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Douglas L, Czerwinski J, Vukovic R, Ashfaq M, Lunstroth R, Wagner C. Disability education and implications for genetic counselor training. J Genet Couns 2023; 32:1131-1143. [PMID: 37877329 DOI: 10.1002/jgc4.1800] [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: 04/29/2022] [Revised: 06/13/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023]
Abstract
The genetic counseling (GC) community has faced criticism about the duality of promoting patient autonomy while also advocating for individuals with disabilities. This study assessed the attitudes of the disability community and GCs to identify content that should be included in GC disability education and evaluate the landscape of GC disability education. Members of the disability community and GCs completed an electronic survey distributed through electronic listservs and partnering organizations. A total of 672 responses were analyzed from both the disability community (n = 596) and the GC community (n = 76). Members of the disability community noted differences in GC comfort level discussing different aspects of disability with GCs being perceived as being very knowledgeable about medical aspects 71% of the time versus 49% of the time when discussing social/lifestyle aspects of disability. This discordance was reflected in GCs reported comfort level in discussing medical aspects (89%) and social aspects of disability (65%) during a session. Most GC respondents (71%) felt they received adequate knowledge during their disability education and variation was reported in the execution of disability education by training programs. Disability education content recommendations from the disability community and GCs included emphasizing four key aspects of disability: medical, social/lifestyle, lived experience, and the disability rights movement. Respondents of both cohorts stressed the inclusion of and exposure to persons with disabilities in disability education to understand the lived experience of persons with disabilities. The disability community identified additional disability education content to be included such as empathy training, family hardships, and mental health. The results of this study have practice implications and provide a foundation for training expectations to ensure future GCs possess the necessary skills to improve the quality of services provided to families and persons with disabilities.
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Affiliation(s)
- Lauren Douglas
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Minnesota Health Fairview, Minneapolis, Minnesota, USA
| | - Jennifer Czerwinski
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern School of Medicine, Houston, Texas, USA
| | - Rose Vukovic
- Department of Education Psychology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | - Myla Ashfaq
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Rebecca Lunstroth
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Department of Humanities & Ethics, McGovern Medical School, Houston, Texas, USA
| | - Chelsea Wagner
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Billion to One, Menlo Park, California, USA
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2
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Human genome editing and the identity politics of genetic disability. J Community Genet 2019; 11:125-127. [PMID: 31489571 DOI: 10.1007/s12687-019-00437-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022] Open
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3
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Clarke AJ, Wallgren-Pettersson C. Ethics in genetic counselling. J Community Genet 2019; 10:3-33. [PMID: 29949066 PMCID: PMC6325035 DOI: 10.1007/s12687-018-0371-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/15/2018] [Indexed: 12/22/2022] Open
Abstract
Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient's family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient's community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term.
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Affiliation(s)
- Angus J Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, CF14 4XN, UK.
| | - Carina Wallgren-Pettersson
- The Folkhaelsan Department of Medical Genetics, Topeliusgatan, 20 00250, Helsinki, Finland
- The Folkhaelsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
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Roadhouse C, Shuman C, Anstey K, Sappleton K, Chitayat D, Ignagni E. Disability Experiences and Perspectives Regarding Reproductive Decisions, Parenting, and the Utility of Genetic Services: a Qualitative Study. J Genet Couns 2018; 27:10.1007/s10897-018-0265-1. [PMID: 29909595 DOI: 10.1007/s10897-018-0265-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
Genetic counselors adopt seemingly contradictory roles: advocating for individuals with genetic conditions while offering prenatal diagnosis and the option of selective termination to prevent the birth of a child with a disability. This duality contributes to the tension between the disability and clinical genetics communities. Varying opinions exist amongst the disability community: some value genetic services while others are opposed. However, there is limited research exploring the opinions of individuals with a disability regarding issues related to reproduction and genetic services in the context of personal experience. This exploratory qualitative study involved interviews with seven women and three men who self-identify as having a disability. We sought to gain their perspectives on experiences with disability, thoughts about reproduction and parenting, and perceptions of genetic services. Transcripts of the interviews were analyzed thematically using qualitative content analysis. Data analysis showed that societal views of disability affected the lived experience and impacted reproductive decision-making for those with a disability. It also showed differing interest in genetic services. Concerns about the perceived collective implications of genetic services were also raised. These findings contribute to the understanding of the disability perspective toward reproductive decision-making and genetic services. A further goal is to promote a meaningful dialogue between the genetics and disability communities, with the potential to enhance the genetic and reproductive care provided to individuals with disabilities.
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Affiliation(s)
- C Roadhouse
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Pediatrics, Clinical Genetics Program, McMaster University Medical Center and McMaster Children's Hospital, Hamilton, ON, Canada.
| | - C Shuman
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Anstey
- Clinical Ethics, Alberta Health Services, Calgary AB, Calgary, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Therapy, University of Toronto, Toronto, ON, Canada
| | - K Sappleton
- Centre for Innovation and Excellence in Child & Family Centered Care, The Hospital for Sick Children, Toronto, ON, Canada
| | - D Chitayat
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - E Ignagni
- School of Disability Studies, Ryerson University, Toronto, ON, Canada
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Boardman FK, Young PJ, Griffiths FE. Impairment Experiences, Identity and Attitudes Towards Genetic Screening: the Views of People with Spinal Muscular Atrophy. J Genet Couns 2017; 27:69-84. [PMID: 28664217 PMCID: PMC5794814 DOI: 10.1007/s10897-017-0122-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
Developments in genetics are rapidly changing the capacity and scope of screening practices. However, people with genetic conditions have been under-represented in the literature exploring their implications. This mixed methods study explores the attitudes of people with Spinal Muscular Atrophy (SMA) towards three different population-level genetic screening programmes for SMA: pre-conception, prenatal and newborn screening. Drawing on qualitative interviews (n = 15) and a survey (n = 82), this study demonstrates that more severely affected individuals with early-onset symptoms (Type II SMA), are less likely to support screening and more likely to view SMA positively than those with milder, later onset and/or fluctuating symptoms (Types III/ IV SMA). Indeed, this clinically milder group were more likely to support all forms of screening and view SMA negatively. This paper highlights that screening is a complex issue for people with genetic conditions, and the nature of impairment experiences plays a critical role in shaping attitudes.
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Affiliation(s)
- Felicity K Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Frances E Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Korngiebel DM, McMullen CK, Amendola LM, Berg JS, Davis JV, Gilmore MJ, Harding CO, Himes P, Jarvik GP, Kauffman TL, Kennedy KA, Simpson DK, Leo MC, Lynch FL, Quigley DI, Reiss JA, Richards CS, Rope AF, Schneider JL, Goddard KAB, Wilfond BS. Generating a taxonomy for genetic conditions relevant to reproductive planning. Am J Med Genet A 2016; 170:565-73. [PMID: 26889673 DOI: 10.1002/ajmg.a.37513] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/22/2015] [Indexed: 01/20/2023]
Abstract
As genome or exome sequencing (hereafter genome-scale sequencing) becomes more integrated into standard care, carrier testing is an important possible application. Carrier testing using genome-scale sequencing can identify a large number of conditions, but choosing which conditions/genes to evaluate as well as which results to disclose can be complicated. Carrier testing generally occurs in the context of reproductive decision-making and involves patient values in a way that other types of genetic testing may not. The Kaiser Permanente Clinical Sequencing Exploratory Research program is conducting a randomized clinical trial of preconception carrier testing that allows participants to select their preferences for results from among broad descriptive categories rather than selecting individual conditions. This paper describes (1) the criteria developed by the research team, the return of results committee (RORC), and stakeholders for defining the categories; (2) the process of refining the categories based on input from patient focus groups and validation through a patient survey; and (3) how the RORC then assigned specific gene-condition pairs to taxonomy categories being piloted in the trial. The development of four categories (serious, moderate/mild, unpredictable, late onset) for sharing results allows patients to select results based on their values without separately deciding their interest in knowing their carrier status for hundreds of conditions. A fifth category, lifespan limiting, was always shared. The lessons learned may be applicable in other results disclosure situations, such as incidental findings.
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Affiliation(s)
- Diane M Korngiebel
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Carmit K McMullen
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - James V Davis
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Marian J Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | - Cary O Harding
- Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon
| | - Patricia Himes
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington
| | - Tia L Kauffman
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Kathleen A Kennedy
- Department of Perinatal Services, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Michael C Leo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Frances L Lynch
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Denise I Quigley
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Jacob A Reiss
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - C Sue Richards
- Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon
| | - Alan F Rope
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, Oregon
| | | | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatrics Bioethics, Seattle Children's Research Institute, Seattle, Washington.,Division of Bioethics, Department of Pediatrics, University of Washington, Seattle, Washington
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Sanborn E, Patterson AR. Disability training in the genetic counseling curricula: bridging the gap between genetic counselors and the disability community. Am J Med Genet A 2014; 164A:1909-15. [PMID: 24845370 DOI: 10.1002/ajmg.a.36613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 04/09/2014] [Indexed: 11/07/2022]
Abstract
Over the past two decades, disability activists, ethicists, and genetic counselors have examined the moral complexities inherent in prenatal genetic counseling and considered whether and in what ways genetic counseling may negatively affect individuals in the disability community. Many have expressed concerns about defining disability in the context of prenatal decision-making, as the definition presented may influence prenatal choices. In the past few years, publications have begun to explore the responsibility of counselors in presenting a balanced view of disability and have questioned the preparedness of counselors for this duty. Currently, the Accreditation Council for Genetic Counseling (ACGC) only minimally includes disability training in their competencies for genetic counselors, and in their accreditation requirements for training programs. In an attempt to describe current practice, this article details two studies that assess disability training in ABGC-accredited genetic counseling programs. Results from these studies demonstrate that experience with disability is not required by the majority of programs prior to matriculation. Though most program directors agree on the importance of including disability training in the curriculum, there is wide variability in the amount and types of training students receive. Hours dedicated to disability exposure among programs ranged from 10 to 600 hours. Eighty-five percent of program directors surveyed agree that skills for addressing disability should be added to the core competencies. Establishing a set of disability competencies would help to ensure that all graduates have the skills necessary to provide patients with an accurate understanding of disability that facilitates informed decision-making.
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Affiliation(s)
- Erica Sanborn
- Laboratory of Genome Maintenance, The Rockefeller University, New York, New York
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Boardman FK. The expressivist objection to prenatal testing: The experiences of families living with genetic disease. Soc Sci Med 2014; 107:18-25. [DOI: 10.1016/j.socscimed.2014.02.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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Current world literature. Curr Opin Obstet Gynecol 2012; 24:470-8. [PMID: 23154665 DOI: 10.1097/gco.0b013e32835ae910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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