing for hereditary cancer syndromes has transitioned from research to clinical settings, research regarding its accompanying psychosocial effects has grown. Men and women being tested for hereditary cancer syndromes may experience some psychological distress while going through the process of testing or after carrier status is identified. Psychological distress appears to decrease over the course of the first year and it is typically not clinically significant. Longer term studies show mixed results with some mutation carriers continuing to experience elevated distress. Baseline distress is the greatest risk factor for both immediate (weeks-12 months) and long-term psychological distress (18 mo-8 years post genetic testing). In addition to baseline psychological distress, other risk factors can be identified to help identify individuals who may need psychosocial interventions during the genetic testing process. The challenges of providing clinical care to the growing population of individuals identified to be at increased risk for heritable cancers present opportunities for research and new models of care.
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Aasen T, Skolbekken JA. Preparing for and communicating uncertainty in cancer genetic counselling sessions in Norway: an interpretative phenomenological analysis. HEALTH RISK & SOCIETY 2014. [DOI: 10.1080/13698575.2014.927838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shipman HE, Arribas-Allyon M, Murray A, Gaff CL. On the limits of genetic responsibility: Communication and consent for tumour testing for Lynch syndrome. ACTA ACUST UNITED AC 2014; 10:225-35. [DOI: 10.1558/cam.v10i3.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Testing cancers for mismatch repair (MMR) gene defects assists selection of families for genetic testing for cancer predisposing Lynch syndrome. Performing MMR tumour testing without consent is debated, though little empirical work has been undertaken. We address this by examining the significance of testing for those who have consented without prior genetic counselling, particularly their ‘accounts’ of testing via displays of knowledge and responsibility. Semi-structured interviews were conducted with participants recruited from a UK genetics service. Participants had difficulties in formulating the benefits of testing when consent was facilitated by a relative or by mail. Discourse analysis revealed that in the absence of specific or accurate understandings of tumour testing, participants displayed responsibility towards themselves and others by generalising and diminishing the implications of testing. Within the framework of ‘genetic responsibility’, MMR tumour testing seems less important in participants’ accounts compared to more definitive genetic testing. If facilitating genetic knowledge and responsibility are goals of genetic testing then developing appropriate consent procedures for MMR tumour testing is an important consideration. Further research is required to differentiate whether genetic counselling is a precondition for enacting genetic responsibility or whether intrinsic differences between types of testing make the concept less relevant.
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Abstract
In the care of patients with Lynch Syndrome (LS), a range of psychosocial issues are encountered, which significantly affect patient outcomes. A brief historical background of 'psycho-onco-genetics' (the domain where psychology, oncology and genetics meet) in relation to LS is presented, followed by an overview of important psychosocial issues identified in the past 20 years. The identification of mismatch repair genes in 1993-1994 made possible genetic counseling and testing for patients who had cancer and for potentially high-risk relatives without cancer. At that time, concerns were raised about the potentially negative psychosocial impact of predictive genetic testing. Since 1993, a large number of studies have been conducted to investigate the possible psychosocial benefits and limitations of such testing. This article presents an overview of: the uptake of and motivations for genetic testing, its psychosocial impact (e.g. psychological adaptation, impact on risk perception and self-concept, and concerns about, and experiences of, genetic discrimination), psychological screening instruments, adherence to and decision-making about preventive strategies, family communication, lifestyle changes, reproductive technology utilization, and professional psychosocial support needs of members of families with LS. Finally, challenges for the future are discussed, including population screening and genomic testing.
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Balancing Life with an Increased Risk of Cancer: Lived Experiences in Healthy Individuals with Lynch Syndrome. J Genet Couns 2014; 23:778-84. [DOI: 10.1007/s10897-013-9682-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
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Quinlivan JA, Battikhi Z, Petersen RW. What Factors Impact upon a Woman's Decision to Undertake Genetic Cancer Testing? Front Oncol 2014; 3:325. [PMID: 24432248 PMCID: PMC3880931 DOI: 10.3389/fonc.2013.00325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/19/2013] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The advent of human genome project has lead to genetic tests that identify high-risk states for certain cancers. Many are privately marketed on the Internet. Despite the availability of tests, limited data has evaluated factors that lead to test uptake. The aim of the present study was to explore the attitudes of a cohort of new mothers toward uptake of a genetic cancer test with a 50% predictive value of cancer. METHODS A cross-sectional survey was undertaken. The project targeted women who had recently given birth at an Australian tertiary referral hospital. Women were asked about a theoretical blood test that detected an increased risk for the development of cancer. Attitudes and knowledge questionnaires were completed. RESULTS Of 232 consecutive women approached, 32 declined, giving a response rate of 86.2%. Only 63 (31.5%) women stated they would have the test. Absence of religious belief, higher level of education, better knowledge of terms used in genetics, an absence of concern over emotional, employment, and insurance discrimination, and previous acceptance of Down syndrome screening in pregnancy were each associated with significantly higher rate of test uptake in univariate analysis (all p < 0.03). In multivariate analysis, a lack of concern over discrimination and a history of having accepted Down syndrome screening in the previous pregnancy remained significantly associated with test uptake (all p < 0.0001). CONCLUSION Concern over discrimination and having made a prior decision to have genetic testing were the principal factors associated with decision-making.
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Affiliation(s)
- Julie A. Quinlivan
- North Metropolitan Health Service, Western Australian Department of Health, Perth, WA, Australia
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Zain Battikhi
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Rodney W. Petersen
- Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia
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Eijzenga W, Hahn DEE, Aaronson NK, Kluijt I, Bleiker EMA. Specific psychosocial issues of individuals undergoing genetic counseling for cancer - a literature review. J Genet Couns 2013; 23:133-46. [PMID: 23996531 DOI: 10.1007/s10897-013-9649-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/12/2013] [Indexed: 01/02/2023]
Abstract
Approximately 25% of individuals undergoing genetic counseling for cancer experiences clinically relevant levels of distress, anxiety and/or depression. However, these general psychological outcomes that are used in many studies do not provide detailed information on the specific psychosocial problems experienced by counselees. The aim of this review was to investigate the specific psychosocial issues encountered by individuals undergoing genetic counseling for cancer, and to identify overarching themes across these issues. A literature search was performed, using four electronic databases (PubMed, PsychInfo, CINAHL and Embase). Papers published between January 2000 and January 2013 were selected using combinations, and related indexing terms of the keywords: 'genetic counseling', 'psychology' and 'cancer'. In total, 25 articles met our inclusion criteria. We identified the specific issues addressed by these papers, and used meta-ethnography to identify the following six overarching themes: coping with cancer risk, practical issues, family issues, children-related issues, living with cancer, and emotions. A large overlap in the specific issues and themes was found between these studies, suggesting that research on specific psychosocial problems within genetic counseling has reached a point of saturation. As a next step, efforts should be made to detect and monitor these problems of counselees at an early stage within the genetic counseling process.
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Affiliation(s)
- Willem Eijzenga
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
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Burton AM, Hovick SR, Peterson SK. Health behaviors in patients and families with hereditary colorectal cancer. Clin Colon Rectal Surg 2013; 25:111-7. [PMID: 23730226 DOI: 10.1055/s-0032-1313782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is estimated that 5 to 10% of all colorectal cancer (CRC) cases are attributed to a hereditary cause. The primary hereditary cancer syndromes that confer an increased risk for colorectal cancers are Lynch syndrome/hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). Through genetic testing, health care providers can identify patients and families who carry gene mutations and subsequently are at a substantially greater risk for developing colorectal cancer than the general population. Genetic testing provides risk information not only about an individual patient, but also his or her biological relatives. A variety of risk-reduction behaviors (including screening, surgery, and health and lifestyle behaviors) have been examined in Lynch syndrome and FAP populations. The research indicates that screening behaviors are less than optimal, although the rates vary from study to study. Prophylactic colectomy is the primary course of treatment for individuals who test positive for a FAP mutation, but the results are inconclusive for cancer-unaffected Lynch syndrome mutation carriers. Although research suggests that the adoption of healthy lifestyles and behaviors (e.g., diet, physical activity, weight control, smoking cessation, limited alcohol consumption) could have a favorable impact on colon cancer burden, there is minimal data on how these behaviors may moderate cancer risk among those at risk of hereditary colon cancer. To date, we know very little about the actual health and lifestyle behaviors of those at risk of hereditary colon cancer. Genetic testing and counseling at risk individuals may resolve uncertainty about their personal and familial cancer risk and provide information to guide and personalize decisions about their future health care.
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Affiliation(s)
- Allison M Burton
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Kuppermann M, Wang G, Wong S, Blanco A, Conrad P, Nakagawa S, Terdiman J, Ladabaum U. Preferences for outcomes associated with decisions to undergo or forgo genetic testing for Lynch syndrome. Cancer 2013; 119:215-25. [PMID: 22786716 PMCID: PMC4356667 DOI: 10.1002/cncr.27634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/24/2012] [Accepted: 04/11/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current guidelines recommend offering genetic testing for Lynch syndrome to individuals whose tumors suggest this condition and to relatives of affected individuals. Little is known, however, regarding how patients view the prospect of such testing. In addition, data on preferences (utilities) for the potential outcomes of testing decisions for use in cost-effectiveness analyses are lacking. METHODS Time tradeoff utilities were elicited for 10 potential outcomes of Lynch syndrome testing decisions and 3 associated cancers from 70 participants, representing a range of knowledge about and experiences with Lynch syndrome. RESULTS Highest mean utilities were assigned to scenarios in which only the assessor's sibling had Lynch-associated colorectal cancer (ranging from 0.669 ± 0.231 to 0.760 ± 0.220). Utilities assigned to scenarios in which the assessor had Lynch-associated colorectal cancer ranged from 0.605 ± 0.252 to 0.682 ± 0.246, whereas the lowest mean utilities were assigned to 2 of the general cancer states (0.601 ± 0.238 and 0.593 ± 0.272 for colorectal and ovarian cancer respectively). Only 43% of the sample assigned higher values to undergoing Lynch testing and receiving negative results versus forgoing Lynch testing, whereas 50% assigned higher values to undergoing rather than forgoing surgery to prevent a subsequent cancer. CONCLUSIONS Genetic testing for Lynch syndrome, regardless of results, can have profound effects on quality of life; the utilities we collected can be used to incorporate these effects into cost-effectiveness analyses. Importantly, preferences for the potential outcomes of testing vary substantially, calling into question the extent to which patients would avail themselves of such testing if it were offered to them.
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Affiliation(s)
- Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA.
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Watkins KE, Way CY, Gregory DM, LeDrew HM, Ludlow VC, Esplen MJ, Dowden JJ, Cox JE, Fitzgerald GWN, Parfrey PS. Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale. BMC Psychol 2013; 1:7. [PMID: 25566359 PMCID: PMC4270033 DOI: 10.1186/2050-7283-1-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/06/2013] [Indexed: 11/20/2022] Open
Abstract
Background The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire family as members adjust to living with a high lifetime cancer risk. The research base on how individuals and families adjust to genetic-linked diseases following predictive genetic testing has increased our understanding of short-term impacts but gaps continue to exist in knowledge of important factors that facilitate or impede long-term adjustment. The failure of existing scales to detect psychosocial adjustment challenges in this population has led researchers to question the adequate sensitivity of these instruments. Furthermore, we have limited insight into the role of the family in promoting adjustment. Methods The purpose of this study was to develop and initially validate the Psychosocial Adjustment to Hereditary Diseases (PAHD) scale. This scale consists of two subscales, the Burden of Knowing (BK) and Family Connectedness (FC). Items for the two subscales were generated from a qualitative data base and tested in a sample of 243 participants from families with LS. Results The Multitrait/Multi-Item Analysis Program-Revised (MAP-R) was used to evaluate the psychometric properties of the PAHD. The findings support the convergent and discriminant validity of the subscales. Construct validity was confirmed by factor analysis and Cronbach’s alpha supported a strong internal consistency for BK (0.83) and FC (0.84). Conclusion Preliminary testing suggests that the PAHD is a psychometrically sound scale capable of assessing psychosocial adjustment. We conclude that the PAHD may be a valuable monitoring tool to identify individuals and families who may require therapeutic interventions.
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Affiliation(s)
- Kathy E Watkins
- Centre for Nursing Studies, Eastern Regional Integrated Health Authority, St. John's, NL Canada ; Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
| | - Christine Y Way
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada ; School of Nursing, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Deborah M Gregory
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada ; Eastern Regional Integrated Health Authority, St. John's, NL Canada
| | - Holly M LeDrew
- Western Regional School of Nursing, Western Regional Integrated Health Authority, Corner Brook, NL Canada
| | - Valerie C Ludlow
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
| | - Mary Jane Esplen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Jeffrey J Dowden
- Newfoundland and Labrador Centre for Health Information, St. John's, NL Canada
| | - Janet E Cox
- Division of Surgery, Charles S. Curtis Memorial Hospital, St. Anthony, NL Canada
| | | | - Patrick S Parfrey
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL Canada
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Lapointe J, Côté C, Bouchard K, Godard B, Simard J, Dorval M. Life events may contribute to family communication about cancer risk following BRCA1/2 testing. J Genet Couns 2012; 22:249-57. [PMID: 22892900 DOI: 10.1007/s10897-012-9531-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 07/19/2012] [Indexed: 02/01/2023]
Abstract
We assessed whether certain life events contributed to the communication about cancer risk within families who have undergone BRCA1/2 testing. We also explored what type of resources participants would have valued to help in supporting family communication about genetic information. Two hundred and forty-six individuals (218 women, 28 men) who received a BRCA1/2 genetic test result 3 to 10 years earlier (mean of 6.4 years) participated in a telephone interview. Participants were asked about the occurrence of a number of life events (cancer diagnosis, death, uptake of prophylactic surgery, and providing care to a family member with cancer) in their family since their BRCA1/2 test result disclosure and, for each occurrence, whether it fostered family communication about cancer risk. A total of 182 participants (74 %) reported that they or one of their relatives received a cancer diagnosis, 176 (72 %) reported that someone died in their family, and 73 (30 %) stated that they or one of their relatives undertook a prophylactic surgery. During this period, 109 participants (44 %) also provided care for a family member who had cancer. Among participants who reported these life events, family communication was fostered by these events in proportions varying from 50 % (death) to 69 % (cancer diagnosis). Our results indicate that life events may contribute to family communication about cancer risk. Further research is needed to determine whether these events provide a "window of opportunity" to reach family members, address their needs and concerns about cancer, update family cancer history, and introduce genetic counseling and risk assessment.
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Factors affecting encouragement of relatives among families with Lynch syndrome to seek medical assessment. Fam Cancer 2012; 10:649-54. [PMID: 21695501 DOI: 10.1007/s10689-011-9462-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lynch syndrome (HNPCC) is an autosomal dominant hereditary cancer syndrome, and members of affected families are at-risk for developing colorectal and other associated tumors. Such individuals should disseminate familial genetic information, so they can seek specific medical assessment or genetic testing to reduce mortality and morbidity rates by early detection. Since published results have been encouraging, we explored which factors influence the likelihood of good communication within families regarding medical assessment. We studied 40 individuals from 33 families who satisfied the Japanese clinical criteria for Lynch syndrome and their relatives at our hospital. We determined the status of relatives of the 40 individuals after genetic counseling and testing using questionnaires and semi-structured interviews based on pedigree charts. We also examined their knowledge or perception of colorectal cancer syndrome, levels of intimacy and whether or not they encouraged their relatives to have specific medical assessments. We found that 75% of the individuals advised their relatives to seek medical assessment, and any significant background factors that promoted such encouragement were observed. They tended to encourage first degree relatives and discuss the issue with other family members such as spouses before undertaking such attempts at encouragement. The reasons and methods of imparting encouragement were essentially identical. We also found that genetic testing for at-risk or more distant relatives was not encouraged so often. Therefore, providing individuals who have been tested for Lynch syndrome with opportunities for disseminating familial genetic information through appropriate genetic counseling is important.
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Ersig AL, Hadley DW, Koehly LM. Understanding patterns of health communication in families at risk for hereditary nonpolyposis colorectal cancer: examining the effect of conclusive versus indeterminate genetic test results. HEALTH COMMUNICATION 2011; 26:587-594. [PMID: 21512927 PMCID: PMC3144288 DOI: 10.1080/10410236.2011.558338] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In families meeting criteria for hereditary nonpolyposis colorectal cancer (HNPCC), genetic testing may or may not identify a mutation. Communication about genetic testing and risk in families with identified HNPCC mutations is associated with individual and relational factors. Similar communication patterns would be expected in families with similar clinical and pathological characteristics, but without an identified HNPCC mutation; however, previous studies have not included such families. Social network analysis was used to compare communication networks and associated individual and relational factors in families with and without identified HNPCC mutations. Respondents from families without identified mutations communicated about genetic counseling and testing and risk for HNPCC with a significantly smaller proportion of network members, compared to respondents from mutation-positive families. Members of families without identified mutations were also more likely to share thoughts about risk for HNPCC with network members whose advice they take, compared to members of families with known mutations. These findings extend our knowledge of communication in families at risk of HNPCC to include the many families in which a causative mutation has not yet been identified. Differences in the breadth of communication about genetics and risk for HNPCC, and the possibility that members of families without identified mutations may seek advice from those with whom they communicate about risk, provide new avenues for future research. Understanding existing communication patterns could help improve education and counseling processes, and facilitate the development of interventions designed to assist in family discussions of risk.
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Affiliation(s)
- Anne L Ersig
- College of Nursing, University of Iowa, Iowa City, IA 52242-1121, USA.
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Aktan-Collan KI, Kääriäinen HA, Kolttola EM, Pylvänäinen K, Järvinen HJ, Haukkala AH, Mecklin JP. Sharing genetic risk with next generation: mutation-positive parents' communication with their offspring in Lynch Syndrome. Fam Cancer 2011; 10:43-50. [PMID: 20857224 DOI: 10.1007/s10689-010-9386-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Identification of hereditary predisposition to cancer has limited significance if not followed by efficient cancer prevention. The responsibility of informing offspring about genetic risk often falls to the parents. We systematically investigated how parents with Lynch Syndrome share knowledge of genetic risk with their offspring, challenges in the communication process and wish for professional support. Of all known mutation carriers over age 40 (n = 337) in 102 Finnish Lynch Syndrome families, 86% completed a self-reported questionnaire; 248 of them (86%) had children. Of the 248 parents, 87% reported disclosure and 13% nondisclosure. Reasons for nondisclosure were mainly the young age of offspring, socially distant relationships, or feeling of difficulty in discussing the topic. Men reported significantly more often disclosure with a support person (spouse etc.) (P < 0.001). The most difficult communication aspect was discussing children's cancer risk. Of the 191 firstborn adult children informed, 69% had taken the predictive genetic test. Every third parent suggested that health professionals should be involved in passing on the information and that a family appointment at the genetic clinic should be organized at the time of disclosure. Nearly all parents had informed their adult offspring about the genetic risk and possibility of genetic testing, but almost one-third were unsure of how their offspring had used the information. The challenge is to improve the communication processes, so that all offspring would get the information important for their health care, and parents would get the professional support desired at disclosure.
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Affiliation(s)
- Katja I Aktan-Collan
- Department of Medical Genetics, Haartman Institute Biomedicum, University of Helsinki, Helsinki, Finland.
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Dandapani M, Stoffel EM. CLINICAL MANAGEMENT OF FAMILIES WITH HEREDITARY COLORECTAL CANCER SYNDROMES. SEMINARS IN COLON AND RECTAL SURGERY 2011; 22:100-104. [PMID: 21743786 PMCID: PMC3129991 DOI: 10.1053/j.scrs.2010.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hereditary colorectal cancer syndromes can be associated with a lifetime risk of CRC of >70% in the absence of specialized surveillance. Diagnosing a genetic predisposition to cancer allows clinicians to tailor cancer prevention strategies for patients and families at highest risk. Once a genetic syndrome has been identified in a family, communication with family members, timely implementation of screening tests and/or surgeries, and psychosocial support are all instrumental for effective cancer prevention.Molecular screening of tumors, computerized risk assessment models, and genetic testing can help clinicians identify individuals at risk for hereditary cancer syndromes. This review discusses some of the complexities involved in the diagnosis and management of families with hereditary CRC syndromes and provides strategies for coordinating clinical care.
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Affiliation(s)
- Monica Dandapani
- Cancer Risk and Prevention Clinic, Dana-Farber Cancer Institute, Boston, MA
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Persson E, Lindholm E, Berndtsson I, Lundstam U, Hultén L, Carlsson E. Experiences of living with increased risk of developing colorectal and gynaecological cancer in individuals with no identified gene mutation. Scand J Caring Sci 2011; 26:20-7. [DOI: 10.1111/j.1471-6712.2011.00898.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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What facilitates or impedes family communication following genetic testing for cancer risk? A systematic review and meta-synthesis of primary qualitative research. J Genet Couns 2010; 19:330-42. [PMID: 20379768 DOI: 10.1007/s10897-010-9296-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
To systematically review and meta-synthesise primary qualitative research findings regarding family communication following genetic testing of cancer risk, in order to inform development of effective interventions. Systematic searches of CINAHL, Embase, Medline, British Nursing Index and PsycINFO databases were undertaken and relevant studies identified using strict criteria. The selected primary qualitative studies were appraised for quality and relevance by three independent researchers and then synthesized using a "Framework" approach. Fourteen (4.3%) studies met the inclusion criteria. The following factors influenced family communication following genetic testing for late-onset hereditary cancer: the informant's feelings about informing relatives about genetic testing; the perceived relevance of the information to other family members and their anticipated reactions; the "closeness" of relationships within the family; family rules and patterns (e.g., who is best placed to share information with whom); finding the right time and level of disclosure; and the supportive role of heath care professionals. The themes identified in this review could provide practitioners with a useful framework for discussing family communication with those undergoing genetic testing. This framework focuses on helping health care professionals to facilitate family communication. The next step will be the development of an intervention to directly support people in talking to their relatives.
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Aronson M. Genetic Counseling for Hereditary Colorectal Cancer: Ethical, Legal, and Psychosocial Issues. Surg Oncol Clin N Am 2009; 18:669-85. [DOI: 10.1016/j.soc.2009.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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The effect of BRCA gene testing on family relationships: A thematic analysis of qualitative interviews. J Genet Couns 2009; 18:418-35. [PMID: 19479365 DOI: 10.1007/s10897-009-9232-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/23/2009] [Indexed: 12/13/2022]
Abstract
Discovery of mutations in the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 can have emotional consequences for both the tested individual and his or her relatives. This secondary analysis study investigated how BRCA testing impacts family dynamics and relationships. For the original study, a grounded theory inquiry, participants were recruited from a hereditary breast/ovarian cancer syndrome support website and open-ended interviews were performed asking about individual and family experiences after BRCA testing. All 12 participants whose interviews were included in the secondary analysis had a BRCA mutation. For the secondary analysis, thematic analysis was conducted and revealed three main themes characterizing the effect of BRCA testing on family relationships: 1. That the first in the family to have testing or seek genetic counseling takes on a special family role that can be difficult for them; 2. That discussions in the family often change; and 3. That individuals may feel more or less connected to certain family members. These changes seemed to relate to family cancer history, relationships, coping strategies, communication patterns, and mutation status. Genetic counselors might find it useful to explore these issues in order to prepare clients before BRCA testing and to support them through shifts in family dynamics after disclosure of results.
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Abstract
PURPOSE OF REVIEW With rapid advances in genetic testing for disease susceptibility, behavioral medicine faces significant challenges in identifying likely patterns of use, how individuals interpret test results, and psychosocial and health impacts of testing. We review recent research on these psychosocial aspects of genetic testing for disease risk. RECENT FINDINGS Individuals exhibit limited sensitivity in their perceptions of genetic risk information, and mental representations of disease risk appear to guide testing perceptions and behavioral responses. Motivations to undergo testing are complex, and efforts to develop decision aids are underway. Findings on psychological and behavioral impacts of genetic testing vary markedly, with some evidence of minimal or positive effects and other evidence indicating negative consequences that may be undetectable using common measures of general well being. Recent evidence suggests that genetic risk information can motivate health behavior change. Research demonstrates wide-ranging influences of testing on family dynamics, and use of genetic testing with children is of increasing concern. SUMMARY More research is needed to determine how to structure health communications and counseling to motivate informed use, promote positive responses, and optimize behavior change. Given the ramifications of genetic information for families, personalized genomics will demand a shift toward a family-based healthcare model.
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Ashida S, Hadley DW, Vaughn BK, Kuhn NR, Jenkins JF, Koehly LM. The impact of familial environment on depression scores after genetic testing for cancer susceptibility. Clin Genet 2008; 75:43-9. [PMID: 19021640 DOI: 10.1111/j.1399-0004.2008.01104.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The associations between characteristics of family relationships and family trends in cancer worry and the psychological adjustment of recipients of genetic testing for cancer susceptibility were investigated. Data provided by 178 individuals from 24 families with Lynch syndrome who participated in a cohort study investigating psychological and behavioral outcomes of genetic testing were used. Responses from multiple family members were aggregated to construct family trends representing norms and departure from norms in cancer worry. Lower perceived family cohesion at baseline and decrease in this variable at 6 months after receipt of test results were associated with higher depression scores at 12 months. More variability in cancer worry among family members at baseline was also associated with higher depression scores at 12 months. Increase in family conflict was associated with decrease in depression scores among individuals from families with higher levels of cancer worry on average and less variability among the members. Family relationships and family trends in levels of cancer worry may play important roles in the psychological adjustment of genetic test recipients. The findings highlight the complexity of familial environment surrounding individuals that undergo genetic testing and suggest the benefits of considering these factors when providing genetic services.
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Affiliation(s)
- S Ashida
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
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