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Mishra A, Deo SVS, Kumar N, Bansal B, Gogia A, Pramanik R, Batra A, Sharma DN, Mathur S, Pathak M. A Prospective Questionnaire-Based Study Evaluating Genetic Literacy and Impact of Brief Educational Intervention Among Breast Cancer Patients in a Low- to Middle-Income Country. Ann Surg Oncol 2024:10.1245/s10434-024-15527-y. [PMID: 38862836 DOI: 10.1245/s10434-024-15527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION A significant proportion of breast cancer cases are hereditary and are potentially preventable. However, adoption of the preventive measures remains a significant challenge, particularly because of to lack of knowledge and awareness in low- to middle-income countries. METHODS This prospective study conducted at a high-volume tertiary care cancer center in North India to assess the knowledge, awareness, and attitudes of female breast cancer patients and impact of a brief educational intervention. The study involved three phases: pre-interventional assessment, educational intervention, and post-interventional assessment utilizing a structured questionnaire. RESULTS The study involved 300 newly diagnosed breast cancer patients; 16.7% were familial. At the outset, 87.0% patients had low knowledge of risk factors, 90.3% about screening, and 32.7% about treatment. Awareness levels were low: 13.7% aware of familial risk and 2.7% of breast cancer genes. Affordability of genetic testing was low (15.2%), and interest in testing for self and family members was limited (32.0% and 26.3%). Following educational intervention, a significant positive percentage change was noticed in knowledge (risk factors: 12.8%, screening: 36.2%, treatment: 82%), awareness (familial risk: 66.7%, BRCA gene: 12.3%), and attitude (testing for self: 17.8%, family: 19.5%). CONCLUSIONS This study highlights the significant knowledge gaps among breast cancer patients regarding genetics. The educational intervention led to notable improvements in knowledge, awareness, and attitudes, underscoring the importance of tailored patient education in breast cancer care.
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Affiliation(s)
- Ashutosh Mishra
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Navin Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Babul Bansal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Batra
- Department of Medical Oncology, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mona Pathak
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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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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Ioffe YJ, Hong L, Joachim-Célestin M, Soret C, Montgomery S, Unternaehrer JJ. Genetic Testing in the Latinx community: Impact of acculturation and provider relationships. Gynecol Oncol 2023; 169:125-130. [PMID: 36577267 DOI: 10.1016/j.ygyno.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The current study aimed to explore attitudes toward genetic germline testing and intentions to test in Latinas from Southern California. We hypothesized that patients' acculturation and education levels, as well as comfort with health care providers, are positively associated with attitudes and intentions toward genetic testing. METHODS A survey was offered concurrently to Latinx female patients at a gynecologic oncology practice and to unaffiliated Latinx community members. The survey assessed demographics, structural, psychosocial, and acculturation factors and genetic testing attitudes and intentions via validated scales. RESULTS Of 148 surveys collected, 66% of responders had low levels of acculturation. 50% of women had government-subsidized insurance; 22% had no schooling in the US. 67% of participants did not carry a diagnosis of cancer. Women with higher acculturation levels were more likely to consider genetic testing (rs = 0.54, p = .001). Higher acculturated women and less acculturated women under 50 were more likely to consider testing if it had been recommended by a female, trusted, or Hispanic/Latinx provider (rs = 0.22, p = .01, rs = 0.27, p = .003 and rs = 0.19, p = .003, respectively) or if there was a recent cancer diagnosis (self or family, rs = 0.19, p = .03). Overall, education correlated with intention to test. The more education outside of the US, the less negative was the attitude toward being tested (rs = -0.41, p = .002). CONCLUSIONS Direct experiences with cancer, more schooling and higher acculturation coupled with provider characteristics determined if Latinas were more open to testing. Provider characteristics mattered: having a female, Latinx, Spanish speaking provider was important for genetic testing decision-making. These findings are particularly pertinent in areas with high Latinx populations.
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Affiliation(s)
- Yevgeniya J Ioffe
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America.
| | - Linda Hong
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | | | - Carmen Soret
- School of Behavioral Health, Loma Linda University, United States of America
| | - Susanne Montgomery
- School of Behavioral Health, Loma Linda University, United States of America
| | - Juli J Unternaehrer
- Department of Basic Sciences, Division of Biochemistry, Loma Linda University School of Medicine, United States of America
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Hurtado-de-Mendoza A, Reyna VF, Wolfe CR, Gómez-Trillos S, Sutton AL, Brennan A, Sheppard VB. Adapting a Theoretically-Based intervention for underserved clinical populations at increased risk for hereditary Cancer: Lessons learned from the BRCA-Gist experience. Prev Med Rep 2022; 28:101887. [PMID: 35855922 PMCID: PMC9287635 DOI: 10.1016/j.pmedr.2022.101887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
The use of GCT in underserved diverse populations is suboptimal. Translational genomics research has been conducted with mostly NHW. Adapting EBIs can enhance the reach of EBI to underserved diverse populations. This paper describes the adaptation BRCA Gist, for at-risk Blacks and Latinas. Findings illustrate the need to integrate fidelity and adaptation considerations.
Background Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 – September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1–5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1–10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Valerie F Reyna
- Human Neuroscience Institute, Cornell University, Ithaca, NY, USA
| | | | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Arnethea L Sutton
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
| | - Ashleigh Brennan
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
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Investigating men's motivations to engage in genetic screening for BRCA1 and BRCA2 mutations. PLoS One 2022; 17:e0265387. [PMID: 35303741 PMCID: PMC8932559 DOI: 10.1371/journal.pone.0265387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/01/2022] [Indexed: 12/28/2022] Open
Abstract
BRCA1 and BRCA2 mutations are associated with an increased risk of developing numerous cancers, including breast, ovarian, pancreatic, melanoma and prostate cancer. Men face BRCA-related cancer risks as women do. However, there is considerably less research on the psychological determinants of men engaging in BRCA1/2-related cancer prevention compared to women. The present research aimed to study the determinants of men’s motivations to engage in genetic screening for BRCA1 and BRCA2 through the lens of the Health Action Process Approach. One hundred and twenty-five men (mean age = 58.53 y/o, SD = 10.37) completed an online survey. The intention to undergo genetic screening for BRCA1/2 mutations in men was significantly and positively associated with self-efficacy and risk perception. Moreover, having offspring positively affected intention as well. The relationships between intention (and planning) and positive outcome expectancies, age, and family history of breast-related cancer were not statistically significant. Most information on BRCA1 and BRCA2 mutations is tailored to women due to the availability of effective surgical risk reduction procedures for women’s breast and ovarian cancer. Future research should focus on the best methods of communicating informed decision-making for men facing the risk of such mutations.
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Jones T, Howard H, Freeman-Costin K, Creighton A, Wisdom-Chambers K, Underhill-Blazey M. Knowledge and perceptions of BRCA1/2 genetic testing and needs of diverse women with a personal or family history of breast cancer in South Florida. J Community Genet 2021; 12:415-429. [PMID: 33555545 PMCID: PMC8241944 DOI: 10.1007/s12687-021-00507-6] [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: 04/20/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022] Open
Abstract
The vast majority of (BRCA1/2) genetic testing has been conducted in White women, in particular Ashkenazi Jewish women, with limited information available for Black and Hispanic women. Understanding perspectives of those who are underserved is critical to developing interventions to support inclusive approaches to genetic testing. This qualitative study explored knowledge and perceptions of BRCA1/2 genetic testing among diverse women in South Florida. We also explored participants' information needs. Convenience sampling was used to recruit a diverse group of 15 women with a personal or family history of breast cancer. We conducted semi-structured interviews and used grounded theory method to analyze the data. Five themes were identified: (1) lacking awareness and knowledge of BRCA1/2 genetic testing and results among Black women, (2) perceiving BRCA1/2 genetic testing as beneficial to themselves and a way to be proactive about cancer risk, (3) perceiving BRCA1/2 genetic testing as beneficial to family members, (4) interactions with healthcare providers and the healthcare system that shape genetic testing experiences, and (5) information needs for reducing cancer risk and promoting health. Our findings suggest that diverse underserved women perceived genetic testing as beneficial to themselves and family members. Women needed more information about the BRCA genes and genetic testing, prevention strategies, and the latest breast cancer research. Healthcare providers, particularly nurse practitioners, need to engage diverse high-risk women in discussions about their cancer risk, address unmet information needs, and, in particular, educate Black women about the benefits of pursuing genetic testing.
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Affiliation(s)
- Tarsha Jones
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA.
| | - Heather Howard
- College for Design and Social Inquiry, Florida Atlantic University, Boca Raton, Florida, 33431, USA
| | - Katherine Freeman-Costin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, 33431, USA
| | - Ana Creighton
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Karen Wisdom-Chambers
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Meghan Underhill-Blazey
- School of Nursing, University of Rochester, Rochester, NY, 14642, USA
- Dana Farber Cancer Institute, Boston, Massachusetts, 02215, USA
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7
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Ding H, Sutton AL, Hurtado-de-Mendoza A, Sheppard VB. The role of psychosocial factors in Black women's self-efficacy in receiving genetic counseling and testing. J Genet Couns 2021; 30:1719-1726. [PMID: 34085362 DOI: 10.1002/jgc4.1439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
Higher self-efficacy in receiving genetic counseling and testing (GCT) has been associated with greater participation in GCT for women at risk of hereditary breast and ovarian cancer (HBOC), but little is known about correlates of self-efficacy in Black women eligible for GCT. The goal of this secondary analysis was to identify sociodemographic and psychosocial factors regarding GCT. Multivariable regression analysis was conducted to assess the relationship between self-efficacy and correlates of interest. Of the 100 Black women surveyed, most women had a college degree (64%), were employed (84%), and had health insurance (93%). In the multivariable model, greater self-efficacy was associated with more positive attitudes toward GCT (Β = 0.126; CI = 0.01 to 0.25; p = 0.039), greater confidence in the Genetic Information Nondiscrimination Act (GINA) (Β = 0.250; CI = 0.04 to 0.46; p = 0.019), and lower ratings of perceived difficulty obtaining GCT (Β = -0.219; CI = -0.46 to -0.10; p = 0.003). Community-level interventions to promote self-efficacy are needed that address perceived barriers to GCT, with the goals of increasing GINA Law awareness in the general public, increasing accessibility to genetic counseling (e.g., telemedicine), and promoting more positive attitudes about GCT.
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Affiliation(s)
- Huanghe Ding
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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8
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Allen CG, Peterson S, Khoury MJ, Brody LC, McBride CM. A scoping review of social and behavioral science research to translate genomic discoveries into population health impact. Transl Behav Med 2021; 11:901-911. [PMID: 32902617 PMCID: PMC8240657 DOI: 10.1093/tbm/ibaa076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the completion of the Human Genome Project, progress toward translating genomic research discoveries to address population health issues has been limited. Several meetings of social and behavioral scientists have outlined priority research areas where advancement of translational research could increase population health benefits of genomic discoveries. In this review, we track the pace of progress, study size and design, and focus of genomics translational research from 2012 to 2018 and its concordance with five social and behavioral science recommended priorities. We conducted a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines for Scoping Reviews. Steps involved completing a search in five databases and a hand search of bibliographies of relevant literature. Our search (from 2012 to 2018) yielded 4,538 unique studies; 117 were included in the final analyses. Two coders extracted data including items from the PICOTS framework. Analysis included descriptive statistics to help identify trends in pace, study size and design, and translational priority area. Among the 117 studies included in our final sample, nearly half focused on genomics applications that have evidence to support translation or implementation into practice (Centers for Disease Control and Prevention Tier 1 applications). Common study designs were cross-sectional (40.2%) and qualitative (24.8%), with average sample sizes of 716 across all studies. Most often, studies addressed public understanding of genetics and genomics (33.3%), risk communication (29.1%), and intervention development and testing of interventions to promote behavior change (19.7%). The number of studies that address social and behavioral science priority areas is extremely limited and the pace of this research continues to lag behind basic science advances. Much of the research identified in this review is descriptive and related to public understanding, risk communication, and intervention development and testing of interventions to promote behavior change. The field has been slow to develop and evaluate public health-friendly interventions and test implementation approaches that could enable health benefits and equitable access to genomic discoveries. As the completion of the human genome approaches its 20th anniversary, full engagement of transdisciplinary efforts to address translation challenges will be required to close this gap.
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Affiliation(s)
- Caitlin G Allen
- Behavioral, Social and Health Education Sciences Department, Emory University, Atlanta, GA, USA
| | - Shenita Peterson
- Woodruff Health Science Center Library, Emory University, Atlanta, GA, USA
| | - Muin J Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lawrence C Brody
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, MD, USA
| | - Colleen M McBride
- Behavioral, Social and Health Education Sciences Department, Emory University, Atlanta, GA, USA
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Conley CC, Castro-Figueroa EM, Moreno L, Dutil J, García JD, Burgos C, Ricker C, Kim J, Graves KD, Ashing KT, Quinn GP, Soliman H, Vadaparampil ST. A pilot randomized trial of an educational intervention to increase genetic counseling and genetic testing among Latina breast cancer survivors. J Genet Couns 2021; 30:394-405. [PMID: 32936981 PMCID: PMC7960565 DOI: 10.1002/jgc4.1324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023]
Abstract
Latinas are less likely to participate in genetic counseling (GC) and genetic testing (GT) than non-Hispanic Whites. A multisite, randomized pilot study tested a culturally targeted educational intervention to increase uptake of GC/GT among Latina breast cancer (BC) survivors (N = 52). Participants were recruited in Tampa, FL and Ponce, PR and randomized to: (a) fact sheet about BC survivorship (control) or (b) a culturally targeted educational booklet about GC/GT (intervention). Participants in the intervention condition were also offered no-cost telephone GC followed by free GT with mail-based saliva sample collection. Participants self-reported hereditary breast and ovarian cancer (HBOC) knowledge and emotional distress at baseline and 1- and 3-month follow-ups. We used logistic regression to examine differences in GC/GT uptake by study arm (primary outcome) and repeated measures ANOVA to examine the effects of study arm and time on HBOC knowledge and emotional distress (secondary outcomes). Compared to the control arm, intervention participants were more likely to complete GC (ORIntervention = 13.92, 95% CI = 3.06-63.25, p < .01) and GT (ORIntervention = 12.93, 95% CI = 2.82-59.20, p < .01). Study site did not predict uptake of GC (p = .08) but Ponce participants were more likely to complete GT (ORPonce = 4.53, 95% CI = 1.04-19.72, p = .04). ANOVAs demonstrated an increase in HBOC knowledge over time across both groups (F(2,88) = 12.24, p < .01, ηp2 = 0.22). We also found a significant interaction of study arm and time, such that intervention participants demonstrated a greater and sustained (to the 3-month follow-up) increase in knowledge than control participants (F(2,88) = 3.66, p = .03, ηp2 = 0.08). No other main or interaction effects were significant (all p's> .15). Study findings demonstrate the potential of our culturally targeted print intervention. Lessons learned from this multisite pilot study for enhancing GC/GT in Latinas include the need to attend to both access to GC/GT and individual factors such as attitudes and knowledge.
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Affiliation(s)
- Claire C. Conley
- Moffitt Cancer Center, Tampa, FL
- Georgetown Lombardi Cancer Center, Washington, DC
| | | | | | | | | | | | - Charité Ricker
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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Southwick SV, Esch R, Gasser R, Cragun D, Redlinger-Grosse K, Marsalis S, Zierhut HA. Racial and ethnic differences in genetic counseling experiences and outcomes in the United States: A systematic review. J Genet Couns 2020; 29:147-165. [PMID: 32144851 DOI: 10.1002/jgc4.1230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
As genetic counseling services expand and reach a wider catchment of the population, there is a critical need to better understand the impact of services on a greater diversity of patients. We conducted a systematic review to evaluate genetic counseling experiences and outcomes among racial and ethnic minorities. Six databases extracted articles published from 2005 to 2019 that assessed genetic counseling participation, knowledge and awareness, motivators, barriers, perceptions, and outcomes for racial and ethnic minority populations in the United States. Genetic counseling outcomes were categorized using the Framework for Outcomes of Clinical commUnication Services. A total of 1,227 abstracts were identified, of which 23 papers met inclusion criteria. Results suggest the possibility of racial and ethnic differences in some genetic counseling experiences and outcomes but noted differences were not adequately replicated between studies. The few included studies differed greatly in aims, methods, and results, which made comparison across study designs challenging and effectively barred thematic analysis. Additional research is needed that includes more study populations and settings with patients of diverse racial and ethnic backgrounds, as well as more structured study designs that allow for elucidations of differences between White and non-White populations.
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Affiliation(s)
- Sabrina V Southwick
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Riley Esch
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Gasser
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Heather A Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Carrera P, Campos C, Anderson L, Luta G, Peshkin BN, Schwartz MD, Cupertino AP, Gonzalez N, Sheppard VB. Culturally Targeted Video Improves Psychosocial Outcomes in Latina Women at Risk of Hereditary Breast and Ovarian Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4793. [PMID: 31795362 PMCID: PMC6926842 DOI: 10.3390/ijerph16234793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022]
Abstract
Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p < 0.001), positive attitudes (p < 0.05), anticipatory positive emotions (p < 0.05), and intentions to participate in counseling (p < 0.001). Importantly, the video also significantly reduced negative attitudes (p < 0.05), and attitudinal ambivalence (p < 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Kristi D. Graves
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Claudia Campos
- Nueva Vida, DC Office—801 N Pitt St., Suite 113, Alexandria, VA 22314, USA;
| | - Lyndsay Anderson
- College of Health and Human Services, School of Nursing, California State University, Sacramento, CA 95819, USA;
| | - George Luta
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Department of Biostatistics, Bioinformatics and Biomathematics, 4000 Reservoir Rd., NW, Washington, DC 20057, USA
| | - Beth N. Peshkin
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Marc D. Schwartz
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Ana-Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, 40 Prospect Avenue, Office number 316, Hackensack, NJ 07601, USA;
| | - Nathaly Gonzalez
- Capital Breast Care Center, 1000 New Jersey Ave, SE, Washington, DC 20003, USA;
| | - Vanessa B. Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Massey Cancer Center, Office of Health Equity and Disparities Research, Richmond, VA 23298, USA
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Sutton AL, He J, Tanner E, Edmonds MC, Henderson A, Hurtado de Mendoza A, Sheppard VB. Understanding Medical Mistrust in Black Women at Risk of BRCA 1/2 Mutations. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2019; 12:35-47. [PMID: 32995070 PMCID: PMC7521839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The benefits of genetic counseling and testing for hereditary breast and/or ovarian cancer (HBOC) are well documented; however, Black women are less likely to use these services compared to White women. Mistrust of the medical system has been associated with Black women's use of genetic counseling and testing (GCT). However, relatively little is known about the correlates of medical mistrust in Black women at increased risk of HBOC. In this study, we examined the prevalence and predictors of medical mistrust in 94 Black women at-risk of HBOC. Most women were married (48.7%) and had at least some collegiate education (57.1%). While no predisposing characteristics were significantly related to medical mistrust, bivariate analysis indicated significant relationships between mistrust and fatalism (p=0.04), perceptions of discrimination in the healthcare setting (p=0.01), and self-efficacy in obtaining GCT (p=0.01). Multivariable analysis revealed that women who reported more discriminatory experiences and women with less confidence in obtaining GCT expressed greater medical mistrust. Multilevel approaches are needed to address psychosocial factors associated with feelings of mistrust. Future efforts must not solely focus on educating women on the importance of and need for GCT; addressing structural barriers, such as patient-provider interactions, that contribute to mistrust must become a priority.
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Affiliation(s)
| | | | - Erin Tanner
- Greater Washington Maternal-Fetal Medicine and Genetics
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