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Afaya A, Kim SW, Park HS, Lim MC, Jung MS, Nam EJ, Park JS, Jeong J, Ryu JM, Kim J, Kim J, Kim M, Jin J, Han J, Kim SY, Park SY, Katapodi MC, Kim S. Psychosocial barriers and facilitators for cascade genetic testing in hereditary breast and ovarian cancer: a scoping review. Fam Cancer 2024; 23:121-132. [PMID: 38662264 DOI: 10.1007/s10689-024-00379-y] [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: 08/14/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Despite increased awareness and availability of genetic testing for hereditary breast and ovarian cancer (HBOC) syndrome for over 20 years, there is still significant underuse of cascade genetic testing among at-risk relatives. This scoping review synthesized evidence regarding psychosocial barriers and facilitators of family communication and/or uptake of cascade genetic testing in relatives from HBOC families. Search terms included 'hereditary breast and ovarian cancer' and 'cascade genetic testing' for studies published from 2012-2022. Through searching common databases, and manual search of references, 480 studies were identified after excluding duplications. Each article was reviewed by two researchers independently and 20 studies were included in the final analysis. CASP, RoBANS 2.0, RoB 2.0, and MMAT were used to assess the quality of included studies. A convergent data synthesis method was used to integrate evidence from quantitative and narrative data into categories and subcategories. Evidence points to 3 categories and 12 subcategories of psychosocial barriers and facilitators for cascade testing: (1) facilitators (belief in health protection and prevention; family closeness; decisional empowerment; family support, sense of responsibility; self-efficacy; supportive health professionals); (2) bidirectional concepts (information; perception of genetic/cancer consequences; negative emotions and attitude); and (3) barriers (negative reactions from family and negative family dynamics). Healthcare providers need to systematically evaluate these psychosocial factors, strengthen facilitators and alleviate barriers to promote informed decision-making for communication of genetic test results and uptake of genetic testing. Bidirectional factors merit special consideration and tailored approaches, as they can potentially have a positive or negative influence on family communication and uptake of genetic testing.
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Affiliation(s)
- Agani Afaya
- College of Nursing, Yonsei University, Seoul, Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sung-Won Kim
- Department of Breast Surgery, Breast Care Center, Dairim St. Mary's Hospital, Seoul, Korea
| | - Hyung Seok Park
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myong Cheol Lim
- Division of Tumor Immunology, Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Mi Sook Jung
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Eun Ji Nam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Hereditary Cancer Clinic, Cancer Prevention Center, Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JiSun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihye Kim
- College of Nursing, Yonsei University, Seoul, Korea
| | | | - Juhye Jin
- Department of Nursing, Korea National University of Transportation, Jeungpyeong, Korea
| | - Jeehee Han
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Soo Yeon Kim
- College of Nursing, Yonsei University, Seoul, Korea
- Korea Armed Forces Nursing Academy, Daejeon, Korea
| | - Sun-Young Park
- College of Nursing, Daegu Catholic University, Daegu, South Korea
| | - Maria C Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sue Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea.
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Allen CG, McBride CM, Escoffery C, Guan Y, Hood C, Zaho J, Brody G, An W. Developing and assessing a kin keeping scale with application to identifying central influencers in African American family networks. J Community Genet 2023; 14:593-603. [PMID: 37648941 PMCID: PMC10725405 DOI: 10.1007/s12687-023-00665-9] [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] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
Promoting family communication about inherited disease risk is an arena in which family systems theory is highly relevant. One family systems' construct that can support promotion of family communication regarding inherited disease risk is the notion of "kin keeping." However, kin keeping and whether it might be capitalized on to encourage family communication about inherited risk has been understudied. The goal of this report was to propose a broadened conceptualization of kin keeping that distinguishes between a structural functional perspective (role conceptualization) and transitional behaviors (skill conceptualization), and to develop and evaluate a scale that would enable this assertion to be tested among a sample of African American community health workers. We developed a scale using four steps: item development using concept analysis and content validity, scale development among a national sample (n = 312), scale evaluation using exploratory factor analysis (n = 52), and scale reduction. We then posed suppositions of associations that would indicate whether the developed kin keeping measure was assessing a specific family role or set of behaviors. Our results included the development of the first quantitative measure of kin keeping (9- and 15-item scales). Model fit for 9-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.09, SMRM = 0.06) and model fit for 15-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.06, SMRM = 0.05). These findings allow us to move toward more rigorous research about the role of kin keeping on information sharing and health decision making. Results also suggest that, contrary to the historical structural functional conceptualization of kin keeping as a role, kin keeping might also be conceptualized as a behavior or set of modifiable behaviors. Ultimately, the kin keeping scale could be used to operationalize kin keeping in various theoretical models and frameworks, guide intervention development to encourage or train for kin keeping behaviors, and test assumptions of whether families vary in the density of kin keeping.
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Affiliation(s)
- Caitlin G Allen
- Medical University of South Carolina, Charleston, SC, USA.
- Emory University, Atlanta, GA, USA.
| | | | | | - Yue Guan
- Emory University, Atlanta, GA, USA
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Zhao J, McBride CM, Campbell GP, Pentz RD, Escoffery C, Konomos M, Bellcross C, Ward K, Shepperd JR, Guan Y. Your Family Connects: A Theory-Based Intervention to Encourage Communication about Possible Inherited Cancer Risk among Ovarian Cancer Survivors and Close Relatives. Public Health Genomics 2023; 26:77-89. [PMID: 37487468 PMCID: PMC10614520 DOI: 10.1159/000531772] [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: 12/16/2022] [Accepted: 06/26/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Encouraging family communication about possible genetic risk has become among the most important avenues for achieving the full potential of genomic discovery for primary and secondary prevention. Yet, effective family-wide risk communication (i.e., conveying genetic risk status and its meaning for other family members) remains a critical gap in the field. We aim to describe the iterative process of developing a scalable population-based communication outreach intervention, Your Family Connects, to reach ovarian cancer survivors and close relatives to communicate the potential for inherited risk and to consider genetic counseling. METHODS Relational-level theories (e.g., interdependence theory) suggest that interventions to promote family cancer risk communication will be most effective if they consider the qualities of specific relationships and activate motives to preserve the relationship. Informed by these theories, we collaborated with 14 citizen scientists (survivors of ovarian cancer or relatives) and collected 261 surveys and 39 structured interviews over 12 weeks of citizen science activities in 2020. RESULTS The citizen science findings and consideration of relational-level theories informed the content and implementation of Your Family Connects (www.yourfamilyconnects.org). CS results showed survivors favor personal contact with close relatives, but relatives were open to alternative contact methods, such as through health professionals. Recognizing the need for varied approaches based on relationship dynamics, we implemented a relative contact menu to enable survivors identify at-risk relatives and provide multiple contact options (i.e., survivor contact, health professional contact, and delayed contact). In line with relational autonomy principles, we included pros and cons for each option, assisting survivors in choosing suitable contact methods for each relative. DISCUSSION Our developed intervention represents a novel application of relational-level theories and partnership with citizen scientists to expand genetic services reach to increase the likelihood for fair distribution of cancer genomic advances. The Your Family Connects intervention as part of a randomized trial in collaboration with the Georgia Cancer Registry compared with standard outreach.
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Affiliation(s)
- Jingsong Zhao
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA,
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Gavin P Campbell
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Rebecca D Pentz
- Department of Hematology and Oncology, Emory School of Medicine, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | | | | | - Kevin Ward
- Georgia Center for Cancer Statistics, Emory University, Atlanta, Georgia, USA
| | - James R Shepperd
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia, USA
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Zhao J, Guan Y, McBride CM. A systematic review of theory-informed strategies used in interventions fostering family genetic risk communication. PATIENT EDUCATION AND COUNSELING 2022; 105:1953-1962. [PMID: 35304074 PMCID: PMC9203975 DOI: 10.1016/j.pec.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Inherited risk is a family issue. Identifying family members who carry a pathogenic genetic variant that increases risk of cancers and other chronic diseases can be lifesaving for those affected. OBJECTIVE The research questions are: (1) which family communication frameworks have been applied, (2) how do intervention strategies employed map to these theories, and (3) to what extent were families receptive to these strategies and communication increased? METHODS Manuscripts published between January 2010 and August 2020 were searched in three databases: PubMed, PsycINFO, and Web of Science. RESULTS Nine intervention trials were identified. All interventions were evaluated in clinical genetic counseling contexts using at least one individual-level strategy (e.g. increase knowledge). Only three focused on dyadic conversations such as preparing for relatives' information needs. CONCLUSIONS This systematic review posed the question whether theoretically based approaches have been applied to foster family genetic risk communication. Greater attention needs to be paid to the utilization of dyadic level and family system level theories to guide intervention developments. PRACTICAL IMPLICATIONS We conclude by calling for accelerating and broadening the development of interventions to enable family communication about inherited risk that are theory-based, incorporate family-systems thinking, and are conducted outside of specialty clinic settings.
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Affiliation(s)
- Jingsong Zhao
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA.
| | - Yue Guan
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social and Health Education Sciences, Emory University, GA, USA
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Differding M, Katz SJ, Strayer LG, White C, Strasser AA, Donny EC, Hatsukami DK, Carroll DM. Educating the Public on the Health Risks of Very Low Nicotine Content Cigarettes: Results From a US-Based Convenience Sample. Nicotine Tob Res 2022; 24:871-880. [PMID: 35023564 PMCID: PMC9048884 DOI: 10.1093/ntr/ntac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION US FDA issued an advance notice of proposed rulemaking to reduce nicotine in cigarettes. To maximize the benefits of this potential standard, very low nicotine content (VLNC) cigarettes must be communicated in a way that does not result in misperceptions. AIMS AND METHODS Adults (n = 567 who smoke; n = 610 non-smokers) from an online platform were randomized to a control message previously associated with accurate addictiveness perceptions of VLNC cigarettes but health misperceptions or to one of five messages that also included messaging on nicotine morbidity effects or VLNC cigarettes morbidity or mortality effects. p value <.01 was significant. RESULTS In participants who smoke, perceived lung cancer risk (responses: 1, very little risk to 10, very high risk) if smoked VLNC cigarettes regularly was higher in conditions that communicated mortality effects of VLNC cigarettes compared to the control (7.12-7.18 vs. 5.97, p values < .01). In non-smokers, perceived lung cancer risk was higher in all five message conditions when compared with the control (7.58-8.22 vs. 6.35, p values < .01). Proportion who responded accurately (ie, False) to the statement Cigarettes with 95% less nicotine are safer than cigarettes with normal nicotine levels was higher in conditions describing VLNC morbidity or mortality effects when compared with the control in both participants who smoke (52.04-67.37% vs. 30.85%, p values < .01) and do not smoke (62.50-72.38% vs. 32.00%, p values < .01). CONCLUSIONS Messaging on mortality effects of VLNC cigarettes (ie, cigarettes with 95% less nicotine are as deadly as current cigarettes) was associated with more accurate perceptions of the health risks of VLNC cigarettes than the control; however, misperceptions remained in one-third of participants. IMPLICATIONS One approach to communicating a VLNC cigarette standard to the public is to include messaging on the mortality effects of VLNC cigarettes. However, further study and possible refinement of this message condition are recommended since approximately one-third of participants exposed to this message still perceived VLNC cigarettes to be safer than normal nicotine content cigarettes.
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Affiliation(s)
| | - Sherri Jean Katz
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Lori G Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Cassidy White
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Dana Mowls Carroll
- Corresponding Author: Dana Mowls Carroll, MPH, PhD, Division of Environmental Health Sciences, School of Public Health, Masonic Cancer Center, University of Minnesota, 717 Delaware St SE, Room 254, Minneapolis, MN 55414, USA. Telephone: 612-624-0132; E-mail:
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Wilsnack C, Young JL, Merrill SL, Groner V, Loud JT, Bremer RC, Greene MH, Khincha PP, Werner-Lin A. Family Identity and Roles in the Context of Li-Fraumeni Syndrome: "No One's Like Us Mutants". HEALTH & SOCIAL WORK 2021; 46:299-307. [PMID: 34618014 PMCID: PMC8783604 DOI: 10.1093/hsw/hlab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 06/13/2023]
Abstract
Li-Fraumeni syndrome (LFS) is a rare hereditary cancer syndrome in which individuals have a significantly increased risk of developing multiple cancers throughout the life span. An LFS diagnosis may shift the individual's sense of self and tolerance of cancer risk as they engage in cancer screening and cancer prevention activities. This study examined the impact of family identity on health decision making, communication, and role function. Forty-five families completed one or more interviews during an annual, protocol-specific cancer screening study. An interdisciplinary team analyzed 66 interviews using interpretive description and modified grounding theory. Thematically, identity emerged as an evolving construct regarding self and/or family, embedded in historical and ongoing experiences with LFS. Notions of individual and shared family identities guided decision making related to healthcare and influenced interpersonal communication and role function between supportive networks and families. Alignment between individual, family, and generational identities may shape engagement in genetic testing, risk management, and family life. Medical teams that are unequipped to address the psychosocial challenges that LFS populations face may include mental health professionals on interprofessional care teams to navigate risk management and consequential familial conflict.
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Dean M, Tezak AL, Johnson S, Pierce JK, Weidner A, Clouse K, Pal T, Cragun D. Sharing genetic test results with family members of BRCA, PALB2, CHEK2, and ATM carriers. PATIENT EDUCATION AND COUNSELING 2021; 104:720-725. [PMID: 33455826 PMCID: PMC8005459 DOI: 10.1016/j.pec.2020.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 12/05/2020] [Accepted: 12/22/2020] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study explored motivators and challenges/barriers to sharing personal genetic test results (GTR) with family members (FM). METHODS Semi-structured, in-depth interviews were conducted with 62 women who had a pathogenic or likely pathogenic (P/LP) variant in aBRCA, PALB2, CHEK2, or ATM gene. Selective qualitative data analysis focused on eliciting motivators and challenges/barriers identified by participants when sharing their GTR with FM. RESULTS Motivators to sharing personal GTR with FM included: health protection and prevention; moral obligation; decisional empowerment; familial ties; written resources; and contextualization for a familial cause for cancer. Challenges/barriers to family sharing included: concern for FM reactions; complexities of information; lack of closeness; perceived relevance; and emotional impact. CONCLUSIONS All motivators and challenges/barriers were identified across BRCA and non-BRCA carriers, demonstrating commonalities in family sharing of GTR among high- to moderate-penetrance hereditary BC (breast cancer) genes. Despite challenges/barriers, participants disclosed their GTR with most close FM, yet restrictions in communication and/or strain on the timing, manner of disclosing, and strategies used varied across certain FM. PRACTICE IMPLICATIONS These findings offer healthcare providers and researchers preliminary practical implications for broadly improving family sharing interventions across P/LP variants in BC risk genes by demonstrating important elements to include in family sharing letters.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL, USA.
| | - Ann L Tezak
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sabrina Johnson
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Joy K Pierce
- Cleveland Clinic, Indian River Hospital, Vero Beach, FL, USA
| | - Anne Weidner
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kate Clouse
- Department of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
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Martin CL, Wain KE, Oetjens MT, Tolwinski K, Palen E, Hare-Harris A, Habegger L, Maxwell EK, Reid JG, Walsh LK, Myers SM, Ledbetter DH. Identification of Neuropsychiatric Copy Number Variants in a Health Care System Population. JAMA Psychiatry 2020; 77:1276-1285. [PMID: 32697297 PMCID: PMC7376464 DOI: 10.1001/jamapsychiatry.2020.2159] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Population screening for medically relevant genomic variants that cause diseases such as hereditary cancer and cardiovascular disorders is increasing to facilitate early disease detection or prevention. Neuropsychiatric disorders (NPDs) are common, complex disorders with clear genetic causes; yet, access to genetic diagnosis is limited. We explored whether inclusion of NPD in population-based genomic screening programs is warranted by assessing 3 key factors: prevalence, penetrance, and personal utility. OBJECTIVE To evaluate the suitability of including pathogenic copy number variants (CNVs) associated with NPD in population screening by determining their prevalence and penetrance and exploring the personal utility of disclosing results. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the frequency of 31 NPD CNVs was determined in patient-participants via exome data. Associated clinical phenotypes were assessed using linked electronic health records. Nine CNVs were selected for disclosure by licensed genetic counselors, and participants' psychosocial reactions were evaluated using a mixed-methods approach. A primarily adult population receiving medical care at Geisinger, a large integrated health care system in the United States with the only population-based genomic screening program approved for medically relevant results disclosure, was included. The cohort was identified from the Geisinger MyCode Community Health Initiative. Exome and linked electronic health record data were available for this cohort, which was recruited from February 2007 to April 2017. Data were collected for the qualitative analysis April 2017 through February 2018. Analysis began February 2018 and ended December 2019. MAIN OUTCOMES AND MEASURES The planned outcomes of this study include (1) prevalence estimate of NPD-associated CNVs in an unselected health care system population; (2) penetrance estimate of NPD diagnoses in CNV-positive individuals; and (3) qualitative themes that describe participants' responses to receiving NPD-associated genomic results. RESULTS Of 90 595 participants with CNV data, a pathogenic CNV was identified in 708 (0.8%; 436 women [61.6%]; mean [SD] age, 50.04 [18.74] years). Seventy percent (n = 494) had at least 1 associated clinical symptom. Of these, 28.8% (204) of CNV-positive individuals had an NPD code in their electronic health record, compared with 13.3% (11 835 of 89 887) of CNV-negative individuals (odds ratio, 2.21; 95% CI, 1.86-2.61; P < .001); 66.4% (470) of CNV-positive individuals had a history of depression and anxiety compared with 54.6% (49 118 of 89 887) of CNV-negative individuals (odds ratio, 1.53; 95% CI, 1.31-1.80; P < .001). 16p13.11 (71 [0.078%]) and 22q11.2 (108 [0.119%]) were the most prevalent deletions and duplications, respectively. Only 5.8% of individuals (41 of 708) had a previously known genetic diagnosis. Results disclosure was completed for 141 individuals. Positive participant responses included poignant reactions to learning a medical reason for lifelong cognitive and psychiatric disabilities. CONCLUSIONS AND RELEVANCE This study informs critical factors central to the development of population-based genomic screening programs and supports the inclusion of NPD in future designs to promote equitable access to clinically useful genomic information.
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Affiliation(s)
- Christa Lese Martin
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Karen E. Wain
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Matthew T. Oetjens
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Kasia Tolwinski
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania,Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Emily Palen
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | | | - Scott M. Myers
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | - David H. Ledbetter
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
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Zimmermann BM, Shaw D, Heinimann K, Knabben L, Elger B, Koné I. How the "control-fate continuum" helps explain the genetic testing decision-making process: a grounded theory study. Eur J Hum Genet 2020; 28:1010-1019. [PMID: 32203201 PMCID: PMC7381626 DOI: 10.1038/s41431-020-0602-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022] Open
Abstract
Genetic testing decision-making for cancer predisposition is inherently complex. Understanding the mechanisms and influencing factors of the decision-making process is essential for genetic counselling and has not yet been investigated in Switzerland. This study's aim is thus to provide a theory about the individual's decision-making process regarding genetic testing for cancer predispositions in order to provide medical geneticists and genetic counsellors with insights into the needs and expectations of counsellees. We interviewed at-risk individuals who underwent genetic counselling in a clinical setting in Switzerland, using a grounded theory approach. Based on the interview data, we propose that a control-fate continuum, which is part of the individuals' life philosophy, importantly influences the decision-making process. Those in need for control decide differently compared with those leaving their future to fate. Several psychosocial factors influence the position on the control-fate continuum: "looking for certainty"; "anticipating consequences"; "being socially influenced"; "simplifying risks"; and "deciding intuitively vs reflectively". The control-fate continuum theory gives insights into the possible reasons behind decision-making regarding genetic testing for cancer predispositions. It includes both acceptors and decliners of genetic testing. Our theory helps healthcare professionals offering genetic counselling to anticipate problems within at-risk families and adapting their services to people's needs.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Human Genomics, University of Basel, Basel, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Maves H, Flodman P, Nathan D, Smith M. Ethnic disparities in the frequency of cancer reported in family histories. J Genet Couns 2020; 29:451-459. [DOI: 10.1002/jgc4.1264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Heather Maves
- Division of Genetic and Genomic Medicine Department of Pediatrics University of California, Irvine Irvine California
| | - Pamela Flodman
- Division of Genetic and Genomic Medicine Department of Pediatrics University of California, Irvine Irvine California
| | - Deepika Nathan
- Division of Genetic and Genomic Medicine Department of Pediatrics University of California, Irvine Irvine California
| | - Moyra Smith
- Division of Genetic and Genomic Medicine Department of Pediatrics University of California, Irvine Irvine California
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Young AL, Butow PN, Tucker KM, Wakefield CE, Healey E, Williams R. Challenges and strategies proposed by genetic health professionals to assist with family communication. Eur J Hum Genet 2019; 27:1630-1638. [PMID: 31189929 PMCID: PMC6871519 DOI: 10.1038/s41431-019-0447-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022] Open
Abstract
Hereditary genetic conditions have implications for the whole family and therefore genetic health professionals (GHPs) interact with multiple family members, sometimes individually and sometimes in aggregate. Family communication is important to ensure dissemination of genetic information to potentially affected relatives and to facilitate supportive family interactions around genetic testing and risk management decisions. Yet, little is known about how GHPs perceive and manage these interactions. A total of 73 GHPs working across Australian cancer genetic clinics participated in semi-structured focus groups or interviews to elucidate what aspects of family communication they found most challenging, the strategies they used, and whether current academic training provides sufficient guidance to address familial concerns. Patients' lack of understanding about the importance of communicating genetic information to at-risk relatives was the most common challenge reported. GHPs reported that the patients' concern for their families' emotional responses as well as wider family system challenges (e.g. estrangement) affected family communication. Common strategies during consultations included structuring appointments logistically to account for family dynamics and post-consultation use of family letters and follow-up appointments. GHPs generally felt equipped with the skills and training provided to address patient concerns, but also desired upskilling in techniques relating to systemic family issues and behavioural change. Reflective practice strategies were requested by geneticists and nurses to foster therapeutic skill usage. Additional family therapy training while on the job may be beneficial in order to meet current challenges faced in clinical practice and can be provided as further professional development.
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Affiliation(s)
- Alison L Young
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia.
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Phyllis N Butow
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Rachel Williams
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
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12
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Alegre N, Perre PV, Bignon YJ, Michel A, Galibert V, Mophawe O, Corsini C, Coupier I, Chiesa J, Robert L, Bernhard L, Picot M, Bertet H, Macioce V, Bastide N, Solassol J, Rey JM, Thomas F, Carton S, Pujol P. Psychosocial and clinical factors of probands impacting intrafamilial disclosure and uptake of genetic testing among families with
BRCA1/2
or MMR gene mutations. Psychooncology 2019; 28:1679-1686. [DOI: 10.1002/pon.5142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Nathalie Alegre
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Pierre Vande Perre
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
- Université Toulouse III Paul Sabatier Toulouse France
| | - Yves Jean Bignon
- Laboratoire d'Oncologie moléculaire, CLCC Jean Perrin Clermont‐Ferrand France
| | - Aude Michel
- Département de PsychologieUniversité Montpellier III Montpellier France
| | - Virginie Galibert
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Ornellia Mophawe
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Carole Corsini
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Isabelle Coupier
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Jean Chiesa
- Département de Génétique médicale et cytogénétiqueCentre Hospitalier Universitaire Nîmes Nîmes France
| | - Laura Robert
- Laboratoire d'Oncologie moléculaire, CLCC Jean Perrin Clermont‐Ferrand France
| | - Lydie Bernhard
- Département de Génétique médicale et cytogénétiqueCentre Hospitalier Universitaire Nîmes Nîmes France
| | - Marie‐Christine Picot
- Unité de Recherche Clinique & Epidémiologie, DIMCentre Hospitalier Universitaire Montpellier Montpellier France
- Clinical Investigation Centre, INSERM U1411 Montpellier France
| | - Héléna Bertet
- Unité de Recherche Clinique & Epidémiologie, DIMCentre Hospitalier Universitaire Montpellier Montpellier France
| | - Valérie Macioce
- Unité de Recherche Clinique & Epidémiologie, DIMCentre Hospitalier Universitaire Montpellier Montpellier France
| | | | - Jérôme Solassol
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Jean Marc Rey
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
| | - Frédéric Thomas
- Centre de Recherches Écologiques et Évolutives sur le Cancer Montpellier France
| | - Solange Carton
- Département de PsychologieUniversité Montpellier III Montpellier France
| | - Pascal Pujol
- Unité d'Oncogénétique, Hôpital Arnaud de VilleneuveCentre Hospitalier Universitaire Montpellier MIVEGEC, Montpellier France
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13
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Himes DO, Gibbons DK, Birmingham WC, Beckstrand RL, Gammon A, Kinney AY, Clayton MF. Female family members lack understanding of indeterminate negative BRCA1/2 test results shared by probands. J Genet Couns 2019; 28:950-961. [PMID: 31199558 DOI: 10.1002/jgc4.1147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/10/2022]
Abstract
Genetic test results have important implications for close family members. Indeterminate negative results are the most common outcome of BRCA1/2 mutation testing. Little is known about family members' understanding of indeterminate negative BRCA1/2 test results. The purpose of this mixed-methods study was to investigate how daughters and sisters received and understood genetic test results as shared by their mothers or sisters. Participants included 81 women aged 40-74 with mothers or sisters previously diagnosed with breast cancer and who received indeterminate negative BRCA1/2 test results. Participants had never been diagnosed with breast cancer nor received their own genetic testing or counseling. This Institutional Review Board-approved study utilized semi-structured interviews and surveys. Descriptive coding with theme development was used during qualitative analysis. Participants reported low amounts of information shared with them. Most women described test results as negative and incorrectly interpreted the test to mean there was no genetic component to the pattern of cancer in their families. Only seven of 81 women accurately described test results consistent with the meaning of an indeterminate negative. Our findings demonstrate that indeterminate negative genetic test results are not well understood by family members. Lack of understanding may lead to an inability to effectively communicate results to primary care providers and missed opportunities for prevention, screening, and further genetic testing. Future research should evaluate acceptability and feasibility of providing family members letters they can share with their own primary care providers.
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Affiliation(s)
| | | | | | | | - Amanda Gammon
- Department of Genetic Counseling, Huntsman Cancer Institute, Salt Lake City, Utah.,Graduate Program in Genetic Counseling, University of Utah, Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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14
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Allen C, Escoffery C, Haardörfer R, McBride C. Factors Influencing Not Perceiving Family Health History Assessments as Important: Opportunities to Improve Dissemination of Evidence-Based Population Screening for Cancer. Public Health Genomics 2019; 21:144-153. [DOI: 10.1159/000499125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
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15
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Ersig AL, Werner-Lin A, Hoskins L, Young J, Loud JT, Peters J, Greene MH. Legacies and Relationships: Diverse Social Networks and BRCA1/2 Risk Management Decisions and Actions. JOURNAL OF FAMILY NURSING 2019; 25:28-53. [PMID: 30537877 PMCID: PMC6581043 DOI: 10.1177/1074840718815844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In families with hereditary breast/ovarian cancer, complex disease histories challenge established patterns of family communication and influence decision-making for clinical surveillance, genetic testing, and risk management. An interdisciplinary team examined longitudinal interview data from women with identified BRCA1/2 mutations to assess interactions within family and social networks about risk information communication and management. We used interpretive description to identify motivation, content, and derived benefit of these interactions. Participants discussed risk information and management strategies with biological and nonbiological network members for multiple purposes: discharging responsibility for risk information dissemination, protecting important relationships, and navigating decision trajectories. Evolving interactions with loved ones balanced long-standing family communication patterns with differing personal preferences for privacy or open sharing, whereas interactions with nonbiological network members expanded participants' range of choices for sources of risk management information. Ongoing assessment of social networks may help support engagement with risk management by aligning with patient social needs.
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Affiliation(s)
| | | | | | | | | | - June Peters
- National Institutes of Health, Bethesda, MD, USA
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16
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Young AL, Butow PN, Rhodes P, Tucker KM, Williams R, Healey E, Wakefield CE. Talking across generations: Family communication about BRCA1
and BRCA2
genetic cancer risk. J Genet Couns 2019; 28:516-532. [DOI: 10.1002/jgc4.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alison Luk Young
- School of Psychology; The University of Sydney; Sydney NSW Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
| | - Phyllis N. Butow
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Paul Rhodes
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Katherine M. Tucker
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital; Wollongong NSW Australia
| | - Claire E. Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
- School of Women’s and Children’s Health; University of New South Wales; Sydney NSW Australia
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17
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Forbes Shepherd R, Browne TK, Warwick L. A Relational Approach to Genetic Counseling for Hereditary Breast and Ovarian Cancer. J Genet Couns 2016; 26:283-299. [PMID: 27761849 DOI: 10.1007/s10897-016-0022-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
Abstract
Ethical issues arise for genetic counselors when a client fails to disclose a genetic diagnosis of hereditary disease to family: they must consider the rights of the individual client to privacy and confidentiality as well as the rights of the family to know their genetic risk. Although considerable work has addressed issues of non-disclosure from the client's perspective, there is a lack of qualitative research into how genetic counselors address this issue in practice. In this study, a qualitative approach was taken to investigate whether genetic counselors in Australia use a relational approach to encourage the disclosure of genetic information from hereditary breast and ovarian cancer (HBOC) clients among family members; and if so, how they use it. Semi-structured qualitative interviews were conducted with 16 genetic counselors from selected states across Australia. Data collection and analysis were guided by a basic iterative approach incorporating a hybrid methodology to thematic analysis. The findings provide indicative evidence of genetic counselors employing a relational approach in three escalating stages--covert, overt and authoritative--to encourage the disclosure of genetic information. The findings lend credence to the notion that genetic counselors envision a form of relational autonomy for their clients in the context of sharing genetic information, and they depart from individualistic conceptions of care/solely client-centered counseling when addressing the needs of other family members to know their genetic status.
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Affiliation(s)
- Rowan Forbes Shepherd
- Research School of Biology, Australian National University, Canberra, ACT, Australia.
- Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Tamara Kayali Browne
- Research School of Biology, Australian National University, Canberra, ACT, Australia.
- Centre for Applied Philosophy and Public Ethics, Charles Sturt University, Canberra, ACT, Australia.
| | - Linda Warwick
- ACT Genetic Service, ACT Health, Canberra, ACT, Australia
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18
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Peters JA, Kenen R, Bremer R, Givens S, Savage SA, Mai PL. Easing the Burden: Describing the Role of Social, Emotional and Spiritual Support in Research Families with Li-Fraumeni Syndrome. J Genet Couns 2015; 25:529-42. [PMID: 26621765 DOI: 10.1007/s10897-015-9905-x] [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: 06/10/2015] [Accepted: 10/19/2015] [Indexed: 01/10/2023]
Abstract
This study presents findings of a mixed-method descriptive exploration of the role of friends and spirituality/religiosity in easing the burden of families with the rare inherited disorder, Li-Fraumeni Syndrome (LFS). LFS is caused by germline mutations in the TP53 gene and is associated with very high lifetime risk of developing one or more malignancies. During the first clinical visit we assessed several types of social support among a subset of study participants (N = 66) using an established interactive research tool called the Colored Eco-Genetic Relationship Map (CEGRM). We performed both quantitative and qualitative analyses of social relationships with LFS family members and close non-kin. Distress scores (N = 59) were mostly low normal, with some outliers. We found that reported friendships varied widely, that the friendships were often deep and enduring, and were important sources of informational, tangible, emotional and spiritual support. Confidantes tended to be best friends and/or spouses. Organized religion was important in selected families, typically from mainstream traditions. However, a number of people identified themselves as "spiritual" and reported spiritual and humanist explorations. Our results shed preliminary light on how some people in families with LFS cope in the face of tremendous medical, social and emotional challenges.
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Affiliation(s)
- June A Peters
- Clinical Genetics Branch (CGB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), NIH, DHHS, Rockville, MD, USA.
| | - Regina Kenen
- Department of Sociology and Anthropology, The College of New Jersey, Ewing, NJ, USA
| | - Renee Bremer
- Clinical Genetics Branch (CGB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), NIH, DHHS, Rockville, MD, USA
| | - Shannon Givens
- Clinical Genetics Branch (CGB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), NIH, DHHS, Rockville, MD, USA
| | - Sharon A Savage
- Clinical Genetics Branch (CGB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), NIH, DHHS, Rockville, MD, USA
| | - Phuong L Mai
- Clinical Genetics Branch (CGB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), NIH, DHHS, Rockville, MD, USA
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19
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Patients’ Attitudes Towards Disclosure of Genetic Test Results to Family Members: The Impact of Patients’ Sociodemographic Background and Counseling Experience. J Genet Couns 2015; 25:314-24. [DOI: 10.1007/s10897-015-9873-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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20
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Khan CM, Rini C, Bernhardt BA, Roberts JS, Christensen KD, Evans JP, Brothers KB, Roche MI, Berg JS, Henderson GE. How can psychological science inform research about genetic counseling for clinical genomic sequencing? J Genet Couns 2015; 24:193-204. [PMID: 25488723 PMCID: PMC4777349 DOI: 10.1007/s10897-014-9804-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/25/2014] [Indexed: 01/02/2023]
Abstract
Next generation genomic sequencing technologies (including whole genome or whole exome sequencing) are being increasingly applied to clinical care. Yet, the breadth and complexity of sequencing information raise questions about how best to communicate and return sequencing information to patients and families in ways that facilitate comprehension and optimal health decisions. Obtaining answers to such questions will require multidisciplinary research. In this paper, we focus on how psychological science research can address questions related to clinical genomic sequencing by explaining emotional, cognitive, and behavioral processes in response to different types of genomic sequencing information (e.g., diagnostic results and incidental findings). We highlight examples of psychological science that can be applied to genetic counseling research to inform the following questions: (1) What factors influence patients' and providers' informational needs for developing an accurate understanding of what genomic sequencing results do and do not mean?; (2) How and by whom should genomic sequencing results be communicated to patients and their family members?; and (3) How do patients and their families respond to uncertainties related to genomic information?
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Affiliation(s)
- Cynthia M Khan
- Department of Health Behavior, University of North Carolina-Chapel Hill, 312 Rosenau Hall, CB#7440, Chapel Hill, NC, 27599-7440, USA,
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21
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Heiniger L, Price MA, Charles M, Butow PN. Facilitators and Challenges in Psychosocial Adaptation to Being at Increased Familial Risk of Breast Cancer. J Genet Couns 2015; 24:890-907. [PMID: 25735441 DOI: 10.1007/s10897-015-9824-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
Little is known about the process of psychosocial adaptation to familial risk in tested and untested individuals at increased familial risk of cancer. This paper presents findings from a qualitative study of 36 women participating in the Kathleen Cuningham Consortium for Research into Familial Breast cancer (kConFab) Psychosocial study. Facilitators and challenges in psychosocial adaptation were identified through semi-structured interviews. The women, who were either tested (carriers or non-carriers of breast cancer susceptibility mutations) or untested (ineligible for testing or eligible but delayed or declined testing), described personal, support network and healthcare characteristics that impacted on the adaptation process. Challenges in one domain could be overcome by facilitators in other domains and key differences relating to whether women had undergone testing, or not, were identified. Tested and untested women with an increased familial risk of breast cancer may benefit from support tailored to their mutation testing status in order to enhance adaptation.
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Affiliation(s)
- Louise Heiniger
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), NSW, 2006, Sydney, Australia. .,School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia.
| | - Melanie A Price
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), NSW, 2006, Sydney, Australia.,School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia
| | - Margaret Charles
- School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia
| | - Phyllis N Butow
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), NSW, 2006, Sydney, Australia.,School of Psychology, University of Sydney, NSW, 2006, Sydney, Australia
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22
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Wolf SM, Branum R, Koenig BA, Petersen GM, Berry SA, Beskow LM, Daly MB, Fernandez CV, Green RC, LeRoy BS, Lindor NM, O'Rourke PP, Breitkopf CR, Rothstein MA, Van Ness B, Wilfond BS. Returning a Research Participant's Genomic Results to Relatives: Analysis and Recommendations. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:440-63. [PMID: 26479555 PMCID: PMC4617203 DOI: 10.1111/jlme.12288] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.
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Affiliation(s)
- Susan M Wolf
- McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; Professor of Medicine; Faculty member, Center for Bioethics; and Chair, Consortium on Law and Values in Health, Environment & the Life Sciences at the University of Minnesota. She is one of three Principal Investigators on NIH/NCI/NHGRI grant 1-R01-CA154517 on return of genomic results to family members, including after the death of the proband
| | - Rebecca Branum
- Policy director at the Minnesota State College Student Association and previously served as a Research Associate at the University of Minnesota's Consortium on Law and Values in Health, Environment & the Life Sciences
| | - Barbara A Koenig
- Professor of Bioethics and Medical Anthropology based at the Institute for Health & Aging, University of California, San Francisco. Currently, she co-directs a Center of Excellence in ELSI Research focused on translational genomics, co-leads an NCI/NHGRI R01 on return of results in genomic biobanks, and directs the ELSI component of a U19 award focused on newborn screening in an era of whole genome analysis
| | - Gloria M Petersen
- Professor of Epidemiology in the Department of Health Sciences Research at Mayo Clinic College of Medicine in Rochester, Minnesota. She earned her Master's degree in Anthropology from University of Oregon, and Ph.D. in Anthropology from UCLA. She is a Founding Fellow of the American College of Medical Genetics and Genomics
| | - Susan A Berry
- Professor of Pediatrics & Genetics and Division Director for Genetics and Metabolism in the Department of Pediatrics, University of Minnesota. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, the Society for Inherited Metabolic Disease, and the American Society of Human Genetics, and is a Fellow of the American Academy of Pediatrics and the American College of Medical Genetics
| | - Laura M Beskow
- Associate Professor at the Duke University School of Medicine and Duke Clinical Research Institute, where her work focuses on ethics and policy issues in biomedical research - particularly human subjects issues in large-scale genomic and translational research. She holds a B.S. in nutrition from Iowa State University, an M.P.H. with a concentration in health law from Boston University, and a Ph.D. in health policy and administration from the University of North Carolina at Chapel Hill
| | - Mary B Daly
- Medical oncologist and epidemiologist who chairs the Department of Clinical Genetics at Fox Chase Cancer Center. Her research focuses on defining the best methods of communicating hereditary cancer risk information and on providing risk management strategies and coping skills to family members dealing with an increased risk for cancer
| | - Conrad V Fernandez
- Professor and Head of the Division of Pediatric Hematology/Oncology in the Department of Pediatrics, IWK Health Centre, Dalhousie University and is cross-appointed in Bioethics, Medicine, and Postgraduate Studies. He obtained his Hon. B.Sc. at the University of Western Ontario, his medical degree at McMaster University, specialist certification in Pediatrics as a Fellow of the Royal College of Physicians and Surgeons of Canada at Dalhousie University, and completed specialty training in Pediatric Hematology/Oncology at the University of British Columbia
| | - Robert C Green
- Medical geneticist and physician-scientist who directs the G2P Research Program in translational genomics and health outcomes in the Division of Genetics, Brigham and Women's Hospital and Harvard Medical School. He is also Associate Director for Research at Partners Personalized Medicine. Dr. Green leads and co-leads the MedSeq Project and the BabySeq Project respectively, two NIH-funded randomized trials designed to explore the medical, behavioral, and economic implications of integrating genome sequencing into the medical care of adults and newborns
| | - Bonnie S LeRoy
- Professor and Director of the Graduate Program in Genetic Counseling, University of Minnesota. The primary focus of her work is on preparing graduate students to enter the profession of genetic counseling. Her research examines the ethical and social challenges associated with the genetic counseling profession. Prof. LeRoy served as the President of the American Board of Genetic Counseling from 2001-03
| | - Noralane M Lindor
- Professor of Medical Genetics in the Department of Health Sciences Research at Mayo Clinic in Scottsdale, Arizona. She received her Bachelor of Arts degree from the University of Minnesota, her doctorate of medicine from Mayo Medical School in Rochester, Minnesota, and did her residencies at Bowman Gray School of Medicine in Winston-Salem, North Carolina, and at Mayo Clinic in Rochester
| | - P Pearl O'Rourke
- Director of Human Research Affairs at Partners HealthCare in Boston, and Associate Professor of Pediatrics at Harvard Medical School. She received her B.A. from Yale University, and completed medical school at Dartmouth Medical School and the University of Minnesota Medical School
| | - Carmen Radecki Breitkopf
- Associate Professor of Health Services Research in the Department of Health Sciences Research at Mayo Clinic College of Medicine in Rochester, Minnesota. She earned her Master's and Doctoral degrees in Psychology from the State University of New York at Albany
| | - Mark A Rothstein
- Herbert F. Boehl Chair of Law & Medicine and Director of the Institute for Bioethics, Health Policy & Law, University of Louisville School of Medicine. From 1999-2008, he served as Chair of the Subcommittee on Privacy and Confidentiality of the National Committee on Vital and Health Statistics, the statutory advisory committee to the Secretary of Health and Human Services on health information policy. He is past-President of the American Society of Law, Medicine & Ethics and serves as Public Health Ethics editor for the American Journal of Public Health
| | - Brian Van Ness
- Professor of Genetics, Cell Biology and Development at the University of Minnesota. He earned his doctorate in Biochemistry from the University of Minnesota, completed a postdoctoral fellowship at Fox Chase Cancer Center in Philadelphia, and has served as the Department Head and Director of the Institute of Human Genetics at the University of Minnesota
| | - Benjamin S Wilfond
- Director of the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital; Professor and Chief of the Division of Bioethics; Professor, Pulmonary and Sleep Medicine, Department of Pediatrics; and Adjunct Professor, Department of Bioethics and Humanities, University of Washington School of Medicine. He is President of the Association of Bioethics Program Directors, Chair for the Clinical Research Ethics Consultation Working Group for the Clinical and Translational Science Awards program, and a member of the Bioethics and Legal Working Group of the Newborn Screening Translational Research Network
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Greene MH, Mai PL, Loud JT, Pathak A, Peters JA, Mirabello L, McMaster ML, Rosenberg P, Stewart DR. Familial testicular germ cell tumors (FTGCT) - overview of a multidisciplinary etiologic study. Andrology 2014; 3:47-58. [PMID: 25303766 DOI: 10.1111/andr.294] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/08/2014] [Accepted: 09/15/2014] [Indexed: 02/06/2023]
Abstract
This Review summarizes the cumulative results of the National Cancer Institute Clinical Genetics Branch Multidisciplinary Etiologic Study of Familial Testicular Germ Cell Tumors (FTGCT). Initiated 12 years ago, this protocol enrolled 724 subjects from 147 unrelated families with either ≥2 affected men (n = 90) with TGCT or a proband with bilateral TGCT and a negative family history for this cancer (n = 57). Data were collected directly from 162 subjects evaluated at the NIH Clinical Center, and 562 subjects provided information from their home communities (Field Cohort). The primary study aims included (i) ascertaining, enrolling eligible FTGCT kindred, (ii) characterizing the clinical phenotype of multiple-case families, (iii) identifying the underlying genetic mechanism for TGCT susceptibility in families, (iv) evaluating counseling, psychosocial, and behavioral issues resulting from membership in an FTGCT family, and (v) creating an annotated biospecimen repository to permit subsequent translational research studies. Noteworthy findings include (i) documenting the epidemiologic similarities between familial and sporadic TGCT, (ii) demonstrating significantly younger age-at-diagnosis for familial vs. sporadic TGCT, (iii) absence of a dysmorphic phenotype in affected family members, (iv) shifting the focus of gene discovery from a search for rare, highly penetrant susceptibility variants to the hypothesis that multiple, more common, lower penetrance genes underlie TGCT genetic risk, (v) implicating testicular microlithiasis in FTGCT risk, and (vi) observing that aberrant methylation may contribute to FTGCT risk. A clinically based, biospecimen-intensive, multidisciplinary research strategy has provided novel, valuable insights into the etiology of FTGCT, and created a research resource which will support FTGCT clinical and laboratory studies for years to come.
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Affiliation(s)
- M H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Kasparian NA, Rutstein A, Sansom-Daly UM, Mireskandari S, Tyler J, Duffy J, Tucker KM. Through the looking glass: an exploratory study of the lived experiences and unmet needs of families affected by Von Hippel-Lindau disease. Eur J Hum Genet 2014; 23:34-40. [PMID: 24690678 DOI: 10.1038/ejhg.2014.44] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/27/2014] [Accepted: 02/13/2014] [Indexed: 12/31/2022] Open
Abstract
Despite well-established protocols for the medical management of Von Hippel-Lindau disease (VHL), families affected by this rare tumour syndrome continue to face numerous psychological, social, and practical challenges. To our knowledge, this is one of the first qualitative studies to explore the psychosocial difficulties experienced by families affected by VHL. A semi-structured interview was developed to explore patients' and carers' experiences of VHL along several life domains, including: self-identity and self-esteem, interpersonal relationships, education and career opportunities, family communication, physical health and emotional well-being, and supportive care needs. Quantitative measures were also used to examine the prevalence of anxiety, depression, and disease-specific distress in this sample. Participants were recruited via the Hereditary Cancer Clinic at the Prince of Wales Hospital in Sydney, Australia. A total of 23 individual telephone interviews were conducted (15 patients, 8 carers), yielding a response rate of 75%. A diverse range of experiences were reported, including: sustained uncertainty about future tumour development, frustration regarding the need for lifelong medical screening, strained family relationships, difficulties communicating with others about VHL, perceived social isolation and limited career opportunities, financial and care-giving burdens, complex decisions in relation to childbearing, and difficulties accessing expert medical and psychosocial care. Participants also provided examples of psychological growth and resilience, and voiced support for continued efforts to improve supportive care services. More sophisticated systems for connecting VHL patients and their families with holistic, empathic, and person-centred medical and psychosocial care are urgently needed.
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Affiliation(s)
- Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Alison Rutstein
- 1] Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia [2] Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Ursula M Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Shab Mireskandari
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Janet Tyler
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Jessica Duffy
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
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Black L, McClellan KA, Avard D, Knoppers BM. Intrafamilial disclosure of risk for hereditary breast and ovarian cancer: points to consider. J Community Genet 2013; 4:203-14. [PMID: 23275181 PMCID: PMC3666841 DOI: 10.1007/s12687-012-0132-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 12/13/2012] [Indexed: 12/21/2022] Open
Abstract
The primary goal of breast and ovarian cancer screening is to minimize the cases of advanced disease and therefore its mortality rate. For hereditary breast and ovarian cancer, one method to reach this goal is to disseminate genetic risk information among family members. However, experience tells us that this information does not always reach family members in a timely manner, if at all. There are many moving parts to a decision to disclose genetic risk information within a family, and the lack of detail and cohesion in current guidelines do a disservice to hereditary breast cancer prevention. Utilizing legal, medical, and policy databases for literature, case law and policy documents relating to communication of genetic test results within families, as well as a consultative process with representative stakeholders, a points to consider has been developed to address a number of issues that might impact the ability and willingness of patients to inform family members of genetic risk. These include: what is "genetic information"; who is the "family"; why should patients inform their family members; and how should health professionals be involved in this process? This represents only an initial step towards fostering better communication within families. Additional research is needed to determine the best methods for encouraging this communication and motivations for disclosing or not and to promote the development of a solution, considering the complexity of human relationships and the probabilistic nature of genetic information.
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Affiliation(s)
- Lee Black
- Centre of Genomics and Policy, McGill University, 740 Dr. Penfield Ave., Suite 5200, Montreal, QC, Canada, H3A 0G1,
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Exploring resources for intrafamilial communication of cancer genetic risk: we still need to talk. Eur J Hum Genet 2013; 21:903-10. [PMID: 23340514 PMCID: PMC3746262 DOI: 10.1038/ejhg.2012.286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 11/17/2012] [Accepted: 11/23/2012] [Indexed: 11/15/2022] Open
Abstract
While the importance of intrafamilial communication of hereditary cancer risk has been acknowledged, the factors that promote and act as barriers to patients disclosing their information to their families are complex and emerging. This raises the question: How are patients guided in practice to contemplate intrafamilial communication? Focusing on breast cancer, we conducted an exploratory study examining current resources supporting patients and health-care professionals, and isolated the messages surrounding intrafamilial communication of cancer risk. We find the duty for health-care professionals to counsel patients regarding intrafamilial communication is acknowledged to varying degrees by multiple actors in the cancer care delivery landscape, including health-care professional associations, health service organizations, and patient groups. A range of medical, psychosocial, and other factors underlying intrafamilial communication are acknowledged in messages to patients. Patients, however, are often referred to a single group of health-care professionals to discuss their diverse and complex needs. At the same time, messages aimed at patients appear to place the emphasis on barriers that could exist for patients contemplating intrafamilial communication, while highlighting the benefits families derive from such communication. Taken together, this points to a lack of coherence within materials directed to patients and suggests the need to do coordinated research among stakeholders to address two related issues: (1) determining who are the actors best positioned to send messages surrounding intrafamilial communication to patients and (2) addressing the content of messages conveyed in patient materials.
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Family Communication Following BRCA1/2 Genetic Testing: A Close Look at the Process. J Genet Couns 2012; 22:323-35. [DOI: 10.1007/s10897-012-9559-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
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Peters JA, Kenen R, Hoskins LM, Glenn GM, Kratz C, Greene MH. Close ties: an exploratory Colored Eco-Genetic Relationship Map (CEGRM) study of social connections of men in Familial Testicular Cancer (FTC) families. Hered Cancer Clin Pract 2012; 10:2. [PMID: 22381132 PMCID: PMC3323467 DOI: 10.1186/1897-4287-10-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 03/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Testicular cancer, while rare compared with other adult solid tumors, is the most common cancer in young men in northern Europe and North America. Risk factors include white race, positive family history, contralateral testicular cancer, cryptorchidism, infertility and testicular microlithiasis. As the genetic causes of familial clusters (Familial Testicular Cancer or FTC) are being sought, it is also important to understand the psycho-social experiences of members of FTC families. METHODS This is a cross-sectional examination via the Colored Eco-Genetic Relationship Map (CEGRM) of social connections reported by 49 men in FTC families participating in NCI research study 02-C-178. RESULTS The CEGRM was acceptable and feasible for use with men in FTC families, and valuable in understanding their social connections. These men have largely adjusted to the TC history in themselves and/or their relatives. They have considerable social and emotional support from family and friends, although there is wide variability in sources and types. CONCLUSIONS The CEGRM focuses on men's social connections and close emotional bonds in FTC families. This action-oriented process of placing colored symbols on significant relationships uncovered previously under-appreciated emotions accompanying men's social exchanges. Most men in FTC families succeed in re-establishing a sense of normalcy in their lives and social connections, in the aftermath of a testicular cancer diagnosis.
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Affiliation(s)
- June A Peters
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, 6120 Executive Blvd, Rockville, MD, 20852 USA.
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