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Ciucă A, Moldovan R, Băban A. Developing genetic counselling services in an underdeveloped healthcare setting. J Community Genet 2021; 12:539-548. [PMID: 34545547 PMCID: PMC8554932 DOI: 10.1007/s12687-021-00546-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022] Open
Abstract
Genetic counselling services are well established in North America, Western Europe and Australia. In other regions, genetic counselling services are still emerging. Where this is the case, an in-depth understanding of the main stakeholders’ needs, challenges and opportunities will inform the changes and innovations required to bring genetic counselling closer to the community. The present study explored the needs and challenges of patients, family members and professionals with a view to setting up a cancer genetic counselling service in Romania. In order to get a comprehensive outlook, key stakeholders were interviewed using data source triangulation method. Thirty-four semi-structured interviews were conducted (13 patients, 11 family members and 10 professionals). Thematic analysis was used to explore and identify needs, barriers and opportunities in emerging cancer genetic counselling services. Three major themes were identified: (1) the “Needs” theme mainly focuses on various types of support that participants mentioned wanting: psychosocial, peer and additional support; (2) the “Challenges” theme includes aspects related to limited access to healthcare, lack of integrated services and pressure on the families; (3) the “Hopes” theme highlights the wish for integrated healthcare and an empathic rapport with healthcare providers. Our findings highlighted the main needs, challenges and hopes the patients, family members and professionals have and provides the groundwork for setting up cancer genetic counselling services.
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Affiliation(s)
- Andrada Ciucă
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania. .,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK. .,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Adriana Băban
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
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Serra G, Memo L, Coscia A, Giuffré M, Iuculano A, Lanna M, Valentini D, Contardi A, Filippeschi S, Frusca T, Mosca F, Ramenghi LA, Romano C, Scopinaro A, Villani A, Zampino G, Corsello G. Recommendations for neonatologists and pediatricians working in first level birthing centers on the first communication of genetic disease and malformation syndrome diagnosis: consensus issued by 6 Italian scientific societies and 4 parents' associations. Ital J Pediatr 2021; 47:94. [PMID: 33874990 PMCID: PMC8054427 DOI: 10.1186/s13052-021-01044-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background Genetic diseases are chronic conditions with relevant impact on the lives of patients and their families. In USA and Europe it is estimated a prevalence of 60 million affected subjects, 75% of whom are in developmental age. A significant number of newborns are admitted in the Neonatal Intensive Care Units (NICU) for reasons different from prematurity, although the prevalence of those with genetic diseases is unknown. It is, then, common for the neonatologist to start a diagnostic process on suspicion of a genetic disease or malformation syndrome, or to make and communicate these diagnoses. Many surveys showed that the degree of parental satisfaction with the methods of communication of diagnosis is low. Poor communication may have short and long-term negative effects on health and psychological and social development of the child and his family. We draw up recommendations on this issue, shared by 6 Italian Scientific Societies and 4 Parents’ Associations, aimed at making the neonatologist’s task easier at the difficult time of communication to parents of a genetic disease/malformation syndrome diagnosis for their child. Methods We used the method of the consensus paper. A multidisciplinary panel of experts was first established, based on the clinical and scientific sharing of the thematic area of present recommendations. They were suggested by the Boards of the six Scientific Societies that joined the initiative: Italian Societies of Pediatrics, Neonatology, Human Genetics, Perinatal Medicine, Obstetric and Gynecological Ultrasound and Biophysical Methodologies, and Pediatric Genetic Diseases and Congenital Disabilities. To obtain a deeper and global vision of the communication process, and to reach a better clinical management of patients and their families, representatives of four Parents’ Associations were also recruited: Italian Association of Down People, Cornelia de Lange National Volunteer Association, Italian Federation of Rare Diseases, and Williams Syndrome People Association. They worked from September 2019 to November 2020 to achieve a consensus on the recommendations for the communication of a new diagnosis of genetic disease. Results The consensus of experts drafted a final document defining the recommendations, for the neonatologist and/or the pediatrician working in a fist level birthing center, on the first communication of genetic disease or malformation syndrome diagnosis. Although there is no universal communication technique to make the informative process effective, we tried to identify a few relevant strategic principles that the neonatologist/pediatrician may use in the relationship with the family. We also summarized basic principles and significant aspects relating to the modalities of interaction with families in a table, in order to create an easy tool for the neonatologist to be applied in the daily care practice. We finally obtained an intersociety document, now published on the websites of the Scientific Societies involved. Conclusions The neonatologist/pediatrician is often the first to observe complex syndromic pictures, not always identified before birth, although today more frequently prenatally diagnosed. It is necessary for him to know the aspects of genetic diseases related to communication and bioethics, as well as the biological and clinical ones, which together outline the cornerstones of the multidisciplinary care of these patients. This consensus provide practical recommendations on how to make the first communication of a genetic disease /malformation syndrome diagnosis. The proposed goal is to make easier the informative process, and to implement the best practices in the relationship with the family. A better doctor-patient/family interaction may improve health outcomes of the child and his family, as well as reduce legal disputes with parents and the phenomenon of defensive medicine.
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Affiliation(s)
- Gregorio Serra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Luigi Memo
- Clinical Genetics Outpatient Service, Neonatology and Neonatal Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Alessandra Coscia
- University Neonatology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Ambra Iuculano
- Unit of Prenatal and Preimplantation Diagnosis, Thalassaemic Hospital, AO Brotzu, Cagliari, Italy
| | - Mariano Lanna
- Unit of Obstetrics and Gynecology, Prenatal Diagnosis and Fetal Therapy "U. Nicolini", Buzzi Hospital, ASST FBF Sacco, Milan, Italy
| | - Diletta Valentini
- Unit of General Pediatrics, Emergency and Acceptance Department, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Anna Contardi
- Coordinator of the Italian Association of Down People, Rome, Italy
| | - Sauro Filippeschi
- President of the Italian National Association of Volunteers Cornelia de Lange, Pesaro, Italy
| | - Tiziana Frusca
- President of the Italian Society of Obstetric and Gynecological Ultrasound and Biophysical Methodologies, Parma, Italy
| | - Fabio Mosca
- President of the Italian Society of Neonatology, Milan, Italy
| | - Luca A Ramenghi
- President of the Italian Society of Perinatal Medicine, Genoa, Italy
| | - Corrado Romano
- Coordinator of the Clinical Genetics Study Group of the Italian Society of Human Genetics, Troina, EN, Italy
| | - Annalisa Scopinaro
- President of Italian Federation of Rare Diseases and of Williams Syndrome People Association, Rome, Italy
| | | | - Giuseppe Zampino
- President of the Italian Society of Pediatric Genetic Diseases and Congenital Disabilities, Rome, Italy
| | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
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Abstract
Neurodevelopmental disorders are the most prevalent chronic medical conditions encountered in pediatric primary care. In addition to identifying appropriate descriptive diagnoses and guiding families to evidence-based treatments and supports, comprehensive care for individuals with neurodevelopmental disorders includes a search for an underlying etiologic diagnosis, primarily through a genetic evaluation. Identification of an underlying genetic etiology can inform prognosis, clarify recurrence risk, shape clinical management, and direct patients and families to condition-specific resources and supports. Here we review the utility of genetic testing in patients with neurodevelopmental disorders and describe the three major testing modalities and their yields - chromosomal microarray, exome sequencing (with/without copy number variant calling), and FMR1 CGG repeat analysis for fragile X syndrome. Given the diagnostic yield of genetic testing and the potential for clinical and personal utility, there is consensus that genetic testing should be offered to all patients with global developmental delay, intellectual disability, and/or autism spectrum disorder. Despite this recommendation, data suggest that a minority of children with autism spectrum disorder and intellectual disability have undergone genetic testing. To address this gap in care, we describe a structured but flexible approach to facilitate integration of genetic testing into clinical practice across pediatric specialties and discuss future considerations for genetic testing in neurodevelopmental disorders to prepare pediatric providers to care for patients with such diagnoses today and tomorrow.
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Affiliation(s)
- Juliann M. Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
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Bucio D, Ormond KE, Hernandez D, Bustamante CD, Lopez Pineda A. A genetic counseling needs assessment of Mexico. Mol Genet Genomic Med 2019; 7:e668. [PMID: 30938092 PMCID: PMC6503023 DOI: 10.1002/mgg3.668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND While genetic counseling has expanded globally, Mexico has not adopted it as a separate profession. Given the rapid expansion of genetic and genomic services, understanding the current genetic counseling landscape in Mexico is crucial to improving healthcare outcomes. METHODS Our needs assessment strategy has two components. First, we gathered quantitative data about genetics education and medical geneticists' geographic distribution through an exhaustive compilation of available information across several medical schools and public databases. Second, we conducted semi-structured interviews of 19 key-informants from 10 Mexican states remotely with digital recording and transcription. RESULTS Across 32 states, ~54% of enrolled medical students receive no medical genetics training, and only Mexico City averages at least one medical geneticist per 100,000 people. Barriers to genetic counseling services include: geographic distribution of medical geneticists, lack of access to diagnostic tools, patient health literacy and cultural beliefs, and education in medical genetics/genetic counseling. Participants reported generally positive attitudes towards a genetic counseling profession; concerns regarding a current shortage of available jobs for medical geneticists persisted. CONCLUSION To create a foundation that can support a genetic counseling profession in Mexico, the clinical significance of medical genetics must be promoted nationwide. Potential approaches include: requiring medical genetics coursework, developing community genetics services, and increasing jobs for medical geneticists.
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Affiliation(s)
- Daiana Bucio
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Department of Clinical Genetics and Genomics, Roy and Patricia Disney Family Cancer Center, Providence Saint Joseph Medical Center, Burbank, California
| | - Kelly E Ormond
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Stanford Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, California
| | - Daisy Hernandez
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Department of Pediatric Genetics, Loma Linda University Health, San Bernardino, California
| | - Carlos D Bustamante
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California.,Chan Zuckerberg Biohub, San Francisco, California
| | - Arturo Lopez Pineda
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
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Rubanovich CK, Cheung C, Torkamani A, Bloss CS. Physician Communication of Genomic Results in a Diagnostic Odyssey Case Series. Pediatrics 2019; 143:S44-S53. [PMID: 30600271 DOI: 10.1542/peds.2018-1099i] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The availability of whole genome sequencing (WGS) is increasing in clinical care, and WGS is a promising tool in diagnostic odyssey cases. Physicians' ability to effectively communicate genomic information with patients, however, is unclear. In this multiperspective study, we assessed physicians' communication of patient genome sequencing information in a diagnostic odyssey case series. METHODS We evaluated physician communication of genome sequencing results in the context of an ongoing study of the utility of WGS for the diagnosis of rare and idiopathic diseases. A modified version of the Medical Communication Competence Scale was used to compare patients' ratings of their physicians' communication of general medical information to communication of genome sequencing information. Physician self-ratings were also compared with patient ratings. RESULTS A total of 47 patients, parents, and physicians across 11 diagnostic odyssey cases participated. In 6 of 11 cases (54%), the patient respondent rated the physician's communication of genome sequencing information as worse than that of general medical information. In 9 of 11 cases (82%), physician self-ratings of communication of genome sequencing information were worse than the patient respondent's rating. Identification of a diagnosis via WGS was positively associated with physician self-ratings (P = .021) but was not associated with patient respondent ratings (P = .959). CONCLUSIONS These findings reveal that even in diagnostic odyssey cases, in which genome sequencing may be clinically beneficial, physicians may not be well-equipped to communicate genomic information to patients. Future studies may benefit from multiperspective approaches to assessing and understanding physician-patient communication of genome-sequencing information.
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Affiliation(s)
- Caryn Kseniya Rubanovich
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | - Ali Torkamani
- Scripps Genomic Medicine Division, Scripps Translational Science Institute, Scripps Health, La Jolla, CA.,Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA; and
| | - Cinnamon S Bloss
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
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García-Acero M, Suárez-Obando F, Gómez-Gutiérrez A. CGH analysis in Colombian patients: findings of 1374 arrays in a seven-year study. Mol Cytogenet 2018; 11:46. [PMID: 30166995 PMCID: PMC6104019 DOI: 10.1186/s13039-018-0398-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022] Open
Abstract
Background Array-based comparative genome hybridization (array CGH) is a first-line test used in the genetic evaluation of individuals with multiple anomalies, developmental delays, and cognitive deficits. In this study, we analyzed clinical indications and findings of array CGH tests of Colombian individuals forwarded to a reference laboratory over a period of seven years in order to evaluate the diagnostic performance of the test in our population. Results The results of 1374 array CGH analyses of Colombian individuals were referred to the Andean Reference Institute in Colombia (Instituto de Referencia Andino) during a 7-year period (2009–2015). Chromosomal imbalances were detected in 488 cases (35%), whereas 121 cases were classified as nonpathogenic variants, 65 cases (4.7%) were classified as variants of uncertain significance, and 302 cases (22%) were classified as abnormal or pathogenic. The most common findings in the abnormal and/or pathogenic set were deletions, followed by duplications and complex rearrangements. Variants in the carrier status of autosomal recessive diseases were identified as incidental findings in 29 subjects (2%). Conclusions Clinical indications preceding the referral of aCGH in Colombian patients are not standardized and result in unexpected pathogenic variants as well as secondary findings that need careful interpretation. Development of local infrastructure will probably improve the communication between all stakeholders, to ensure accurate clinical diagnoses.
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Affiliation(s)
- Mary García-Acero
- 1Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- 1Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.,2Servicio de Genética, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Alberto Gómez-Gutiérrez
- 1Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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