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Genetics in primary care: validating a tool to pre-symptomatically assess common disease risk using an Australian questionnaire on family history. Clin Transl Med 2019; 8:17. [PMID: 31044318 PMCID: PMC6494887 DOI: 10.1186/s40169-019-0233-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A positive family history for diabetes, cardiovascular diseases or various types of cancer increases the relative risk for these diseases by 2 to 5 times compared to people without a positive family history. Taking a family history in daily general practice is useful for early, pre-symptomatic risk assessment, but at the moment no standardized family history questionnaire is available in the Dutch language. In this study we used a 9-item questionnaire, previously developed and applied in an Australian study, to probe family history for 7 specific conditions. The aim of the present qualitative study was to test face and content validity of the Australian family history questionnaire in Dutch general practice and to advance the standardization of intake information at an international level. We conducted 10 cognitive interviews with patients over 4 rounds, using the verbal probing technique. This approach allows the collection of data through a series of probe questions, with the aim of obtaining detailed information. After each interview round we modified the questionnaire based on the answers of the interviewees. We also performed 10 semi-structured interviews with general practitioners (GPs) to get their opinion on the content and usability of the questionnaire in practice. RESULTS Patients varied in age and gender, and 4 patients were known to have a genetic disorder. The GPs varied in age, gender, clinical experience, type of practice and location. In the first round, seven problems were identified in the questionnaire in the categories Comprehension (1), Recall (2), Judgement (0), Response process (2) and Completeness, (2); by the fourth and final round no problems remained. The content and usability of the questionnaire were assessed positively. CONCLUSIONS When translated for everyday use in Dutch general practice, the Australian family history questionnaire showed a strong face and content validity, and GPs were positive regarding feasibility. Validation of this family history questionnaire could aid in the standardized integration of genetically relevant information in the electronic health record and clinical research. Conspicuous questionnaire information might alert the GP regarding specific conditions and enable detection of disease at an earlier stage. Additional questionnaire requirements needed however are accurate patient information and consistent, accessible locations in the electronic health record with a possibility to be automatically registered. By deriving a Dutch family history questionnaire convenient for GPs, we adapted a template that might also prove useful for other countries and other medical professionals. This development could make the rapid operationalization of readily available genetic knowledge feasible in daily practice and clinical research, leading to improved medical care.
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van Erkelens A, Sie AS, Spanier MBW, van Kouwen M, Visser A, Prins JB, Hoogerbrugge N. An online self-test added to colorectal cancer screening can increase the effectiveness of familial cancer risk assessment without increasing distress. Colorectal Dis 2018; 20:897-904. [PMID: 29956442 DOI: 10.1111/codi.14319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023]
Abstract
AIM Most people who are at increased familial colorectal cancer (FCRC) risk are not identified, despite the need for enhanced surveillance colonoscopy for effective CRC prevention. An online self-test may enhance this identification. We assessed whether taking an online self-test to identify increased FCRC risk increases anxiety, distress or CRC risk perception in population-based CRC screening. METHOD After the precolonoscopy consultation, patients who had a positive immunohistochemical occult faecal blood test (iFOBT+) in population-based CRC screening were invited by email to take an online self-test at home which returned details of family history. Anxiety (STAI-DY), distress (HADS) and CRC risk perception were assessed immediately before and after taking the online self-test and 2 weeks later. RESULTS Of 250 participants invited, 177 (71%) completed the online self-test and psychological questionnaires and 153 (61%) completed questionnaires 2 weeks later. The median age was 65 years (range 61-75). The FCRC risk was increased in 17 participants (9.6%). Of these, 12 (6.8%) had a highly increased FCRC risk and may benefit from germline genetic testing for Lynch syndrome. In 7 of 17 participants (40%) the self-test obtained novel information on family history. Anxiety and distress levels were, and remained, below a clinically relevant level. Perception of CRC risk remained unchanged. Most participants (83%) would recommend the online self-test to others. CONCLUSION Of those with a iFOBT+, 9.6% had a previously unidentified increasedFCRC risk and require an enhanced surveillance colonoscopy instead of iFOBT. As screening for this risk did not increase anxiety or distress, and was highly acceptable, we recommend adding the online self-test to population-based CRC screening.
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Affiliation(s)
- A van Erkelens
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A S Sie
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M B W Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - M van Kouwen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Visser
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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Walker JG, Macrae F, Winship I, Oberoi J, Saya S, Milton S, Bickerstaffe A, Dowty JG, De Abreu Lourenço R, Clark M, Galloway L, Fishman G, Walter FM, Flander L, Chondros P, Ait Ouakrim D, Pirotta M, Trevena L, Jenkins MA, Emery JD. The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial. Trials 2018; 19:397. [PMID: 30045764 PMCID: PMC6060496 DOI: 10.1186/s13063-018-2764-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care. This paper describes the protocol for a phase II multi-site individually randomised controlled trial of the CRISP tool in primary care. METHODS This trial aims to test whether a standardised consultation using the CRISP tool in general practice (the CRISP intervention) increases risk-appropriate colorectal cancer screening compared to control participants who receive standardised information on cancer prevention. Patients between 50 and 74 years old, attending an appointment with their general practitioner for any reason, will be invited into the trial. A total of 732 participants will be randomised to intervention or control arms using a computer-generated allocation sequence stratified by general practice. The primary outcome (risk-appropriate screening at 12 months) will be measured using baseline data for colorectal cancer risk and objective health service data to measure screening behaviour. Secondary outcomes will include participant cancer risk perception, anxiety, cancer worry, screening intentions and health service utilisation measured at 1, 6 and 12 months post randomisation. DISCUSSION This trial tests a systematic approach to implementing risk-stratified colorectal cancer screening in primary care, based on an individual's absolute risk, using a state-of-the-art risk assessment tool. Trial results will be reported in 2020. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry, ACTRN12616001573448p . Registered on 14 November 2016.
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Affiliation(s)
- Jennifer G. Walker
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Finlay Macrae
- Department of Medicine, The University of Melbourne, Melbourne, VIC Australia
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC Australia
- Colorectal Medicine and Genetics, Royal Melbourne Hospital, Melbourne, VIC Australia
| | - Ingrid Winship
- Department of Medicine, The University of Melbourne, Melbourne, VIC Australia
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC Australia
| | - Jasmeen Oberoi
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Sibel Saya
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Shakira Milton
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Adrian Bickerstaffe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - James G. Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Richard De Abreu Lourenço
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW Australia
| | - Malcolm Clark
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
- IPN Medical Centres, Camberwell, VIC Australia
| | - Louise Galloway
- Department of Health and Human Services, Victorian Government, Melbourne, VIC Australia
| | - George Fishman
- Joint Consumer Advisory Group, Primary Care Collaborative Cancer Clinical Trials Group, Carlton, Australia
| | - Fiona M. Walter
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, VIC Australia
| | - Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Marie Pirotta
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Lyndal Trevena
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Mark A. Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Jon D. Emery
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Llewellyn R, Cunningham W, Jaye C, Young J, Egan R, Radue P. 'Why worry about something you can't control?' Negotiated risk, longevity and health behaviours. Health (London) 2017; 21:259-277. [PMID: 28521650 DOI: 10.1177/1363459317695869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While we know about lay attitudes towards death and dying, we understand little about the ways people estimate their overall personal risk of life-limiting disease and/or death. This study contributes to the limited literature on lay longevity reckonings, with a particular focus on how these reckonings may influence health behaviours. Semi-structured interviews were held with 21 young older adults (54-65 years), addressing the core questions of 'What do you think you will die from, and how long do you expect to live?' Participants indicated their longevity estimation was guided by three key frameworks: family history, environment and lifestyle factors and lived experience. The reckoning process was also moderated by assumptions about loci of control and self-efficacy and the information available to participants. A tripartite model of death risk assessment is proposed, extending the idea of 'negotiated risk' beyond the scope of family history where it has received most attention. We argue that by drawing on the three risk-assessment frameworks, determining patients' predisposition for external/internal attributions of control and perceptions of self-efficacy, clinicians will be better equipped to understand - and thus guide - patients' reckonings of longevity and health behaviours that are influenced by it.
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Affiliation(s)
| | - Wayne Cunningham
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain
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Online self-test identifies women at high familial breast cancer risk in population-based breast cancer screening without inducing anxiety or distress. Eur J Cancer 2017; 78:45-52. [PMID: 28412588 DOI: 10.1016/j.ejca.2017.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Identifying high familial breast cancer (FBC) risk improves detection of yet unknown BRCA1/2-mutation carriers, for whom BC risk is both highly likely and potentially preventable. We assessed whether a new online self-test could identify women at high FBC risk in population-based BC screening without inducing anxiety or distress. METHODS After their visit for screening mammography, women were invited by email to take an online self-test for identifying highly increased FBC risk-based on Dutch guidelines. Exclusion criteria were previously diagnosed as increased FBC risk or a personal history of BC. Anxiety (State-Trait Anxiety Inventory Dutch Version), distress (Hospital Anxiety Depression Scale) and BC risk perception were assessed using questionnaires, which were completed immediately before and after taking the online self-test and 2 weeks later. RESULTS Of the 562 women invited by email, 406 (72%) completed the online self-test while 304 also completed questionnaires (response rate 54%). After exclusion criteria, 287 (51%) were included for data analysis. Median age was 56 years (range 50-74). A high or moderate FBC risk was identified in 12 (4%) and three (1%) women, respectively. After completion of the online self-test, anxiety and BC risk perception were decreased while distress scores remained unchanged. Levels were below clinical relevance. Most women (85%) would recommend the self-test; few (3%) would not. CONCLUSION The online self-test identified previously unknown women at high FBC risk (4%), who may carry a BRCA1/2-mutation, without inducing anxiety or distress. We therefore recommend offering this self-test to women who attend population-based screening mammography for the first time.
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