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Lanjouw L, Mourits MJE, Bart J, Ter Elst A, Berger LPV, van der Hout AH, Alam N, de Bock GH. BRCA1/2 testing rates in epithelial ovarian cancer: a focus on the untested patients. Int J Gynecol Cancer 2023; 33:1260-1269. [PMID: 37137525 PMCID: PMC10423510 DOI: 10.1136/ijgc-2023-004307] [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: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Since 2015, Dutch guidelines have recommended BRCA1/2 pathogenic variant testing for all patients with epithelial ovarian cancer. Recently, recommendations shifted from germline testing to the tumor-first approach, in which tumor tissue is tested first, and subsequent germline testing is performed only in those with BRCA1/2 tumor pathogenic variants or a positive family history. Data on testing rates and on characteristics of patients missing out on testing remain scarce. OBJECTIVE To evaluate BRCA1/2 testing rates in patients with epithelial ovarian cancer and compare testing rates of germline testing (performed from 2015 until mid-2018) versus tumor-first testing (implemented mid-2018). METHODS A consecutive series of 250 patients diagnosed with epithelial ovarian cancer between 2016 and 2019 was included from the OncoLifeS data-biobank of the University Medical Center Groningen, the Netherlands. Testing rates were analyzed for the overall study population and for germline testing (period I) and tumor-first testing (period II) separately. Characteristics of tested and untested patients were compared and predictors for receiving testing were assessed with multivariable logistic regression. RESULTS Median age was 67.0 years (IQR 59.0-73.0) and 173 (69.2%) patients were diagnosed with high-grade serous carcinoma. Overall, 201 (80.4%) patients were tested. In period I, 137/171 (80.1%) patients were tested and in period II this was 64/79 (81.0%). Patients with non-high-grade serous carcinoma were significantly less likely to receive BRCA1/2 testing than patients with high-grade serous carcinoma (OR=0.23, 95% CI 0.11 to 0.46, p<0.001). CONCLUSIONS The results show that BRCA1/2 testing rates are suboptimal and suggest that clinicians may not be choosing to test patients with epithelial ovarian cancer with non-high-grade serous ovarian carcinoma, although guidelines recommend BRCA1/2 testing in all patients with epithelial ovarian cancer. Suboptimal testing rates limit optimization of care for patients with epithelial ovarian cancer and counseling of potentially affected relatives.
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Affiliation(s)
- Lieke Lanjouw
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joost Bart
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arja Ter Elst
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lieke P V Berger
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annemieke H van der Hout
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Naufil Alam
- AstraZeneca Pharmaceuticals LP, Cambridge, UK
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Bijlsma R, Wouters R, Wessels H, Sleijfer S, Beerepoot L, Ten Bokkel Huinink D, Cruijsen H, Heijns J, Lolkema MP, Steeghs N, van Voorthuizen T, Vulink A, Witteveen E, Ausems M, Bredenoord A, May AM, Voest E. Preferences to receive unsolicited findings of germline genome sequencing in a large population of patients with cancer. ESMO Open 2021; 5:S2059-7029(20)30053-3. [PMID: 32312756 PMCID: PMC7200077 DOI: 10.1136/esmoopen-2019-000619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/05/2019] [Accepted: 12/29/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In precision medicine, somatic and germline DNA sequencing are essential to make genome-guided treatment decisions in patients with cancer. However, it can also uncover unsolicited findings (UFs) in germline DNA that could have a substantial impact on the lives of patients and their relatives. It is therefore critical to understand the preferences of patients with cancer concerning UFs derived from whole-exome (WES) or whole-genome sequencing (WGS). METHODS In a quantitative multicentre study, adult patients with cancer (any stage and origin of disease) were surveyed through a digital questionnaire based on previous semi-structured interviews. Background knowledge was provided by showing two videos, introducing basic concepts of genetics and general information about different categories of UFs (actionable, non-actionable, reproductive significance, unknown significance). RESULTS In total 1072 patients were included of whom 701 participants completed the whole questionnaire. Overall, 686 (85.1%) participants wanted to be informed about UFs in general. After introduction of four UFs categories, 113 participants (14.8%) changed their answer: 718 (94.2%) participants opted for actionable variants, 537 (72.4%) for non-actionable variants, 635 (87.0%) participants for UFs of reproductive significance and 521 (71.8%) for UFs of unknown significance. Men were more interested in receiving certain UFs than women: non-actionable: OR 3.32; 95% CI 2.05 to 5.37, reproductive significance: OR 1.97; 95% CI 1.05 to 3.67 and unknown significance: OR 2.00; 95% CI 1.25 to 3.21. In total, 244 (33%) participants conceded family members to have access to their UFs while still alive. 603 (82%) participants agreed to information being shared with relatives, after they would pass away. CONCLUSION Our study showed that the vast majority of patients with cancer desires to receive all UFs of genome testing, although a substantial minority does not wish to receive non-actionable findings. Incorporation of categories in informed consent procedures supports patients in making informed decisions on UFs.
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Affiliation(s)
- Rhode Bijlsma
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Roel Wouters
- Department of Medical Humanities, University Medical Center Utrecht, Julius Center, Utrecht, The Netherlands
| | - Hester Wessels
- Department of Corporate Communications, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Center for Personalized Cancer Treatment (CPCT), Rotterdam, The Netherlands
| | - Laurens Beerepoot
- Department of Medical Oncology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Hester Cruijsen
- Department of Medical Oncology, Antonius Hospital, Sneek, The Netherlands
| | - Joan Heijns
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Annelie Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Els Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Margreet Ausems
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Julius Center, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emile Voest
- Center for Personalized Cancer Treatment (CPCT), Rotterdam, The Netherlands .,Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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3
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van der Giessen JAM, Ausems MGEM, van Riel E, de Jong A, Fransen MP, van Dulmen S. Development of a plain-language guide for discussing breast cancer genetic counseling and testing with patients with limited health literacy. Support Care Cancer 2021; 29:2895-2905. [PMID: 33001269 PMCID: PMC8062319 DOI: 10.1007/s00520-020-05800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Due to limited health literacy and resulting ineffective communication between healthcare professionals and patients, not all eligible patients are offered breast cancer genetic counseling and testing. We aimed to develop a plain-language guide to increase effective communication about genetic counseling and testing with breast cancer patients with limited health literacy. METHODS Together with oncological healthcare professionals, we drafted a list of jargon words frequently used during (breast) cancer genetic counseling. In a focus group interview with breast cancer counselees with limited health literacy, who had received genetic counseling before, we reformulated these words in plain language. Low-literate individuals, who are not familiar with breast cancer care or genetic counseling, reflected on the draft of the guide. Completeness, acceptability, and perceived usability were tested in an online questionnaire among healthcare professionals. RESULTS The result is a plain-language guide for genetic counseling and testing with 33 frequently used jargon words and a reformulation of these words in plain language. Acceptability and perceived usefulness of the guide among healthcare professionals (n = 58) were high. CONCLUSION The plain-language guide provides opportunities to facilitate communication about genetic counseling and testing with patients with limited health literacy and could enhance opportunities for patients to make informed decisions to participate in genetic testing. As the intention from healthcare professionals to use the plain-language guide is high, implementation of the guide in a real-life setting seems promising.
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Affiliation(s)
- J A M van der Giessen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E van Riel
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A de Jong
- Reading & Writing Foundation, Den Haag, The Netherlands
| | - M P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dulmen
- Research Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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4
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Systematic development of a training program for healthcare professionals to improve communication about breast cancer genetic counseling with low health literate patients. Fam Cancer 2021; 19:281-290. [PMID: 32323055 PMCID: PMC7497313 DOI: 10.1007/s10689-020-00176-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a disproportionate underuse of genetic testing in breast cancer patients from lower education or migrant background. Within these groups, communication about referral to genetic counseling appears challenging due to limited health literacy and cultural barriers. Our aim was to develop and evaluate a training program for healthcare professionals (breast surgeons and specialized nurses), to increase effective communication. We systematically developed a blended training program based on patients’ and healthcare professionals’ needs and preferences. Prior to the training, we assessed awareness, knowledge and self-efficacy of healthcare professionals. Acceptability and usefulness of the training program were assessed directly after the training. Healthcare professionals (n = 65) from 17 hospitals showed moderate to high awareness and knowledge about the prevalence and impact of limited health literacy. They were aware of cultural factors that influence communication. However, they did not feel confident in recognizing limited health literacy and their self-efficacy to communicate effectively with these patients was low. The training program was rated as acceptable and useful. Healthcare professionals lack confidence to effectively communicate with patients with limited health literacy or migrant background. The training program offers opportunities to improve communication about referral to breast cancer genetic counseling.
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5
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Armstrong N, Quek RGW, Ryder S, Ross J, Buksnys T, Forbes C, Fox KM, Castro E. DNA damage repair gene mutation testing and genetic counseling in men with/without prostate cancer: a systematic review. Future Oncol 2021; 17:853-864. [DOI: 10.2217/fon-2020-0569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Ongoing clinical trials are investigating PARP inhibitors to target the DNA damage repair (DDR) pathway in prostate cancer. DDR mutation screening will guide treatment strategy and assess eligibility for clinical trials. Materials & methods: This systematic review estimated the rate of DDR mutation testing or genetic counseling among men with or at risk of prostate cancer. Results: From 6856 records, one study fulfilled the inclusion criteria and described men undiagnosed with prostate cancer with a family history of BRCA1/2 mutation who received DDR mutation testing. Conclusion: With only one study included in this first systematic review of DDR mutation testing or genetic counseling in men with or at risk of prostate cancer, more research is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Kathleen M Fox
- Strategic Healthcare Solutions, LLC, Aiken, SC 29803, USA
| | - Elena Castro
- Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
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6
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Grindedal EM, Jørgensen K, Olsson P, Gravdehaug B, Lurås H, Schlichting E, Vamre T, Wangensteen T, Heramb C, Mæhle L. Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway. Fam Cancer 2021; 19:133-142. [PMID: 32002722 PMCID: PMC7101297 DOI: 10.1007/s10689-020-00160-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies have shown that a significant number of eligible breast cancer patients are not offered genetic testing or referral to genetic counseling. To increase access to genetic testing in South Eastern Norway, testing has since 2014 been offered directly to breast cancer patients by surgeons and oncologists. This practice is termed “mainstreamed genetic testing”. The aim of this study was to investigate to what extent patients in South Eastern Norway are offered testing. Three hundred and sixty one patients diagnosed in 2016 and 2017 at one regional and one university hospital in South Eastern Norway were included. Data on whether the patients fulfilled the criteria, whether they had been offered testing and if they were tested were collected. In total, 26.6% (96/361) fulfilled the criteria for testing. Seventy five percent (69/92) of these were offered testing, and 71.7% (66/92) were tested. At the university hospital, 90.2% (37/41) of eligible patients were offered testing, and at the regional hospital 62.7% (32/51). Fifty two percent (12/23) of eligible patient not offered testing were younger than 50 years at time of diagnosis. As many as 95.4% (125/131) of all patients who were offered testing, wanted to be tested. The majority of patients who fulfilled the criteria were offered testing, supporting the practice of mainstreamed genetic testing. There were nevertheless differences in rates of testing between the hospitals that affected all groups of patients, indicating that genetic testing may not be equally accessible to all patients. We suggest that efforts should be made to increase awareness and improve routines for genetic testing of breast cancer patients in Norway.
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Affiliation(s)
| | - Kjersti Jørgensen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Pernilla Olsson
- Department of Surgery, Section of Breast and Endocrine Surgery, Innlandet Hospital, Hamar, Norway
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ellen Schlichting
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Section of Breast- and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Tone Vamre
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Heramb
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Lovise Mæhle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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7
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van der Giessen J, Fransen MP, Spreeuwenberg P, Velthuizen M, van Dulmen S, Ausems MGEM. Communication about breast cancer genetic counseling with patients with limited health literacy or a migrant background: evaluation of a training program for healthcare professionals. J Community Genet 2021; 12:91-99. [PMID: 33319336 PMCID: PMC7846648 DOI: 10.1007/s12687-020-00497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Access to breast cancer genetic counseling is suboptimal for patients with limited health literacy or a migrant background due to ineffective communication and lack of healthcare professionals' recommendation. This study examines the effect of a blended training program (Erfo4all) for healthcare professionals on their awareness, knowledge, and self-efficacy towards communication about genetic counseling with patients with limited health literacy or a migrant background. In total, 59 breast surgeons and specialized nurses from 16 Dutch hospitals completed an online module and group training. Knowledge, self-assessed awareness, and self-efficacy were assessed before the training and 33 participants also completed a posttest questionnaire 6 months after the training program. We also assessed the perceived applicability and relevance of the training program from healthcare professionals' perspectives. We found a significant increase in self-assessed awareness of the prevalence and impact of limited health literacy and in healthcare professionals' self-efficacy to recognize limited health literacy and to communicate effectively with patients with limited health literacy or a migrant background. We did not find an increase in knowledge score. Almost all healthcare professionals reported that they use the techniques learned in the training, such as the teach-back method and plain language, and felt more confident discussing breast cancer genetic counseling. Our results suggest that a blended training program for healthcare professionals has potential to improve their ability to communicate effectively about breast cancer genetic counseling with patients with limited health literacy or a migrant background and offers a promising way to increase the referral rate for these groups of patients.
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Affiliation(s)
- Jeanine van der Giessen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P. O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, P. O. Box 22660, 1100, DD, Amsterdam, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), P. O Box 1568, 3500, BN, Utrecht, The Netherlands
| | - Mary Velthuizen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P. O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), P. O Box 1568, 3500, BN, Utrecht, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, P. O Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, P. O. Box 85500, 3508, GA, Utrecht, The Netherlands.
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8
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Opportunistic genomic screening. Recommendations of the European Society of Human Genetics. Eur J Hum Genet 2020; 29:365-377. [PMID: 33223530 PMCID: PMC7940405 DOI: 10.1038/s41431-020-00758-w] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
If genome sequencing is performed in health care, in theory the opportunity arises to take a further look at the data: opportunistic genomic screening (OGS). The European Society of Human Genetics (ESHG) in 2013 recommended that genome analysis should be restricted to the original health problem at least for the time being. Other organizations have argued that ‘actionable’ genetic variants should or could be reported (including American College of Medical Genetics and Genomics, French Society of Predictive and Personalized Medicine, Genomics England). They argue that the opportunity should be used to routinely and systematically look for secondary findings—so-called opportunistic screening. From a normative perspective, the distinguishing characteristic of screening is not so much its context (whether public health or health care), but the lack of an indication for having this specific test or investigation in those to whom screening is offered. Screening entails a more precarious benefits-to-risks balance. The ESHG continues to recommend a cautious approach to opportunistic screening. Proportionality and autonomy must be guaranteed, and in collectively funded health-care systems the potential benefits must be balanced against health care expenditures. With regard to genome sequencing in pediatrics, ESHG argues that it is premature to look for later-onset conditions in children. Counseling should be offered and informed consent is and should be a central ethical norm. Depending on developing evidence on penetrance, actionability, and available resources, OGS pilots may be justified to generate data for a future, informed, comparative analysis of OGS and its main alternatives, such as cascade testing.
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9
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Reumkens K, Tummers MHE, Severijns Y, Gietel-Habets JJG, van Kuijk SMJ, Aalfs CM, van Asperen CJ, Ausems MGEM, Collée M, Dommering CJ, Kets M, van der Kolk LE, Oosterwijk JC, Tjan-Heijnen VCG, van der Weijden T, de Die-Smulders CEM, van Osch LADM. Reproductive decision-making in the context of hereditary cancer: the effects of an online decision aid on informed decision-making. J Community Genet 2020; 12:101-110. [PMID: 32880035 PMCID: PMC7846643 DOI: 10.1007/s12687-020-00484-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022] Open
Abstract
Individuals having a genetic predisposition to cancer and their partners face challenging decisions regarding their wish to have children. This study aimed to determine the effects of an online decision aid to support couples in making an informed decision regarding their reproductive options. A nationwide pretest-posttest study was conducted in the Netherlands among 131 participants between November 2016 and May 2018. Couples were eligible for participation if one partner had a pathogenic variant predisposing for an autosomal dominant hereditary cancer syndrome. Participants completed a questionnaire before use (T0), and at 3 months (T3) after use of the decision aid to assess the primary outcome measure informed decision-making, and the secondary outcome measures decisional conflict, knowledge, realistic expectations, level of deliberation, and decision self-efficacy. T0-T3 comparisons show an overall positive effect for all outcome measures (all ps < 0.05; knowledge (ES = - 1.05), decisional conflict (ES = 0.99), participants' decision self-efficacy (ES = -0.55), level of deliberation (ES = - 0.50), and realistic expectations (ES = - 0.44). Informed decision-making increased over time and 58.0% of the participants made an informed reproductive decision at T3. The online decision aid seems to be an appropriate tool to complement standard reproductive counseling to support our target group in making an informed reproductive decision. Use of the decision aid may lessen the negative psychological impact of decision-making on couples' daily life and wellbeing.
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Affiliation(s)
- Kelly Reumkens
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Marly H E Tummers
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Yil Severijns
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands. .,Department of Health Promotion, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Postbox 616, 6200, MD, Maastricht, the Netherlands.
| | - Joyce J G Gietel-Habets
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Amsterdam UMC, Academic Medical Centre, Amsterdam, the Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Margreet G E M Ausems
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Charlotte J Dommering
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marleen Kets
- Department of Human Genetics, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | | | - Jan C Oosterwijk
- Department of Genetics, Groningen University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Vivianne C G Tjan-Heijnen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Medical Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Liesbeth A D M van Osch
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Health Promotion, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Postbox 616, 6200, MD, Maastricht, the Netherlands
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10
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Vos JR, Fakkert IE, de Hullu JA, van Altena AM, Sie AS, Ouchene H, Willems RW, Nagtegaal ID, Jongmans MCJ, Mensenkamp AR, Woldringh GH, Bulten J, Leter EM, Kets CM, Simons M, Ligtenberg MJL, Hoogerbrugge N. Universal Tumor DNA BRCA1/2 Testing of Ovarian Cancer: Prescreening PARPi Treatment and Genetic Predisposition. J Natl Cancer Inst 2020; 112:161-169. [PMID: 31076742 PMCID: PMC7019087 DOI: 10.1093/jnci/djz080] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Women with epithelial ovarian cancer (OC) have a higher chance to benefit from poly (ADP-ribose) polymerase inhibitor (PARPi) therapy if their tumor has a somatic or hereditary BRCA1/2 pathogenic variant. Current guidelines advise BRCA1/2 genetic predisposition testing for all OC patients, though this does not detect somatic variants. We assessed the feasibility of a workflow for universal tumor DNA BRCA1/2 testing of all newly diagnosed OC patients as a prescreen for PARPi treatment and cancer predisposition testing. Methods Formalin-fixed paraffin-embedded tissue was obtained from OC patients in seven hospitals immediately after diagnosis or primary surgery. DNA was extracted, and universal tumor BRCA1/2 testing was then performed in a single site. Diagnostic yield, uptake, referral rates for genetic predisposition testing, and experiences of patients and gynecologists were evaluated. Results Tumor BRCA1/2 testing was performed for 315 (77.6%) of the 406 eligible OC samples, of which 305 (96.8%) were successful. In 51 of these patients, pathogenic variants were detected (16.7%). Most patients (88.2%) went on to have a genetic predisposition test. BRCA1/2 pathogenic variants were shown to be hereditary in 56.8% and somatic in 43.2% of patients. Participating gynecologists and patients were overwhelmingly positive about the workflow. Conclusions Universal tumor BRCA1/2 testing in all newly diagnosed OC patients is feasible, effective, and appreciated by patients and gynecologists. Because many variants cannot be detected in DNA from blood, testing tumor DNA as the first step can double the identification rate of patients who stand to benefit most from PARP inhibitors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Edward M Leter
- Radboud University Medical Center, Nijmegen, the Netherlands. Department of Clinical Genetics (EML), Maastricht University Medical Center, Maastricht, the Netherlands
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Noordman J, van Vliet L, Kaunang M, van den Muijsenbergh M, Boland G, van Dulmen S. Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers. BMC Palliat Care 2019; 18:37. [PMID: 30979368 PMCID: PMC6461806 DOI: 10.1186/s12904-019-0421-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Person-centred palliative care poses high demands on professionals and patients regarding appropriate and effective communication and informed decision-making. This is even more so for patients with limited health literacy, as they lack the necessary skills to find, understand and apply information about their health and healthcare. Recognizing patients with limited health literacy and adapting the communication, information provision and decision-making process to their skills and needs is essential to achieve desired person-centred palliative care. The aim of this study is to summarize available strategies and tools for healthcare providers towards successful communication, information provision and/or shared decision-making in supporting patients with limited health literacy in hospital-based palliative care in Western countries. METHODS A scoping review was conducted. First, databases PubMed, Embase, CINAHL, and PsycINFO were searched. Next, grey literature was examined using several online databases and by contacting national experts. In addition, all references of included studies were checked. RESULTS Five studies were included that showed that there are face-to-face, written as well as online strategies available for healthcare providers to support communication, information provision and, to a lesser extent, (shared) decision-making in palliative care for patients with limited health literacy. Strategies that were mentioned several times were: teach-back method, jargon-free communication and developing and testing materials with patients with limited health literacy, among others. Two supporting tools were found: patient decision aids and question prompt lists. CONCLUSIONS To guarantee high quality person-centred palliative care, the role of health literacy should be considered. Although there are several strategies available for healthcare providers to facilitate such communication, only few tools are offered. Moreover, the strategies and tools appear not specific for the setting of palliative care, but seem helpful for providers to support the communication, information provision and decision making with patients with limited health literacy in general. Future research should focus on which strategies or tools are (most) effective in supporting patients with limited health literacy in palliative care, and the implementation of these strategies and tools in practice.
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Affiliation(s)
- Janneke Noordman
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Liesbeth van Vliet
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Menno Kaunang
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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12
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Reumkens K, Tummers MHE, Gietel-Habets JJG, van Kuijk SMJ, Aalfs CM, van Asperen CJ, Ausems MGEM, Collée M, Dommering CJ, Kets CM, van der Kolk LE, Oosterwijk JC, Tjan-Heijnen VCG, van der Weijden T, de Die-Smulders CEM, van Osch LADM. Online decision support for persons having a genetic predisposition to cancer and their partners during reproductive decision-making. J Genet Couns 2018; 28:533-542. [PMID: 30629779 PMCID: PMC7380023 DOI: 10.1002/jgc4.1056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
A nationwide pretest–posttest study was conducted in all clinical genetic centres in the Netherlands, to evaluate the effects of an online decision aid to support persons who have a genetic predisposition to cancer and their partners in making an informed decision regarding reproductive options. Main outcomes (decisional conflict, knowledge, realistic expectations, level of deliberation, and decision self‐efficacy) were measured before use (T0), immediately after use (T1), and at 2 weeks (T2) after use of the decision aid. Paired sample t tests were used to compute differences between the first and subsequent measurements. T0–T1 and T0–T2 comparisons indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict. Furthermore, use of the decision aid resulted in increased knowledge levels and improved realistic expectations. Level of deliberation only increased for participants with lower baseline levels of deliberation. Decision self‐efficacy increased for those with low baseline scores, whereas those with high baseline scores showed a reduction at T2. It can be concluded that use of the decision aid resulted in several positive outcomes indicative of informed decision‐making. The decision aid is an appropriate and highly appreciated tool to be used in addition to reproductive counseling.
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Affiliation(s)
- Kelly Reumkens
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marly H E Tummers
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joyce J G Gietel-Habets
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet G E M Ausems
- Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - C Marleen Kets
- Department of Human Genetics, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | - Jan C Oosterwijk
- Department of Genetics, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Medical Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, School CAPHRI, Maastricht University, Maastricht, The Netherlands
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13
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Cornel MC, Bonham VL. Genomics for all in the 21st century? J Community Genet 2017; 8:249-251. [PMID: 28905227 PMCID: PMC5614891 DOI: 10.1007/s12687-017-0333-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/03/2017] [Indexed: 01/08/2023] Open
Abstract
As the field of genomics enters the second decade after the completion of the International Human Genome Project, human genomics research is still far from reflective of the ancestral diversity found in global populations. This special issue of the Journal of Community Genetics brings together a global perspective on the need for researchers and health care professionals to support achievable milestones that will enhance global ancestral diversity in genomic research for the 21st century, and integrate the resulting knowledge into health care that benefits everyone. As the publications in this special issue illustrate, this will require focused community engagement, including often overlooked isolated populations, as well as meaningful integration of genomics and health services across the global landscape. With the advancement of sequencing technology and reduction in the cost, the time has come to address critical barriers.
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Affiliation(s)
- Martina C Cornel
- Department of Clinical Genetics and Amsterdam Public Health Research Institute, Section Community Genetics, VU University Medical Center, BS7, A527, Mail A509 APH, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Vence L Bonham
- Division of Intramural Research, Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, MD, USA
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