Facilitators and Challenges in Psychosocial Adaptation to Being at Increased Familial Risk of Breast Cancer

Uncertainty in the Process of Communicating Cancer-related Genetic Risk Information with Patients: A Scoping Review

In the era of precision medicine, patients must manage the uncertainty caused by ambiguous genetic information. To aid health practitioners in effectively communicating genetic information, this study classified the types of uncertainty involved in these communication processes. A search of recent literature turned up 64 articles that measured and/or discussed patients' perceptions and/or feelings of uncertainty related to the communication process of cancer-related genetic information. In reviewing these papers, six types of uncertainty regarding cancer-related genetic information were identified: (1) uncertainty about understanding genetic information (n = 25; 39.1%); (2) uncertainty about future cancer risks (n = 34; 53.1%); (3) uncertainty about managing known genetic information or mutation status (n = 33; 51.6%); (4) uncertainty about the utility of genetic information (n = 5; 7.8%); (5) uncertainty about genetic test results before undergoing testing or receiving the results (n = 10; 15.6%); and (6) uncertainty about the impact of genetic results on family and life (n = 11; 17.2%). These six types of uncertainty serve as a helpful taxonomy for developing, validating, and utilizing future measures of uncertainty in the context of cancer-related genetic risk communication.

An intervention based on protective factors to improve resilience for breast cancer patients: Study protocol for a randomized controlled trial

AIM

To present a study protocol for evaluating the feasibility and effectiveness of an individual face-to-face intervention based on protective factors to improve resilience among breast cancer patients.

BACKGROUND

Research involving the effectiveness of universal interventions to improve resilience for breast cancer patients has seldom been reported and there is an urgent need to find a more acceptable, cost-effective method of providing emotional support. Through health education and psychological interventions, increasing protective factors could promote recovery to the original condition and improve resilience.

DESIGN

A randomized controlled trial of an individual face-to-face intervention.

METHODS

A total of 160 adults diagnosed with confirmed breast cancer will be recruited. The patients will be randomly assigned to the control group (N = 80) or the intervention group (N = 80). An intervention focusing on protective factors will be implemented in the intervention group. A survey of the patients from the two groups will be conducted at baseline, 1, 3, 6, and 12 months. The primary outcome is resilience, measured by the 14-item Resilience Scale. Secondary outcomes include self-efficacy, optimism, perceived social support, and mastery. The Chinese versions of the General Self-Efficacy Scale, revised Life Orientation Test, Multidimensional Scale of Perceived Social Support, and Self-Mastery Scale will be used to measure the four protective factors.

IMPACT

One-to-one and face-to-face interventions have many potential advantages for inpatients, including convenience, accessibility and individuality. Once its effectiveness is confirmed, the intervention will be implemented broadly and make support available for a large number of patients.

When to Consider Risk-Reducing Mastectomy in BRCA1/BRCA2 Mutation Carriers with Advanced Stage Ovarian Cancer: a Case Study Illustrating the Genetic Counseling Challenges

Germline mutations in BRCA1/BRCA2 significantly increase the risk of breast and ovarian cancer in women. This case report describes a BRCA1 germline mutation identified in a woman with stage IV epithelial ovarian cancer and the provision of genetic counseling about BRCA1-associated breast cancer risk in the three years following diagnosis. The report centers on the patient’s enquiry about risk-reducing breast surgery. We focus on the challenges for health professionals and patients in understanding and balancing the risks and benefits of major prophylactic surgery in the context of a potentially life-limiting cancer diagnosis. Breast cancer risk management in BRCA1/BRCA2 carriers with advanced ovarian cancer is an under-explored area of genetic counseling research. This article includes a case report, a review of the relevant literature and considers some implications for practice.

The experience of women carriers of BRCA mutations following risk-reducing surgery: A cultural perspective

In this qualitative study, we examine the experience of 13 Jewish Israeli women carriers of BRCA mutations following risk-reducing surgery. Thematic analysis of in-depth, semi-structured interview texts yielded three themes: (a) dialectic of vulnerability and control, (b) presentation of self as a "normal" woman, and (c) genetic chain of negative life events and guilt. Aspects of Israeli culture impacting participants' experiences are: personal and collective responsibility, the shift toward consumerism, and pro-natal ideology. The findings may be useful for health practitioners working with other nationalities with similar cultural characteristics and to prompt practitioners to explore their own and their patients' perceptions regarding women's risk-reducing surgery and genetic illnesses.

Population screening for BRCA1/BRCA2 mutations: lessons from qualitative analysis of the screening experience

PURPOSE

Population screening for BRCA1/BRCA2. mutations is being considered for Ashkenazi Jews (AJ) because 2.5% carry recurrent deleterious mutations and effective cancer prevention exists. This study aimed to provide a qualitative focus on perspectives of individuals, particularly carriers, who were tested through a screening trial. In this trial, the pretest process included only written information.

METHODS

Interviews were performed with 26 carriers and 10 noncarriers who participated in a BRCA population screening trial for AJ.

RESULTS

Attitudes toward screening were generally positive. The main motivator for testing was knowledge of BRCA status to enable cancer risk reduction. Knowledge of carrier status, although challenging, was thus viewed as health-empowering. The screening paradigm was sensed as increasing awareness and as overcoming access, referral, and familial barriers. Streamlining the pretest process was positively perceived as offering gradual, stepwise knowledge commensurate with test results. Participants were concerned that health systems provide the necessary conceptual and infrastructural framework and that individual autonomy be maintained.

CONCLUSIONS

BRCA screening in AJ is viewed favorably, even by carriers. Stepwise acquisition of knowledge based on test results was viewed as most relevant to the screening context. Screening program development should account for safeguarding autonomy and providing requisite post-test services.Genet Med advance online publication 01 December 2016.