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Bond E, Yashar B, Else T, Osborne J, Marvin M. Disclosure of genetic risk to dating partners among young adults with von Hippel-Lindau disease. Fam Cancer 2023; 22:203-215. [PMID: 35984582 DOI: 10.1007/s10689-022-00311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
Individuals with genetic disease face unique challenges related to navigating dating relationships. While previous studies have explored the impact of hereditary breast and ovarian cancer syndrome on dating, research investigating psychosocial implications for young adults with early-onset multi-organ tumor predisposition syndromes such as von Hippel-Lindau disease (VHL) is scarce. This study assessed young adults' attitudes towards dating and decisions related to disclosing a diagnosis of VHL to a dating partner. Twenty-six young adults with VHL participated in semi-structured interviews exploring this issue, using a guide informed by the literature in consultation with providers and an individual with VHL. Interviews were coded with a primarily deductive approach using codes derived from the literature, with inductive coding employed for perspectives unique to VHL. Our results support previous findings that genetic disease contributes to fear of rejection due to decreased desirability. However, participants report that partners' reactions to VHL uniquely exacerbate this concern due to unfamiliarity with VHL and a perception that it is exceptionally serious, leading to different strategies in disclosure. While many cited negative reactions from partners, participants also described how disclosure can strengthen relationships by deepening trust. Participants discussed a desire for healthcare providers to offer support in this context and described the benefit of speaking with peers about their dating experiences and approaches to disclosure. Our findings provide insight into the diverse needs of young adults with VHL as they approach romantic relationships and decision-making regarding disclosure and highlight the importance of patient-centered support from providers and patient organizations.
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Affiliation(s)
- Elysa Bond
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
- Department of Medicine, Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL, USA.
| | - Beverly Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Jenae Osborne
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Monica Marvin
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, MI, USA
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2
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Kimura M, Matsuzaki S, Ishii K, Ogawa M, Kato K. Individual experiences and issues in predictive genetic testing for untreatable hereditary neuromuscular diseases in Japan. Eur J Med Genet 2022; 66:104667. [PMID: 36410650 DOI: 10.1016/j.ejmg.2022.104667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
Predictive genetic testing (PT) for hereditary diseases that do not have effective treatment or prevention strategies places a psychological burden on parties and their families. There has been little research on the psychosocial aspects of PT in Japan, nor are there any guidelines. To address this gap, we conducted a questionnaire survey of parties at genetic risk for untreatable hereditary neuromuscular diseases, and the National Liaison Conference of Genetic Medicine Departments (GMDs). Of the 63 parties who responded to the survey, 10 (15.9%) had undergone PT. Of the 67 GMDs, only 18 facilities (26.9%) were conducting PT with written procedures. At least two of the six parties with such results felt that some follow-up would be helpful. One party had taken PT for preimplantation genetic testing for monogenic (PGT-M); four, who had no experience, provided free text responses indicating that PGT-M or prenatal genetic testing was chosen as a motivation. Eight were unaware of PT, and six were unaware of their blood relatives' diseases being "hereditary." The results highlighted the need to: 1) develop guidelines for PT in untreatable hereditary diseases; 2) provide access to PT information; and 3) share the "heritability" of diseases with family and relatives.
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Affiliation(s)
- Midori Kimura
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Sawako Matsuzaki
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kanako Ishii
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanobu Ogawa
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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3
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Jeong J, Park B, Kim D, Kim J, Lee BY, Yoon J, Kim SW. Sex Differences in Attitudes Toward Marriage and Childbearing Based on the Assumption of Being BRCA1/2 Mutation Carriers Among Young People. J Breast Cancer 2022; 25:233-243. [PMID: 35775702 PMCID: PMC9250881 DOI: 10.4048/jbc.2022.25.e25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose This study investigated changes in attitudes toward marriage and childbearing assuming a BRCA1/2 mutation carrier status among healthy, unmarried individuals in Korea. Methods A nationally representative sample of healthy, unmarried individuals aged 20–39 years was surveyed. A questionnaire on marriage and childbearing intentions was administered to the participants before and after providing them with information on BRCA1/2 mutation carriers’ breast and ovarian cancer risks and their autosomal dominant inheritance pattern. The participants were asked about their attitudes toward childbearing through preimplantation genetic diagnosis (PGD). Results Of the participants who initially wanted to marry, the assumption that they or their partners had BRCA1/2 mutation caused 25.3% to no longer want to get married and 36.2% to change their attitude from wanting to bear children to no longer wanting them. Females were more likely than males to change their attitudes toward marriage and childbearing. The participants who had negative attitudes toward genetic testing were more likely to change their attitudes regarding marriage and childbearing than those who were favorable toward both disclosure and testing. More than 50% of the participants who did not want children were willing to bear children through PGD when it was assumed that they were BRCA mutation carriers. Conclusion On the assumption of being carriers, general, young, and healthy females were more likely than males to negatively change their attitudes toward marriage and childbearing. Public education on the implications of living with mutation carriers and reproductive options may be required.
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Affiliation(s)
- Jiwon Jeong
- Department of Internal Medicine, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dongwon Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jiyoung Kim
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Bom-Yi Lee
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Junghyun Yoon
- Department of Health Sciences, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
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4
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Mahmood S, Law S, Bombard Y. "I have to start learning how to live with becoming sick": A scoping review of the lived experiences of people with Huntington's disease. Clin Genet 2021; 101:3-19. [PMID: 34216010 DOI: 10.1111/cge.14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023]
Abstract
Person-centered care (PCC) is recognized as a key component of the delivery of quality healthcare and a model for healthcare systems worldwide. The experience of illness through a person's perspective is one domain defining PCC contributing to a growing interest in examining the lived experiences of illness. This scoping review sought to examine what is known from the existing literature about the lived experiences of persons gene-positive for or living with Huntington's disease (HD) as described in their own voices and to outline prominent psychosocial themes of those experiences. Five databases were systematically searched and analyzed resulting in 19 publications for inclusion. Using a thematic analysis, five prominent psychosocial themes were identified: grappling with control, avoidance as an escape from realities, adaptation to new realities, managing emotions, and appreciation for life. Variation in themes existed across HD life stage of being undiagnosed or diagnosed with HD. The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC.
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Affiliation(s)
- Saadia Mahmood
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Yvonne Bombard
- Genomics Health Service Research Group, St. Michael's Hospital - Unity Health Toronto, Toronto, Ontario, Canada
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5
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Owaidah T, Alabbas F, Alhazmi I, Al Saeed H, Balelah S, ElYamany G, Kashari O, Qari M, Saleh M, Roushdy S, ElBagoury M. Diagnosis and management of hematological manifestations of gaucher disease: Insights from Saudi Arabia. JOURNAL OF APPLIED HEMATOLOGY 2021. [DOI: 10.4103/joah.joah_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Radtke HB, Bergner AL, Goetsch AL, McGowan C, Panzer K, Cannon A. Genetic Counseling for Neurofibromatosis 1, Neurofibromatosis 2, and Schwannomatosis—Practice Resource of the National Society of Genetic Counselors. J Genet Couns 2020; 29:692-714. [DOI: 10.1002/jgc4.1303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Heather B. Radtke
- Department of Pediatrics Medical College of Wisconsin Milwaukee Wisconsin USA
- Children’s Tumor Foundation New York New York USA
| | - Amanda L. Bergner
- Department of Genetics and Development Columbia University New York New York USA
| | - Allison L. Goetsch
- Division of Genetics Birth Defects and Metabolism, Ann and Robert H. Lurie Children’s Hospital of Chicago Chicago Illinois USA
- Department of Pediatrics Northwestern University Chicago Illinois USA
| | - Caroline McGowan
- Division of Genetics and Genomics Boston Children’s Hospital Boston Massachusetts USA
| | - Karin Panzer
- Department of Pediatrics University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Ashley Cannon
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
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Tian X, Solomon DH, Smith RA. A Stress Buffering Perspective on the Progression of Alpha-1 Antitrypsin Deficiency. HEALTH COMMUNICATION 2020; 35:747-755. [PMID: 30843437 DOI: 10.1080/10410236.2019.1584782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study used the stress buffering perspective to identify social resources, including social network support, having a high quality marriage, and spousal support, that protect against deleterious effects of the progression of Alpha-1 antitrypsin deficiency (AATD) on quality of life. Participants included 130 married adults living with AATD. We measured participants' quality of life in three ways: perceived stress, life satisfaction, and perceptions of social stigma. The results suggested that disease progression corresponded positively with perceived stress and negatively with life satisfaction. Social network support moderated the association between disease progression and perceived stress and social stigma, and spousal support moderated the association between disease progression and perceived stress and life satisfaction. Marital quality was not a significant moderator. The discussion highlights the stress buffering effects of social support from close others.
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Affiliation(s)
- Xi Tian
- Department of Communication Arts and Sciences, The Pennsylvania State University
| | | | - Rachel A Smith
- Department of Communication Arts and Sciences, The Pennsylvania State University
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8
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Zhu X, Smith RA, Parrott RL. Living with a Rare Health Condition: The Influence of a Support Community and Public Stigma on Communication, Stress, and Available Support. JOURNAL OF APPLIED COMMUNICATION RESEARCH : JACR 2017; 45:179-198. [PMID: 29398734 PMCID: PMC5793934 DOI: 10.1080/00909882.2017.1288292] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
People affected by rare diseases often have limited coping resources and sometimes face stigma. They build communities with others who share their conditions, but not all members may benefit from these communities. This study investigated how adults with a rare genetic health condition (Alpha-1 antitrypsin deficiency; AATD) think about both the Alpha-1 community and public stigma about AATD, and how these cognitions were associated with their communication responses and well-being. The results showed that people with AATD encountered stigmatization from various sources, including family, employers, healthcare providers, and insurance companies. Stronger public stigma predicted more secrecy, more stress, and less available support. Stronger group identification with the Alpha-1 community predicted less secrecy; stronger group activism predicted more available support and more communication to challenge stigmatizers. Post-hoc analyses showed significant interactions between public stigma and group cognitions on communication to challenge stigmatizers. Practical implications for bolstering communities to improve the well-being of people with rare diseases were discussed.
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Affiliation(s)
- Xun Zhu
- Communication Arts & Sciences, Pennsylvania State University, 316 Sparks Building, University Park, PA 16802
| | - Rachel A Smith
- Communication Arts & Sciences, Pennsylvania State University, 216 Sparks Building, University Park, PA 16802, (814) 865-4201
| | - Roxanne L Parrott
- Communication Arts & Sciences and Health Policy & Administration, Pennsylvania State University
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9
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Reproductive Decision-Making in Women with BRCA1/2 Mutations. J Genet Couns 2016; 26:594-603. [PMID: 27796678 DOI: 10.1007/s10897-016-0035-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
Expanded genetic testing of BRCA mutations has led to identification of more reproductive-aged women who test positive for the mutation which might impact attitudes and decisions about relationships, childbearing and the use of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). A cross-sectional survey was administered to 1081 self-reported BRCA carriers to investigate how knowledge of BRCA status influences these issues. The mean age at BRCA test disclosure was 44 years and 36 % reported a personal history of cancer. Of 163 women who were unpartnered, 21.5 % felt more pressure to get married. Of 284 women whose families were not complete, 41 % reported that carrier status impacted their decision to have biological children. Women with a history of cancer were more likely to report that knowledge of BRCA+ status impacted their decision to have a child (OR 1.8, 95 % CI 1-3.2). Fifty-nine percent thought PGD should be offered to mutation carriers and 55.5 % thought PND should be offered. In conclusion, knowledge of BRCA status impacts attitudes regarding relationships and childbearing, and most carriers believe that PGD and PND should be offered to other carriers. This study suggests that BRCA carriers desire and would benefit from reproductive counseling after test disclosure.
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10
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Impact of Huntington Disease Gene-Positive Status on Pre-Symptomatic Young Adults and Recommendations for Genetic Counselors. J Genet Couns 2016; 25:1188-1197. [PMID: 27103420 DOI: 10.1007/s10897-016-9951-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 01/09/2023]
Abstract
Huntington disease (HD) is an autosomal dominant, progressive neurodegenerative disorder for which there is no cure. Predictive testing for HD is available to asymptomatic at-risk individuals. Approximately half of the population undergoing predictive testing for HD consists of young adults (≤35 years old). Finishing one's education, starting a career, engaging in romantic relationships and becoming a parent are key milestones of young adulthood. We conducted a qualitative study to explore how testing gene-positive for HD influences young adults' attainment of these milestones, and to identify major challenges that pre-symptomatic young adults face to aid the development of targeted genetic counseling. Results of our study demonstrate that 1) knowing one's gene-positive status results in an urgency to reach milestones and positively changes young adults' approach to life; 2) testing positive influences young adults' education and career choices, romantic relationships, and family planning; 3) young adults desire flexible and tailored genetic counseling to address needs and concerns unique to this population. Findings of this study contribute to the understanding of the impact of predictive testing for HD on young adults, and highlight issues unique to this population that call for further research, intervention and advocacy.
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11
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Ernst ME, Sandberg DE, Keegan C, Quint EH, Lossie AC, Yashar BM. The Lived Experience of MRKH: Sharing Health Information with Peers. J Pediatr Adolesc Gynecol 2016; 29:154-8. [PMID: 26453829 DOI: 10.1016/j.jpag.2015.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To examine the process and emotional effect of disclosing a personal diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) to peers during adolescence and young adulthood. DESIGN AND SETTING Qualitative study using semistructured telephone interviews. PARTICIPANTS Nine women diagnosed with MRKH, aged 21-31 years, recruited via patient support groups. INTERVENTIONS AND MAIN OUTCOME MEASURES Motivators and barriers to self-disclosure of a diagnosis of MRKH to peers and partners. RESULTS Motivators to tell peers about a diagnosis included significant trust in the relationship (whether platonic or romantic), needing to unload the experienced burden of diagnosis, and a sense of responsibility to be forthcoming if a long-term romantic future was desired. The most common barrier to telling others was fear of rejection or being labeled a "freak." Although most participants did not receive guidance from a health care provider regarding approaches to sharing diagnostic information with others, almost all participants reported wishing they had received such counseling. CONCLUSION A diagnosis of MRKH elicits recurring anxieties about disclosure and the effect on relationships that are inadequately addressed by health care providers. Guidance and support on disclosure to friends and romantic partners should be provided whenever possible.
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Affiliation(s)
- Michelle E Ernst
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan.
| | - David E Sandberg
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Catherine Keegan
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Amy C Lossie
- Department of Animal Sciences, Purdue University, Lafayette, Indiana
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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12
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Hershberger PE, Gallo AM, Molokie R, Thompson AA, Suarez ML, Yao Y, Dallas CM, Wilkie DJ. Toward understanding family-related characteristics of young adults with sickle-cell disease or sickle-cell trait in the USA. J Clin Nurs 2016; 25:1587-97. [PMID: 26970444 DOI: 10.1111/jocn.13144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the family-related characteristics of young adults with sickle-cell disease or sickle-cell trait prior to taking part in a randomised controlled trial on sickle-cell reproductive health education. BACKGROUND There is a critical need for educational programmes that target the reproductive needs of young adults with sickle-cell disease or trait. However, little is known about the family-related characteristics (i.e., demographic attributes and reproductive health behaviours) in which these young adults live. DESIGN A descriptive cross-sectional analysis. METHOD At study enrolment, 234 young adults (mean age = 25·9 years, 65% female) completed the SCKnowIQ questionnaire. Descriptive statistics depict the demographic attributes and reproductive health behaviours of young adults with sickle-cell disease (n = 138) or trait (n = 96). For group comparisons, independent t tests or Fisher's tests were used, as appropriate. RESULTS Young adults with sickle-cell trait had significantly higher education, income and health insurance than those with sickle-cell disease. Both groups believed that sickle-cell disease was a severe condition. A majority of young adults with sickle-cell disease (65%) had no children compared to 42% of those with sickle-cell trait. Most young adults (85% sickle-cell disease, 82% sickle-cell trait) were not planning a pregnancy in the next six months, and many used condoms, withdrawal or oral contraceptives. CONCLUSIONS Socioeconomic disparities exist between young adults with sickle-cell disease and sickle-cell trait. Future research that advances education about how and when to communicate appropriate genetic risk information to partners and children especially for young adults with sickle-cell trait would be beneficial. RELEVANCE TO CLINICAL PRACTICE Awareness of the similarities and differences in the family-related characteristics among young adults with sickle-cell disease or trait can allow for more tailored reproductive education.
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Affiliation(s)
- Patricia E Hershberger
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Agatha M Gallo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert Molokie
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Alexis A Thompson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marie L Suarez
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, FL, USA.,Prairieview Trust, College of Nursing, University of Florida, Gainesville, FL, USA.,Center of Excellence in Palliative Care Research, College of Nursing, University of Florida, Gainesville, FL, USA
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13
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Shaw LK, Sherman K, Fitness J. Dating concerns among women with breast cancer or with genetic breast cancer susceptibility: a review and meta-synthesis. Health Psychol Rev 2015; 9:491-505. [PMID: 26315681 DOI: 10.1080/17437199.2015.1084891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE While dating is critical in the formation of a lifelong romantic relationship, women with breast cancer or a genetic susceptibility to developing this disease report a myriad of dating concerns. This review synthesises and discusses the perceived dating barriers and concerns in this population. METHOD A systematic search of CINAHL, Embase, MEDLINE, PsycINFO and PubMed was undertaken and yielded 19 published qualitative studies. Papers were subjected to critical appraisal to ensure the integrity of findings. RESULTS Six areas of concern were identified: Feeling unattractive due to treatment side effects; perceiving limited dating partners available; determining how, when and what to disclose; fear of cancer recurrence and reduced life expectancy; apprehension about entering into a new sexual relationship; and dating urgency and not wanting to 'waste time' on partners without long-term potential. CONCLUSIONS This paper provides a valuable synthesis of the complex issues, concerns and decisions that single women face at different stages of relationship formation following their breast cancer experience. Future research is warranted to explore the perceptions, appraisals and beliefs underlying these concerns, to help guide the future design and development of appropriate informational and supportive care offered to breast cancer patients.
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Affiliation(s)
- Laura-Kate Shaw
- a Department of Psychology , Macquarie University , Sydney , Australia
| | - Kerry Sherman
- a Department of Psychology , Macquarie University , Sydney , Australia.,b Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney , Sydney , Australia
| | - Julie Fitness
- a Department of Psychology , Macquarie University , Sydney , Australia
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14
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Higa LA, McDonald J, Himes DO, Rothwell E. Life experiences of individuals with hereditary hemorrhagic telangiectasia and disclosing outside the family: a qualitative analysis. J Community Genet 2015; 7:81-9. [PMID: 26340858 DOI: 10.1007/s12687-015-0254-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/27/2015] [Indexed: 11/24/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT; OMIM 187300) is a disorder that affects 1:5000-1:10,000 people worldwide, with an estimated 60,000 affected individuals in the USA. Approximately 50 % of patients with HHT experience potentially life-threatening health complications such as stroke, brain abscess, or heart failure. However, the most common symptom is spontaneous and frequent nosebleeding. HHT is a hereditary condition with significant health consequences, but little is known about how individuals cope with HHT on a daily basis and how individuals share information about the disorder with social groups outside of the family. The objectives of this study were to improve understanding of the daily experiences of patients with diagnosed HHT and to investigate how they disclose their diagnosis to various social groups (friends, dating partners, employers, and coworkers) outside of their biological family. Adult patients seen at a university HHT clinic and who had been diagnosed with HHT for at least 6 months were recruited by mail. Participants completed semi-structured telephone interviews (n = 19). A qualitative content analysis of interview transcripts identified four major categories: (1) the emotional impact of HHT, (2) the social impact of HHT, (3) concerns for current and future health related to HHT, and (4) social context drives disclosure of HHT. Participants reported that although HHT was a manageable hereditary disorder, the symptoms negatively affected their daily life. It is important for health care providers to understand how individuals with rare genetic disorders are managing.
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Affiliation(s)
- Leigh Ann Higa
- Graduate Program in Genetic Counseling, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Jamie McDonald
- Department of Radiology, University of Utah, Salt Lake City, UT, USA.,College of Nursing, Brigham Young University, Provo, UT, USA
| | - Deborah O Himes
- College of Nursing, Brigham Young University, Provo, UT, USA
| | - Erin Rothwell
- Graduate Program in Genetic Counseling, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA. .,College of Nursing, University of Utah, Salt Lake City, UT, USA.
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15
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Mauer C, Spencer S, Dungan J, Hurley K. Exploration of Male Attitudes on Partnerships and Sexuality with Female BRCA1/2 Mutation Carriers. J Genet Couns 2015; 25:290-7. [PMID: 26250348 DOI: 10.1007/s10897-015-9870-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/23/2015] [Indexed: 11/24/2022]
Abstract
Women with BRCA mutations are inundated with decisions about managing cancer risks and childbearing considerations. Decisions become more complicated when women face disclosing their mutation and risk-reduction options to a romantic partner. This study identifies the concerns and perspectives of male romantic partners regarding these unique decisions. Twenty-five male participants completed an online survey posted to cancer support group message boards. Participants reported relationship changes regarding intimacy levels (n = 9), attraction (n = 2), and communication (n = 22) after mutation disclosure. Participants whose partners had not undergone prophylactic mastectomy (n = 14) reported concerns regarding sexual relations (n = 5), post-surgical appearance (n = 2), post-surgical attraction (n = 5), and health/lifespan (n = 9). Participants did not express attitude changes toward childbearing. While mutation disclosure conversations and surgical options are concerns for many BRCA mutation carriers in relationships, male partners share these concerns. Aspects of the relationship may change, but male study participants continued to support their partners. This information can benefit female BRCA mutation carriers, their current or future partners, and genetic counselors working with this particular population.
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Affiliation(s)
- Caitlin Mauer
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9323, USA.
| | - Sara Spencer
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffery Dungan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Hurley
- Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Hart RI, Foster HE, McDonagh JE, Thompson B, Kay L, Myers A, Rapley T. Young people's decisions about biologic therapies: who influences them and how? Rheumatology (Oxford) 2015; 54:1294-301. [PMID: 25661469 PMCID: PMC4473768 DOI: 10.1093/rheumatology/keu523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/03/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Young people with inflammatory arthritis can have severe disease warranting biologic therapy. They face complex treatment decisions, with profound consequences. This study aimed to explore the influence of individuals outside the care team (trusted others) on the treatment decisions made by young people, in particular their decisions about biologic therapies. METHODS Young people (16-25 years of age) with inflammatory arthritis and experience of treatment decision making were recruited from three NHS Hospital Trusts. Twenty-five were interviewed, plus 11 trusted others identified by young people as being involved in their decision making, as well as 6 health professionals. The data were analysed using coding, memoing and mapping techniques and the findings were tested through a series of focus groups. RESULTS Young people initially emphasized their decisional autonomy, typically describing people other than health professionals as limited in influence. However, discussions revealed the involvement--in deliberation and enactment--of a range of other people. This cast of trusted others was small and largely consistent; mothers played a particularly prominent role, providing cognitive, practical and emotional support. Members of the wider cast of trusted others were involved in more limited but still significant ways. CONCLUSION Young people claim autonomy but other people enable this. The network of relationships in which they are embedded is distinctive and evolving. Mothers play a supporting role well into early adulthood; in contrast, partners are involved in far more limited ways. As such, the applicability of adult models of decision making is unclear. This must be taken into account if the support provided by professionals is to be optimally tailored to young people's needs.
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Affiliation(s)
- Ruth I Hart
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Helen E Foster
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Janet E McDonagh
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Ben Thompson
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lesley Kay
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Andrea Myers
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Grubs RE, Parker LS, Hamilton R. Subtle Psychosocial Sequelae of Genetic Test Results. CURRENT GENETIC MEDICINE REPORTS 2014. [DOI: 10.1007/s40142-014-0053-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Current understanding of genetics and genetic testing and information needs and preferences of adults with inherited retinal disease. Eur J Hum Genet 2014; 22:1058-62. [PMID: 24398793 DOI: 10.1038/ejhg.2013.296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 11/07/2013] [Accepted: 11/22/2013] [Indexed: 11/08/2022] Open
Abstract
Advances in sequencing technology and the movement of genetic testing into all areas of medicine will increase opportunities for molecular confirmation of a clinical diagnosis. For health-care professionals without formal genetics training, there is a need to know what patients understand about genetics and genetic testing and their information needs and preferences for the disclosure of genetic testing results. These topics were explored during face-to-face interviews with 50 adults with inherited retinal disease, selected in order to provide a diversity of opinions. Participants had variable understanding of genetics and genetic testing, including basic concepts such as inheritance patterns and the risk to dependents, and many did not understand the term 'genetic counselling'. Most were keen for extra information on the risk to others, the process for genetic testing and how to share the information with other family members. Participants were divided as to whether genetic testing should be offered at the time of the initial diagnosis or later. Many would prefer the results to be given by face-to-face consultation, supplemented by further information in a format accessible to those with visual impairment. Health-care professionals and either leaflets or websites of trusted agencies were the preferred sources of information. Permission should be sought for disclosure of genetic information to other family members. The information needs of many patients with inherited retinal disease appear to be unmet. An understanding of their information needs and preferences is required to help health-care professionals provide optimal services that meet patient expectations.
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Otlowski M, Taylor S, Bombard Y. Genetic Discrimination: International Perspectives. Annu Rev Genomics Hum Genet 2012; 13:433-54. [DOI: 10.1146/annurev-genom-090711-163800] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - S. Taylor
- School of Sociology and Social Work, University of Tasmania, Hobart, Tasmania 7001, Australia;
| | - Y. Bombard
- Department of Epidemiology and Public Health, Division of Health Policy and Administration, Yale University, New Haven, Connecticut 06510
- Department of Epidemiology and Biostatistics, Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY 10065;
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Roberts R, Mathias J. Psychosocial Functioning in Adults with Congenital Craniofacial Conditions. Cleft Palate Craniofac J 2012; 49:276-85. [DOI: 10.1597/10-143] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To examine the psychosocial functioning of adults with congenital craniofacial conditions relative to normative data. Design Single sample cross-sectional design. Setting The Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, which is one of the main craniofacial treatment centers in Australia. Participants Adults ( N = 93) with congenital craniofacial conditions (excluding cleft lip/palate) who were treated in the Australian Craniofacial Unit. Main Outcome Measures All participants completed self-report scales assessing health-related quality of life (SF-36); life satisfaction, anxiety, and depression (HADS); self-esteem (Rosenberg); appearance-related concerns; perceived social support; and social anxiety. Results Overall, participants were very similar in psychosocial function to the general population. However, adults with craniofacial conditions were less likely to be married and have children (females), were more likely to be receiving a disability pension, and reported more appearance-related concerns and less social support from friends. They also reported more limitations in both their social activities, due to physical or emotional problems, and usual role activities, because of emotional problems, as well as poorer mental health. Conclusions These results give cause to be very positive about the long-term outcomes of children who are undergoing treatment for craniofacial conditions, while also identifying specific areas that interventions could target.
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Affiliation(s)
- R.M. Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - J.L. Mathias
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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