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Schulze J, Dhaliwal JK, Miller M, Quinn E, Wetherill L, Cook L. Factors Influencing Patient Disclosure of Parkinson's Disease Genetic Testing Results to Relatives. Mov Disord Clin Pract 2024; 11:786-794. [PMID: 38586948 PMCID: PMC11233843 DOI: 10.1002/mdc3.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/09/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Persons with Parkinson's disease (PD) who have received genetic test results are faced with the decision of whether, and how, to share that information with family. Studies in other specialties have shown high rates of disclosure motivated by a sense of responsibility. Rates of, and attitudes surrounding, disclosure have yet to be reported in this population. OBJECTIVES To explore the disclosure practices and motivations of patients with PD regarding genetic test results, allowing insight to guide genetic counseling and navigation of test result discussions. METHODS A cross-sectional online survey was distributed to adults with PD and previous genetic test results. Survey questions assessed demographics, genetic testing results and delivery, sharing behaviors, perceptions of PD, and motivations and barriers to family disclosure. RESULTS Among respondents, 88.9% shared results with at least one family member, most often a child (73.5%) or sibling (65.4%). Seventy-four percent reported sharing results with someone outside of their family, most frequently a friend (88.4%). The most common motivation for disclosure was the perception that family members would want to know. Barriers to disclosure were lack of close relationships, understanding results, and perceived utility. CONCLUSIONS Disclosure rates in this PD population were consistent with those in previously reported populations. Motivations were anchored in perceptions of utility and family desire for information, suggesting a need to adjust patient education to improve retention and to explore family dynamics and perceptions of results.
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Affiliation(s)
- Jeanine Schulze
- Indiana University School of MedicineMedical and Molecular GeneticsIndianapolisIndianaUSA
| | | | - Mandy Miller
- Indiana University School of MedicineMedical and Molecular GeneticsIndianapolisIndianaUSA
| | - Emily Quinn
- Keck Graduate InstituteClaremontCaliforniaUSA
| | - Leah Wetherill
- Indiana University School of MedicineMedical and Molecular GeneticsIndianapolisIndianaUSA
| | - Lola Cook
- Indiana University School of MedicineMedical and Molecular GeneticsIndianapolisIndianaUSA
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Ballard LM, Band R, Lucassen AM. Interventions to support patients with sharing genetic test results with at-risk relatives: a synthesis without meta-analysis (SWiM). Eur J Hum Genet 2023; 31:988-1002. [PMID: 37344572 PMCID: PMC10474271 DOI: 10.1038/s41431-023-01400-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/22/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Whilst the finding of heritable susceptibility to disease was once relatively rare, mainstreaming of genetic testing has resulted in a steady increase. Patients are often encouraged to share their genetic test results with relevant relatives, but relatives may not receive this information, leaving them without knowledge of their own risk. Therefore, strategies to help communicate such information are important. This review aimed to explore the efficacy of existing interventions to improve the sharing of genetic test results. A synthesis without meta-analysis design was used. A systematic search of Medline, CINAHL, PsychINFO, and AMED was conducted, and five studies were identified worldwide. Data were extracted for each study regarding study aim, participant characteristics, condition, intervention details, comparison, study duration, outcome measures, theory and behaviour change techniques used. Limited efficacy and application of theory was found. Knowledge, motivation and self-efficacy were not increased in any intervention. No gender differences in communication behaviour were encountered in interventions that recruited men and women. Two studies reported an evaluation of acceptability, which showed that the interventions were well received by patients and health professionals. No study reported the involvement of the target population in any phase of intervention development. Given the lack of health psychology-informed interventions in this area of clinical genetics, we recommend genetic health professionals, health psychologists and patients collaborate on all stages of future interventions that involve the cascading of genetic health information within families. We also provide guidance regarding use of theory and intervention elements for future intervention development.
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Affiliation(s)
- Lisa Marie Ballard
- Clinical Ethics, Law and Society (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Rebecca Band
- Health Sciences, Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Anneke M Lucassen
- Clinical Ethics, Law and Society (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical ethics, law and society (CELS), Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
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Van Steijvoort E, Peeters H, Vandecruys H, Verguts J, Peeraer K, Matthijs G, Borry P. Experiences of nonpregnant couples after receiving reproductive genetic carrier screening results in Belgium. Eur J Hum Genet 2023; 31:696-702. [PMID: 36788144 PMCID: PMC9928592 DOI: 10.1038/s41431-023-01310-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) allows for the identification of couples who have an increased likelihood of conceiving a child with a particular autosomal recessive or X-linked condition. The aim of this study was to assess the level of satisfaction, anxiety, knowledge retention, psychosocial and counseling-related aspects among couples who chose to have RGCS. Participants were initially informed about their screening results by telephone. After obtaining a written report of test results, participants were asked to complete an individual self-administered questionnaire. All participants (n = 67) felt they had enough information to make an informed choice. None of the participants regretted their choice to have RGCS. Test results were most often shared with parents (61%) or siblings (37%). Our findings demonstrate that the information/counseling and reporting strategy that was used in the context of this study led to high participant satisfaction, an increase in knowledge over time and favorable psychosocial and counseling-related outcomes.
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Affiliation(s)
- Eva Van Steijvoort
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Hilde Peeters
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Hilde Vandecruys
- Department of Gynecology and Obstetrics, Jessa Ziekenhuis Hasselt, Hasselt, Belgium
| | - Jasper Verguts
- Department of Gynecology and Obstetrics, Jessa Ziekenhuis Hasselt, Hasselt, Belgium
| | - Karen Peeraer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert Matthijs
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Development of a Secure Website to Facilitate Information Sharing in Families at High Risk of Bowel Cancer-The Familyweb Study. Cancers (Basel) 2021; 13:cancers13102404. [PMID: 34065728 PMCID: PMC8155923 DOI: 10.3390/cancers13102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Families with an inherited high risk of bowel cancer may struggle to share information about their diagnosis. This means that relatives are not always aware of their increased risk of cancer or able to access screening for the early detection of cancer. Through this study, we aimed to help such families by creating a website where patients could share confidential information with their relatives securely online. Following a survey and telephone interviews with affected individuals, the content of the website was developed to suit the needs of families. Website function was tested with patients to check feasibility and acceptability. Most participants wanted more information to support their adaptation to the diagnosis and help inform their relatives. This study demonstrates how health professionals can improve access to genetic testing and cancer screening in families at high risk of cancer, thus reducing morbidity and mortality. Abstract Individuals with pathogenic variants in genes predisposing to bowel cancer are encouraged to share this information within their families. Close relatives at 50% risk can have access to bowel cancer surveillance. However, many relatives remain unaware of their vulnerability or have insufficient information. We investigated the feasibility and acceptability of using a secure website to support information sharing within families at high risk of bowel cancer. Patients (n = 286) answered an anonymous cross-sectional survey, with 14 participating in telephone interviews. They reported that the diagnosis had a profound effect on them and their family relationships, and consequently desired more support from health professionals. Website content was created in response to the preferences of survey and interview participants. Reactions to the website from 12 volunteers were captured through remote usability testing to guide further refinement of the website. Participants welcomed the opportunity to store and share personal information via the website and wanted more information and help informing their relatives about the diagnosis. Important website topics were: healthy lifestyle; genetic testing; and how to talk to children about the diagnosis. A website providing online access to confidential documents was both feasible and acceptable and could translate into increased uptake of cancer surveillance, resulting in lower morbidity and mortality in these families.
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Subramonian A, Smith D, Dicks E, Dawson L, Borgaonkar M, Etchegary H. Universal tumor screening for lynch syndrome: perspectives of patients regarding willingness and informed consent. Per Med 2020; 17:373-387. [PMID: 32875945 DOI: 10.2217/pme-2020-0026] [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] [Indexed: 11/21/2022]
Abstract
Aim: Lynch Syndrome is associated with a significant risk of colorectal carcinoma (CRC) and other cancers. Universal tumor screening is a strategy to identify high-risk individuals by testing all CRC tumors for molecular features suggestive of Lynch Syndrome. Patient interest in screening and preferences for consent have been underexplored. Methods: A postal survey was administered to CRC patients in a Canadian province. Results: Most patients (81.4%) were willing to have tumors tested if universal tumor screening were available and were willing to discuss test results with family members and healthcare professionals. The majority (62.6%) preferred informed consent be obtained prior to screening. Conclusion: Patients were supportive of universal screening. They expected consent to be obtained, contrary to current practice across Canada and elsewhere.
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Affiliation(s)
- Anusree Subramonian
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | | | - Elizabeth Dicks
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Lesa Dawson
- Gynecologic Oncology, Women's Health & Genetics, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Women's Health and Genetics, Eastern Health, St John's NL, Canada
| | - Mark Borgaonkar
- Gastroenterology, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St John's, NL, Canada
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Pieper E, Sexton A, Ryan MM, Forbes R. Communication about spinal muscular atrophy and genetic risk within families: An Australian pilot study. J Paediatr Child Health 2020; 56:1263-1269. [PMID: 32468641 DOI: 10.1111/jpc.14915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
AIM In families with a child diagnosed with spinal muscular atrophy (SMA), siblings who do not have SMA could still be genetic carriers of the condition. This study is the first to explore how siblings of patients with SMA learn about the condition and their genetic risk. METHOD In-depth, semi-structured interviews were conducted with several parents and unaffected siblings of people with SMA types II and III in Australia. Thematic analysis was performed. RESULTS Siblings described learning about SMA gradually over time through conversations with their parents and other sources, including the Internet, biology classes and support groups. Parents and unaffected siblings described challenges in family communication due to the emotional intensity associated with having SMA in the family. Most siblings did not report learning from their family how the inheritance of SMA related to their own genetic carrier risk and possible reproductive implications. CONCLUSION Siblings described their parents as being open and honest in communicating about SMA; however, this study found that communication before the age of understanding abstract concepts, in combination with the emotional intensity of SMA, resulted in gaps in knowledge about SMA.
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Affiliation(s)
- Ellen Pieper
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrienne Sexton
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Genomic Medicine and Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Monique M Ryan
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Medicine, Dentistry and Health science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robin Forbes
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Evaluation of the template letter regarding the disclosure of genetic information within the family in France. J Community Genet 2019; 10:489-499. [PMID: 30919323 DOI: 10.1007/s12687-019-00418-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 03/15/2019] [Indexed: 12/16/2022] Open
Abstract
The 2011 French Bioethics Law regarding disclosure of genetic information within families enables health professionals to notify any at-risk relatives directly, with the patient's consent, using a template letter. To assess the impact of this template letter in terms of understanding, personal feelings and intent to contact a health professional, we conducted a study interviewing patients, members of the public and genetic professionals. Although the main response to the letter was anxiety, this was associated with good understanding of the content and most individuals mentioned intention to contact a health professional.
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Abstract
PURPOSE OF REVIEW To compile data from the past 10 years regarding the role of modifying genes in cystic fibrosis (CF). RECENT FINDINGS CF is a model disease for understanding of the action of modifying genes. Although it is a monogenic (CFTR) autosomal recessive disease, CF presents with wide phenotypic variability. In CF, variability occurs with different intensity among patients by each organ, being organ-specific, resulting from the mutual interaction of environmental and genetic factors, including CFTR mutations and various other genes, most of which are associated with inflammatory processes. In individuals, using precision medicine, gene modification studies have revealed individualized responses to drugs depending on particular CFTR mutations and modifying genes, most of which are alternative ion channels. SUMMARY Studies of modifying genes in CF allow: understanding of clinical variability among patients with the same CFTR genotype; evaluation of precision medicine; understanding of environmental and genetic effects at the organ level; understanding the involvement of genetic variants in inflammatory responses; improvements in genetic counseling; understanding the involvement of genetic variants in inflammatory responses in lung diseases, such as asthma; and understanding the individuality of the person with the disease.
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