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Recchia G, Lawrence ACE, Capacchione L, Freeman ALJ. Making BRCA1 genetic test reports easier to understand through user-centered design: A randomized trial. Genet Med 2022; 24:1684-1696. [PMID: 35522238 DOI: 10.1016/j.gim.2022.04.016] [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: 12/14/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our objective was to apply a user-centered design process to identify phrases, graphics, and ways of communicating numerical risks that could be used to help patients understand their cancer risk and next steps on receiving BRCA1 genetic test results (positive, negative, and variants of uncertain significance). METHODS The first phase of the study, a user-centered design process, consisted of 4 rounds of interviews (N = 42, including 13 health care professionals and 16 patients having undergone BRCA testing). The second was a randomized, between-participants experimental study of 456 United Kingdom residents that compared the resulting reports to reports used in a United Kingdom national genomic laboratory hub. Outcomes were subjective and objective comprehension, communication efficacy, actionability, and perceived risk. RESULTS Subjective comprehension, communication efficacy, and actionability were all higher for the user-centered reports, with no difference in perceived risk. Comprehension of participants viewing user-centered reports was significantly better on 2 items, directionally (but not significantly) better on 6 items, and directionally (but not significantly) worse on 2 items. CONCLUSION Our results imply that user-centered design is a promising approach for developing materials about complex genetic risks. We suggest wordings that are likely to lead to improved comprehension when communicating BRCA-associated risks.
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Affiliation(s)
- Gabriel Recchia
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom.
| | - Alice C E Lawrence
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | | | - Alexandra L J Freeman
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
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Scott A, Mohan A, Austin S, Amini E, Raupp S, Pannecouk B, Kelley MJ, Narla G, Ramnath N. Integrating Medical Genetics Into Precision Oncology Practice in the Veterans Health Administration: The Time Is Now. JCO Oncol Pract 2022; 18:e966-e973. [PMID: 35258993 PMCID: PMC9191304 DOI: 10.1200/op.21.00693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Increased access and utilization of tumor profiling of cancers in our veteran population uncovered a modest number of potentially pathogenic germline variants (PPGVs) that require genetics referral for follow-up evaluation and germline sequencing. Challenges identified specific to the veteran population include paucity of genetics providers, either at a veteran's VA facility or nearby non-VA facilities. We sought to investigate the number of veterans who would benefit from having such resources at both local and national levels. METHODS Annotated clinical reports of mutations identified by tumor-only profiling and medical records of veterans with solid tumors at the Veterans Administration Ann Arbor Healthcare System (VA AAHS) between 2015 and 2020 were reviewed. PPGVs were identified according to society recommendations (such as ESMO and American Board of Medical Genetics and Genomics), expert review, and/or previously published criteria. After the analysis of our local VA population, these same criteria were then applied to veterans in the National Precision Oncology Program (NPOP). RESULTS Two hundred eight veterans underwent tumor profiling at the VA AAHS over the defined time period. This included 20 different primary tumor sites with over half (n = 130) being advanced cancer at diagnosis. Of these, 18 veterans (8.5%) had mutations suggestive of a PPGV. Applying these criteria to the larger NPOP database (n = 20,014), a similar percentage (6%) of PPGVs were identified. CONCLUSION These results indicate a PPGV frequency (6%-9% of veterans) consistent with the prevalence of inherited cancer predisposition syndromes in the general population, underscoring the need for medical genetics as part of standard oncologic care for veterans. We explore current and future care delivery models to optimize incorporation of medical genetics and genetic counseling to best serve veterans needing such services.
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Affiliation(s)
- Anthony Scott
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.,Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Arathi Mohan
- Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Sarah Austin
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.,Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Erika Amini
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Shelby Raupp
- Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Brittany Pannecouk
- Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Michael J Kelley
- Division of Hematology Oncology, Department of Medicine, Duke University, VA Medical Center in Durham, Durham, NC
| | - Goutham Narla
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.,Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Nithya Ramnath
- Division of Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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