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Carlsson L, Bedard PL, Kim RH, Metcalfe K. Psychological distress following multi-gene panel testing for hereditary breast and ovarian cancer risk. J Genet Couns 2024. [PMID: 39044246 DOI: 10.1002/jgc4.1940] [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: 03/15/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024]
Abstract
Advances in our understanding of the genetic landscape of hereditary breast and ovarian cancer (HBOC) have led to the clinical adoption of multi-gene panel testing. Panel testing introduces new sources of genetic uncertainty secondary to the inclusion of moderate- and low-penetrance genes, as well as the increased likelihood of identifying a variant of uncertain significance (VUS). This cross-sectional study explored the post-test psychological functioning of women who underwent multi-gene panel testing for HBOC susceptibility genes. Two hundred and ninety-five women who underwent panel testing within the previous 2 years completed a study questionnaire to measure levels of cancer-related and genetic testing-related distress using the Impact of Events Scale (IES) and the Multidimensional Impact of Cancer Risk Assessment (MICRA), respectively. Multiple regression analyses were conducted to evaluate the relationship between genetic test results and levels of psychological distress captured by the IES and MICRA. In this cohort, a pathogenic variant (PV) was identified in 41 (14%) of participants, and 77 (26%) participants were found to have a VUS. In the multi-variate model, higher mean levels of genetic testing-related distress were observed in individuals with a PV (p < 0.001) or a VUS (p = 0.007) compared to those with a negative result. Furthermore, participants with a PV in a moderate-penetrance gene were found to have higher levels of genetic testing-related distress compared to those with a PV in a high-risk gene (p = 0.03). Overall, participants were highly satisfied with their genetic testing experience, with 92% of individuals reporting they would recommend testing to others. Our findings highlight differences in psychological outcomes based on both variant pathogenicity and gene penetrance, which contribute to our understanding of the impact of panel testing and sources of both cancer-related and genetic testing-related distress secondary to testing.
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Affiliation(s)
- Lindsay Carlsson
- Phase 1 Drug Development Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Philippe L Bedard
- Phase 1 Drug Development Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raymond H Kim
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Ontario Institute of Cancer Research, Toronto, Ontario, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
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Shibata Y, Matsushima M, Takeuchi M, Kato M, Yabe I. Inappropriate Metacognitive Status Increases State Anxiety in Genetic Counseling Clients. Front Psychol 2022; 13:871416. [PMID: 35645862 PMCID: PMC9133628 DOI: 10.3389/fpsyg.2022.871416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Background Many genetic counseling (GC) studies have focused on anxiety status because clients of GC often feel anxious during their visits. Metacognition is known to be one of the causes of having an inappropriate thinking style. In this study, we examined the relationship between anxiety and the metacognitive status of GC clients according to their characteristics. Methods The participants were 106 clients who attended their first GC session in our hospital from November 2018 to March 2021. The survey items were the clients’ characteristics, anxiety status at the time of the visit, and metacognitive status. Results High state anxiety and high trait anxiety were observed in 34.9 and 11.3% of clients, respectively. Clients who were a relative or had a family history were significantly more likely to have high state anxiety. As for metacognitive status, only negative beliefs about thoughts concerning uncontrollability and danger were associated with having an anxiety status. Furthermore, multivariate analysis showed that negative beliefs about thoughts concerning uncontrollability and danger were an independent determinant of higher state anxiety, but not being a relative or having a family history. Metacognitive status scores were significantly lower in clients than in the control group. Conclusion State anxiety was shown to be more dependent on negative beliefs about thoughts concerning uncontrollability and danger of GC clients than their characteristics such as being a relative or having a family history. The results of this study will contribute to the development of new GC psychosocial support measures to address the anxiety of GC clients.
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Affiliation(s)
- Yuka Shibata
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo, Japan
| | - Masaaki Matsushima
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo, Japan
- Faculty of Medicine, Graduate School of Medicine, Department of Neurology, Hokkaido University, Sapporo, Japan
| | - Megumi Takeuchi
- Faculty of Medicine, Graduate School of Medicine, Department of Neurology, Hokkaido University, Sapporo, Japan
| | - Momoko Kato
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo, Japan
| | - Ichiro Yabe
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo, Japan
- Faculty of Medicine, Graduate School of Medicine, Department of Neurology, Hokkaido University, Sapporo, Japan
- *Correspondence: Ichiro Yabe,
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3
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Psychiatric symptoms in a Spanish sample with hereditary cancer risk. J Community Genet 2022; 13:339-346. [DOI: 10.1007/s12687-022-00580-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
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Richardson M, Min HJ, Hong Q, Compton K, Mung SW, Lohn Z, Nuk J, McCullum M, Portigal-Todd C, Karsan A, Regier D, Brotto LA, Sun S, Schrader KA. Oncology Clinic-Based Hereditary Cancer Genetic Testing in a Population-Based Health Care System. Cancers (Basel) 2020; 12:cancers12020338. [PMID: 32028617 PMCID: PMC7072228 DOI: 10.3390/cancers12020338] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022] Open
Abstract
New streamlined models for genetic counseling and genetic testing have recently been developed in response to increasing demand for cancer genetic services. To improve access and decrease wait times, we implemented an oncology clinic-based genetic testing model for breast and ovarian cancer patients in a publicly funded population-based health care setting in British Columbia, Canada. This observational study evaluated the oncology clinic-based model as compared to a traditional one-on-one approach with a genetic counsellor using a multi-gene panel testing approach. The primary objectives were to evaluate wait times and patient reported outcome measures between the oncology clinic-based and traditional genetic counselling models. Secondary objectives were to describe oncologist and genetic counsellor acceptability and experience. Wait times from referral to return of genetic testing results were assessed for 400 patients with breast and/or ovarian cancer undergoing genetic testing for hereditary breast and ovarian cancer from June 2015 to August 2017. Patient wait times from referral to return of results were significantly shorter with the oncology clinic-based model as compared to the traditional model (403 vs. 191 days; p < 0.001). A subset of 148 patients (traditional n = 99; oncology clinic-based n = 49) completed study surveys to assess uncertainty, distress, and patient experience. Responses were similar between both models. Healthcare providers survey responses indicated they believed the oncology clinic-based model was acceptable and a positive experience. Oncology clinic-based genetic testing using a multi-gene panel approach and post-test counselling with a genetic counsellor significantly reduced wait times and is acceptable for patients and health care providers.
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Affiliation(s)
- Matthew Richardson
- Interdisciplinary Oncology Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Hae Jung Min
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Quan Hong
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Katie Compton
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Sze Wing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Zoe Lohn
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Mary McCullum
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Cheryl Portigal-Todd
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Aly Karsan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Dean Regier
- Department of School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC V6Z 2K8, Canada;
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
- Division of Medical Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Correspondence: (S.S.); (K.A.S.); Tel.: +604-877-6000 (ext. 2752) (S.S.); +604-877-6000 (ext. 672324) (K.A.S.)
| | - Kasmintan A. Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1G1, Canada
- Correspondence: (S.S.); (K.A.S.); Tel.: +604-877-6000 (ext. 2752) (S.S.); +604-877-6000 (ext. 672324) (K.A.S.)
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Black Women's Confidence in the Genetic Information Nondiscrimination Act. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245112. [PMID: 31847347 PMCID: PMC6950717 DOI: 10.3390/ijerph16245112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/27/2022]
Abstract
Black women at-risk for hereditary breast and ovarian cancer (HBOC) continue to underutilize genetic counseling and testing (GCT). One reason for this disparity is a fear of discrimination from insurance companies if identified as high-risk. The Genetic Information Nondiscrimination Act (GINA) was enacted to protect against this type of discrimination; however, Black women’s levels of confidence in this law are unknown. In this descriptive study, we sought to (1) assess Black women’s confidence in the GINA law and (2) identify multilevel factors related to their confidence in GINA. Ninety-four Black women at-risk of HBOC completed surveys that assessed intrapersonal, interpersonal, and structural factors. Multiple regression analysis determined factors associated with confidence in GINA. Most women were ≤50 years of age (66.0%) and about half never had a cancer diagnosis (51.1%). Confidence in GINA was moderate (mean = 10.67; standard deviation = 2.54; range = 5–15). Women who valued GCT reported more confidence in GINA (β = 0.345; CI 0.017 to 0.673; p = 0.040). Lack of confidence in GINA may serve as a barrier to seeking GCT. Efforts to increase the perceived value of GCT among Black women could be benefited by increasing awareness of national efforts towards privacy protections of genetic information.
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 322:652-665. [PMID: 31429903 DOI: 10.1001/jama.2019.10987] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. EVIDENCE REVIEW The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery. FINDINGS For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Nelson HD, Pappas M, Cantor A, Haney E, Holmes R. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322:666-685. [PMID: 31429902 DOI: 10.1001/jama.2019.8430] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Pathogenic mutations in breast cancer susceptibility genes BRCA1 and BRCA2 increase risks for breast, ovarian, fallopian tube, and peritoneal cancer in women; interventions reduce risk in mutation carriers. OBJECTIVE To update the 2013 US Preventive Services Task Force review on benefits and harms of risk assessment, genetic counseling, and genetic testing for BRCA1/2-related cancer in women. DATA SOURCES Cochrane libraries; MEDLINE, PsycINFO, EMBASE (January 1, 2013, to March 6, 2019, for updates; January 1, 1994, to March 6, 2019, for new key questions and populations); reference lists. STUDY SELECTION Discriminatory accuracy studies, randomized clinical trials (RCTs), and observational studies of women without recently diagnosed BRCA1/2-related cancer. DATA EXTRACTION AND SYNTHESIS Data on study methods, setting, population characteristics, eligibility criteria, interventions, numbers enrolled and lost to follow-up, outcome ascertainment, and results were abstracted. Two reviewers independently assessed study quality. MAIN OUTCOMES AND MEASURES Cancer incidence and mortality; discriminatory accuracy of risk assessment tools for BRCA1/2 mutations; benefits and harms of risk assessment, genetic counseling, genetic testing, and risk-reducing interventions. RESULTS For this review, 103 studies (110 articles; N = 92 712) were included. No studies evaluated the effectiveness of risk assessment, genetic counseling, and genetic testing in reducing incidence and mortality of BRCA1/2-related cancer. Fourteen studies (n = 43 813) of 8 risk assessment tools to guide referrals to genetic counseling demonstrated moderate to high accuracy (area under the receiver operating characteristic curve, 0.68-0.96). Twenty-eight studies (n = 8060) indicated that genetic counseling was associated with reduced breast cancer worry, anxiety, and depression; increased understanding of risk; and decreased intention for testing. Twenty studies (n = 4322) showed that breast cancer worry and anxiety were higher after testing for women with positive results and lower for others; understanding of risk was higher after testing. In 8 RCTs (n = 54 651), tamoxifen (relative risk [RR], 0.69 [95% CI, 0.59-0.84]; 4 trials), raloxifene (RR, 0.44 [95% CI, 0.24-0.80]; 2 trials), and aromatase inhibitors (RR, 0.45 [95% CI, 0.26-0.70]; 2 trials) were associated with lower risks of invasive breast cancer compared with placebo; results were not specific to mutation carriers. Mastectomy was associated with 90% to 100% reduction in breast cancer incidence (6 studies; n = 2546) and 81% to 100% reduction in breast cancer mortality (1 study; n = 639); oophorectomy was associated with 69% to 100% reduction in ovarian cancer (2 studies; n = 2108); complications were common with mastectomy. CONCLUSIONS AND RELEVANCE Among women without recently diagnosed BRCA1/2-related cancer, the benefits and harms of risk assessment, genetic counseling, and genetic testing to reduce cancer incidence and mortality have not been directly evaluated by current research.
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Affiliation(s)
- Heidi D Nelson
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Miranda Pappas
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Elizabeth Haney
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Rebecca Holmes
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
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Weber E, Shuman C, Wasserman JD, Barrera M, Patenaude AF, Fung K, Chitayat D, Malkin D, Druker H. "A change in perspective": Exploring the experiences of adolescents with hereditary tumor predisposition. Pediatr Blood Cancer 2019; 66:e27445. [PMID: 30207072 DOI: 10.1002/pbc.27445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hereditary tumor predisposition syndromes (HTPSs) are being recognized more frequently in the etiology of pediatric cancer. Previous research indicates that disclosure of tumor susceptibility is a significant event in adolescents' lives. Insight into adolescents' adjustment to knowledge of their syndromes can guide healthcare delivery, particularly genetic counseling. This study explored the experiences of adolescents with hereditary tumor predisposition and their perceptions of living at risk. METHODS Seven adolescents, ages 14 to 17, representing six different childhood-onset HTPSs, were purposively sampled and interviewed using a study-specific semistructured interview guide. We explored the disclosure process, support systems, and the perceived benefits and harms of knowledge of hereditary tumor susceptibility. Interview transcripts were analyzed via interpretive description. RESULTS Three major themes emerged from the data: (1) The benefits of knowledge outweigh the harms; (2) context surrounding genetic testing must be recognized; and (3) self-concept is influenced but not defined by tumor risk. CONCLUSIONS We conclude that adolescents recognize the challenges associated with awareness of tumor predisposition but may also identify positive aspects in their experiences, reflecting a changed life perspective. Results of this exploratory study suggest strategies that can guide pretest and posttest genetic counseling of adolescents for HTPSs, facilitating the adaptive incorporation of genetic information into an adolescent's self-concept.
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Affiliation(s)
- Evan Weber
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cheryl Shuman
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D Wasserman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maru Barrera
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrea F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Karen Fung
- Department of Social Work, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Harriet Druker
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Communication about genetic testing with breast and ovarian cancer patients: a scoping review. Eur J Hum Genet 2018; 27:511-524. [PMID: 30573802 PMCID: PMC6460583 DOI: 10.1038/s41431-018-0310-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/04/2018] [Accepted: 11/07/2018] [Indexed: 12/28/2022] Open
Abstract
Genetic testing of patients with cancer is increasingly offered to guide management, resulting in a growing need for oncology health professionals to communicate genetics information and facilitate informed decision-making in a short time frame. This scoping review aimed to map and synthesise what is known about health professionals’ communication about genetic testing for hereditary breast and ovarian cancer with cancer patients. Four databases were systematically searched using a recognised scoping review method. Areas and types of research were mapped and a narrative synthesis of the findings was undertaken. Twenty-nine papers from 25 studies were included. Studies were identified about (i) information needs, (ii) process and content of genetic counselling, (iii) cognitive and emotional impact, including risk perception and recall, understanding and interpretation of genetic test results, and anxiety and distress, (iv) patients’ experiences, (v) communication shortly after diagnosis and (vi) alternatives to face-to-face genetic counselling. Patients’ need for cancer-focused, personalised information is not always met by genetic counselling. Genetic counselling tends to focus on biomedical information at the expense of psychological support. For most patients, knowledge is increased and anxiety is not raised by pre-test communication. However, some patients experience anxiety and distress when results are disclosed, particularly those tested shortly after diagnosis who are unprepared or unsupported. For many patients, pre-test communication by methods other than face-to-face genetic counselling is acceptable. Research is needed to identify patients who may benefit from genetic counselling and support and to investigate communication about hereditary breast and ovarian cancer by oncology health professionals.
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Madlensky L, Trepanier AM, Cragun D, Lerner B, Shannon KM, Zierhut H. A Rapid Systematic Review of Outcomes Studies in Genetic Counseling. J Genet Couns 2017; 26:361-378. [PMID: 28168332 DOI: 10.1007/s10897-017-0067-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.
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Affiliation(s)
- Lisa Madlensky
- Moores UCSD Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92091-0901, USA.
| | - Angela M Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Deborah Cragun
- Department of Global Health, University of South Florida, Tampa, FL, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Barbara Lerner
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | | | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, Minneapolis, MN, USA
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Population screening for BRCA1/BRCA2 founder mutations in Ashkenazi Jews: proactive recruitment compared with self-referral. Genet Med 2016; 19:754-762. [DOI: 10.1038/gim.2016.182] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/13/2016] [Indexed: 12/20/2022] Open
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12
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Brédart A, Kop JL, De Pauw A, Caron O, Fajac A, Noguès C, Stoppa-Lyonnet D, Dolbeault S. Effect on perceived control and psychological distress of genetic knowledge in women with breast cancer receiving a BRCA1/2 test result. Breast 2016; 31:121-127. [PMID: 27837705 DOI: 10.1016/j.breast.2016.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/28/2023] Open
Abstract
Information provision during BRCA1/2 genetic counseling is complex and expected to be increasingly so with gene panel testing. This prospective study evaluated whether genetic knowledge in counselees with breast cancer (BC) after a pre-test genetic counseling visit (T1) enhance their feeling of personal control while minimizing distress after the notification of BRCA1/2 result (T2). At T1, 243 (89% response rate) counselees completed questionnaires on genetic knowledge (BGKQ), perceived cancer genetic risk; of which, at T2, 180 (66%) completed the BGKQ again, scales of anxiety/depression, distress specific to genetic risk, and perceived control. Multilevel models were performed accounting for clinician, and testing an effect of knowledge on psychological outcomes according to the adequacy of counselees' perceived genetic predisposition to cancer. The mean knowledge score was moderate at T1, decreased while not significantly differing by BRCA1/2 test result at T2. Knowledge at T1 had no direct effect on psychological outcomes, but in counselees who over-estimated their cancer genetic risk, higher knowledge at T1 predicted higher specific distress at T2. In BC affected counselees who over-estimate their cancer genetic risk, higher BRCA1/2 pre-test genetic knowledge seem to lead to increased specific distress. Identifying these BC affected counselees who over-estimate their genetic cancer risk and helping them to interpret their genetic knowledge instead of providing them with exhaustive genetic information could minimize their distress after test result receipt.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; University Paris Descartes, 71, Avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, Inter-Psy, Inter-Psy, 3 Place Godefroy de Bouillon, BP 33 97, 54 015 Nancy Cedex, France
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, 26 rue d'Ulm, 75005 Paris Cedex 05, France
| | - Olivier Caron
- Gustave Roussy Hôpital Universitaire, Cancer Genetic Clinic, 114 rue Ed Vaillant, 94 805 Villejuif, France
| | - Anne Fajac
- Hôpital Tenon Service d'Histologie-Biologie Tumorale, AP-HP, ER2 UPMC Université Pierre et Marie Curie, 4 rue de la Chine, 75020, France
| | - Catherine Noguès
- Institut Paoli-Calmettes, 232, Boulevard Sainte Margueritte, Marseille, France
| | | | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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Amara N, Blouin-Bougie J, Jbilou J, Halilem N, Simard J, Landry R. The knowledge value-chain of genetic counseling for breast cancer: an empirical assessment of prediction and communication processes. Fam Cancer 2016; 15:1-17. [PMID: 26334522 DOI: 10.1007/s10689-015-9835-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this paper is twofold: to analyze the genetic counseling process for breast cancer with a theoretical knowledge transfer lens and to compare generalists, medical specialists, and genetic counselors with regards to their genetic counseling practices. This paper presents the genetic counseling process occurring within a chain of value-adding activities of four main stages describing health professionals' clinical practices: (1) evaluation, (2) investigation, (3) information, and (4) decision. It also presents the results of a cross-sectional study based on a Canadian medical doctors and genetic counselors survey (n = 176) realized between July 2012 and March 2013. The statistical exercise included descriptive statistics, one-way ANOVA and post-hoc tests. The results indicate that even though all types of health professionals are involved in the entire process of genetic counseling for breast cancer, genetic counselors are more involved in the evaluation of breast cancer risk, while medical doctors are more active in the decision toward breast cancer risk management strategies. The results secondly demonstrate the relevance and the key role of genetic counselors in the care provided to women at-risk of familial breast cancer. This paper presents an integrative framework to understand the current process of genetic counseling for breast cancer in Canada, and to shed light on how and where health professionals contribute to the process. It also offers a starting point for assessing clinical practices in genetic counseling in order to establish more clearly where and to what extent efforts should be undertaken to implement future genetic services.
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Affiliation(s)
- Nabil Amara
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
| | - Jolyane Blouin-Bougie
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
| | - Jalila Jbilou
- New Brunswick Medical Training Centre and School of Psychology, University of Monction, Moncton, NB, Canada.
| | - Norrin Halilem
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
| | - Jacques Simard
- Cancer Genomics Laboratory, Department of Molecular Medicine, Laval University, Quebec, QC, Canada.
| | - Réjean Landry
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
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David D, Gherman A, Podina I, Mogoaşe C, Sucală M, Voinescu B. The Added Value of CBT in the Genetic Counseling Process: Concept Development, State of the Art and New Directions. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2016. [DOI: 10.1007/s10942-016-0245-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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15
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Lambin P, Zindler J, Vanneste B, van de Voorde L, Jacobs M, Eekers D, Peerlings J, Reymen B, Larue RTHM, Deist TM, de Jong EEC, Even AJG, Berlanga AJ, Roelofs E, Cheng Q, Carvalho S, Leijenaar RTH, Zegers CML, van Limbergen E, Berbee M, van Elmpt W, Oberije C, Houben R, Dekker A, Boersma L, Verhaegen F, Bosmans G, Hoebers F, Smits K, Walsh S. Modern clinical research: How rapid learning health care and cohort multiple randomised clinical trials complement traditional evidence based medicine. Acta Oncol 2015; 54:1289-300. [PMID: 26395528 DOI: 10.3109/0284186x.2015.1062136] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Trials are vital in informing routine clinical care; however, current designs have major deficiencies. An overview of the various challenges that face modern clinical research and the methods that can be exploited to solve these challenges, in the context of personalised cancer treatment in the 21st century is provided. AIM The purpose of this manuscript, without intending to be comprehensive, is to spark thought whilst presenting and discussing two important and complementary alternatives to traditional evidence-based medicine, specifically rapid learning health care and cohort multiple randomised controlled trial design. Rapid learning health care is an approach that proposes to extract and apply knowledge from routine clinical care data rather than exclusively depending on clinical trial evidence, (please watch the animation: http://youtu.be/ZDJFOxpwqEA). The cohort multiple randomised controlled trial design is a pragmatic method which has been proposed to help overcome the weaknesses of conventional randomised trials, taking advantage of the standardised follow-up approaches more and more used in routine patient care. This approach is particularly useful when the new intervention is a priori attractive for the patient (i.e. proton therapy, patient decision aids or expensive medications), when the outcomes are easily collected, and when there is no need of a placebo arm. DISCUSSION Truly personalised cancer treatment is the goal in modern radiotherapy. However, personalised cancer treatment is also an immense challenge. The vast variety of both cancer patients and treatment options makes it extremely difficult to determine which decisions are optimal for the individual patient. Nevertheless, rapid learning health care and cohort multiple randomised controlled trial design are two approaches (among others) that can help meet this challenge.
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Affiliation(s)
- Philippe Lambin
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Jaap Zindler
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Ben Vanneste
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Lien van de Voorde
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Maria Jacobs
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Daniëlle Eekers
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Jurgen Peerlings
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Bart Reymen
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Ruben T H M Larue
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Timo M Deist
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Evelyn E C de Jong
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Aniek J G Even
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Adriana J Berlanga
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Erik Roelofs
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Qing Cheng
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Sara Carvalho
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Ralph T H Leijenaar
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Catharina M L Zegers
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Evert van Limbergen
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Maaike Berbee
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Wouter van Elmpt
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Cary Oberije
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Ruud Houben
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Andre Dekker
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Liesbeth Boersma
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Frank Verhaegen
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Geert Bosmans
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Frank Hoebers
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Kim Smits
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Sean Walsh
- a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
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Albada A, van Dulmen S, Dijkstra H, Wieffer I, Witkamp A, Ausems MGEM. Counselees' Expressed Level of Understanding of the Risk Estimate and Surveillance Recommendation are Not Associated with Breast Cancer Surveillance Adherence. J Genet Couns 2015; 25:279-89. [PMID: 26321750 PMCID: PMC4799246 DOI: 10.1007/s10897-015-9869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
We studied counselees’ expressed understanding of the risk estimate and surveillance recommendation in the final consultation for breast cancer genetic counseling in relation with their risk perception, worry and cancer surveillance adherence 1 year post-counseling. Consecutive counselees were included from 2008 to 2010. Counselees with an indication for diagnostic DNA-testing for themselves or a breast cancer affected relative were requested to complete online questionnaires before and after counseling and one year after counseling (N = 152–124). Self-reported surveillance was compared to surveillance recommendations. Consultations were videotaped. Counselees’ reactions to the risks and recommendations were coded. Statements about the risk perception and surveillance intentions of breast cancer unaffected counselees were transcribed. Associations with outcomes were explored. Almost all breast cancer unaffected counselees (>90 %) reacted to their risk estimate with an utterance indicating understanding and this reaction was not significantly associated with their post-visit risk perception alignment. Over one-third (38.6 %) overestimated their risk post-counseling. Few counselees (5.8 %) expressed surveillance intentions. One year after counseling, about three-quarters (74.0 %) of the breast cancer unaffected counselees had adhered to the surveillance recommendation. Almost one-quarter (23.3 %) had performed more mammograms/MRI scans than recommended, which was associated with prior mammography uptake (n = 47; X2 = 5.2; p = .02). Counselees’ post-counseling overestimation of their risk, high levels of worry and high surveillance uptake were not reflected in their reactions to the counselor’s information during the final visit.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Henrietta Dijkstra
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ivette Wieffer
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arjen Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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Albada A, van Dulmen S, Spreeuwenberg P, Ausems MGEM. Follow-up effects of a tailored pre-counseling website with question prompt in breast cancer genetic counseling. PATIENT EDUCATION AND COUNSELING 2015; 98:69-76. [PMID: 25455796 DOI: 10.1016/j.pec.2014.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/21/2014] [Accepted: 10/04/2014] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Pre-counseling education helps counselees to prepare for breast cancer genetic counseling and might subsequently result in more positive experiences, improved cognitive outcomes and more experienced control. This study assessed the effects of a website with tailored information and a blank sheet to fill in questions (question prompt; QP), at 1 week and 1 year post-counseling. METHODS Consecutive counselees were randomized to the usual care group (UC) or the intervention group (UC+website+QP). Counselees completed questionnaires pre- and post-counseling and 1 year follow-up. We conducted multilevel regression analyses corrected for time. RESULTS Intervention group counselees (n = 103) were more satisfied about their final visit (β = .35; CI: .06-.65; P = .02; n = 156) than UC group counselees (n = 94). Intervention group counselees also reported more positive experiences with the counseling (β = .32; CI: .06-.59; P = .02; n = 188) and higher perceived personal control 1 year post-counseling (β = .51; CI: .18-.84; P = .002; n = 193). No significant effects were found on recall, knowledge, anxiety, cancer worry, risk perception alignment and adherence to breast surveillance advice. CONCLUSION This study shows that pre-counseling education providing tailored information and QP, might lead to improvements in experiences with the counseling and perceived personal control 1 year post-counseling. PRACTICE IMPLICATIONS Online pre-visit information is a feasible tool to enhance counselees' experiences.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Health Science, Buskerud and Vestfold University College, Drammen, Norway
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
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Blue GM, Kasparian NA, Sholler GF, Kirk EP, Winlaw DS. Genetic counselling in parents of children with congenital heart disease significantly improves knowledge about causation and enhances psychosocial functioning. Int J Cardiol 2015; 178:124-30. [DOI: 10.1016/j.ijcard.2014.10.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/21/2014] [Indexed: 01/12/2023]
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McAllister M, Dearing A. Patient reported outcomes and patient empowerment in clinical genetics services. Clin Genet 2014; 88:114-21. [PMID: 25307491 DOI: 10.1111/cge.12520] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 12/20/2022]
Abstract
Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.
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Affiliation(s)
- M McAllister
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A Dearing
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Albada A, Ausems MGEM, van Dulmen S. Counselee participation in follow-up breast cancer genetic counselling visits and associations with achievement of the preferred role, cognitive outcomes, risk perception alignment and perceived personal control. Soc Sci Med 2014; 116:178-86. [PMID: 25016325 DOI: 10.1016/j.socscimed.2014.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 06/02/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
The purpose of the study was to assess the counselee participation in the follow-up visits, compared to the first visits, for breast cancer genetic counselling and to explore associations with counselees' achievement of their preferred role in decision making, information recall, knowledge, risk perception alignment and perceived personal control. First and follow-up visits for breast cancer genetic counselling of 96 counselees of a Dutch genetics center were videotaped (2008-2010). Counselees completed questionnaires before counselling (T1), after the follow-up visit (T2) and one year after the follow-up visit (T3). Consultations were rated with the Roter Interaction Analysis System (RIAS). Counselee participation was measured as the percentage of counselee utterances, the percentage of counselee questions and the interactivity (number of turns per minute). Follow-up visits had higher levels of counselee participation than first visits as assessed by the percentage of counselee talk, the interactivity and counselee questions. More counselee talk in the follow-up visit was related to higher achievement of the preferred role (T2) and higher perceived personal control (T3). Higher interactivity in the follow-up visit was related to lower achievement of the preferred role in decision making and lower information recall (T2). There were no significant associations with the percentage of questions asked and none of the participation measures was related to knowledge, risk perception alignment and perceived personal control (T2). In line with the interviewing admonishment 'talk less and listen more', the only assessment of counselee participation associated to better outcomes is the percentage of counselee talk. High interactivity might be associated with lower recall in breast cancer genetic counselees who are generally highly educated. However, this study was limited by a small sample size and a heterogeneous group of counselees. Research is needed on the interactions causing interactivity and its relationships with involvement in decision making and recall.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, Buskerud University College, Drammen, Norway
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Jbilou J, Halilem N, Blouin-Bougie J, Amara N, Landry R, Simard J. Medical genetic counseling for breast cancer in primary care: a synthesis of major determinants of physicians' practices in primary care settings. Public Health Genomics 2014; 17:190-208. [PMID: 24993835 DOI: 10.1159/000362358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This paper aims to identify relevant potential predictors of medical genetic counseling for breast cancer (MGC-BC) in primary care and to develop a comprehensive questionnaire to study MGC-BC. METHODS A scoping review was conducted to identify the predictors of MGC-BC among primary care physicians. Relevant articles were identified in selected databases (PubMed, Embase, CINAHL, ISI Web of Science, PsycINFO, and Cochrane CENTRAL) and 4 selected relevant electronic journals. RESULTS An inductive analysis of the 193 quantitatively tested variables, conducted by 3 researchers, showed that 6 conceptual categories of determinants, namely (1) demographic, (2) organizational, (3) experiential, (4) professional, (5) psychological, and (6) cognitive, influence MGC-BC practices. CONCLUSION There is a scarcity of literature addressing the medical behavior determinants of MGC-BC. Future research is needed to identify effective strategies put into action to support the integration of MGC-BC in primary care medical practices and routines. However, our results shed light on 2 levels of actions that could improve genetic counseling services in primary care: (1) medical training and educational efforts emphasizing family history collection (individual level), and (2) clarification of roles and responsibilities in ordering and referral practices in genetic counseling and genetic testing for better healthcare management (organizational level).
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Affiliation(s)
- Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick, Université de Moncton, Moncton, N.B., Canada
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Dijkstra H, Albada A, Klöckner Cronauer C, Ausems MGEM, van Dulmen S. Nonverbal communication and conversational contribution in breast cancer genetic counseling: are counselors' nonverbal communication and conversational contribution associated with counselees' satisfaction, needs fulfillment and state anxiety in breast cancer genetic counseling? PATIENT EDUCATION AND COUNSELING 2013; 93:216-223. [PMID: 23786807 DOI: 10.1016/j.pec.2013.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/28/2013] [Accepted: 05/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The current study aimed to examine how counselors' nonverbal communication (i.e. nonverbal encouragements and counselee-directed eye gaze) and conversational contribution (i.e. verbal dominance and interactivity) during the final visit within breast cancer genetic counseling relate to counselee satisfaction, needs fulfillment and anxiety. METHODS Breast cancer counselees (N=85) completed questionnaires measuring satisfaction, needs fulfillment and anxiety after the final consultation and anxiety before the initial visit. Consultations were videotaped. Counselor nonverbal encouragements and counselee-directed eye gaze were coded. Verbal dominance and interactivity were measured using the Roter Interaction Analysis System (RIAS). RESULTS More counselor nonverbal encouragements and higher counselor verbal dominance were both significantly related to higher post-visit anxiety. Furthermore, counselor verbal dominance was associated with lower perceived needs fulfillment. No significant associations with eye gaze and interactivity were found. CONCLUSION More research is needed on the relationship between nonverbal encouragements and anxiety. Given the unfavorable association of counselor verbal dominance with anxiety and needs fulfillment, more effort could be devoted to involve counselees in the dialog and reduce the counselor's verbal contribution during the consultation. PRACTICE IMPLICATIONS Interventions focused on increasing counselees' contribution in the consultation may be beneficial to counselees.
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Affiliation(s)
- Henriëtta Dijkstra
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Wiering BM, Albada A, Bensing JM, Ausems MGEM, van Dulmen AM. The influence of dispositional optimism on post-visit anxiety and risk perception accuracy among breast cancer genetic counselees. Psychooncology 2013; 22:2419-27. [PMID: 23630180 DOI: 10.1002/pon.3292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/10/2013] [Accepted: 03/24/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Much is unknown about the influence of dispositional optimism and affective communication on genetic counselling outcomes. This study investigated the influence of counselees' optimism on the counselees' risk perception accuracy and anxiety, while taking into account the affective communication during the first consultation for breast cancer genetic counselling. METHODS Counselees completed questionnaires measuring optimism, anxiety and the perceived risk that hereditary breast cancer runs in the family before, and anxiety and perceived risk after the first consultation. Consultations were videotaped. The duration of eye contact was measured, and verbal communication was rated using the Roter Interaction Analysis System. RESULTS Less-optimistic counselees were more anxious post-visit (β = -.29; p = .00). Counsellors uttered fewer reassuring statements if counselees were more anxious (β = -.84; p = .00) but uttered more reassurance if counselees were less optimistic (β = -.76; p = .01). Counsellors expressed less empathy if counselees perceived their risk as high (β = -1.51; p = .04). An increase in the expression of reassurance was related to less post-visit anxiety (β = -.35; p = .03). More empathy was related to a greater overestimation of risk (β = .92; p = .01). CONCLUSIONS Identification of a lack of optimism as a risk factor for high anxiety levels enables the adaptation of affective communication to improve genetic counselling outcomes. Because reassurance was related to less anxiety, beneficial adaptation is attainable by increasing counsellors' reassurance, if possible. Because of a lack of optimally adapted communication in this study, further research is needed to clarify how to increase counsellors' ability to adapt to counselees.
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Affiliation(s)
- B M Wiering
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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Albada A, van Dulmen S, Lindhout D, Bensing JM, Ausems MGEM. A pre-visit tailored website enhances counselees' realistic expectations and knowledge and fulfils information needs for breast cancer genetic counselling. Fam Cancer 2012; 11:85-95. [PMID: 21901499 DOI: 10.1007/s10689-011-9479-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Counselees who are the first in their family to request breast cancer genetic counselling often don't know what to expect or have unrealistic expectations of genetic counselling. Receiving tailored information might help them to prepare for their first visit. We conducted a study of the effects of a pre-visit website providing computer-tailored information (E-info gene(ca)), on counselees' expectations, knowledge about breast cancer and heredity and information needs. Counselees were randomized to receive usual care (UC) or UC plus website. All counselees completed a baseline questionnaire and those randomized to the intervention group also completed a questionnaire after having viewed the website. After having accessed E-info gene(ca) counselees (n = 101) better knew what to expect of their first visit (χ(2) = 4.43; P = .04) and less often showed unrealistic expectations about possibilities for DNA-testing (χ(2) = 4.84; P = .03) than counselees in the UC group (n = 89). In addition, the website increased counselees' knowledge of breast cancer and heredity (B = .23; P = .003) and lowered their information needs (B = -.16; P = .000) compared to the UC group. Especially, information concerning procedural aspects and emotional consequences of genetic counselling was considered less important. This study showed that counselees know more and need less when they are provided with extended pre-visit information through a tailored website and counselees enter the visit with more realistic expectations of genetic counselling. This might facilitate and focus communication within the subsequent consultation.
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Affiliation(s)
- Akke Albada
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
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McAllister M, Wood AM, Dunn G, Shiloh S, Todd C. The perceived personal control (PPC) questionnaire: Reliability and validity in a sample from the United Kingdom. Am J Med Genet A 2011; 158A:367-72. [DOI: 10.1002/ajmg.a.34374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 10/17/2011] [Indexed: 11/07/2022]
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Albada A, Werrett J, Van Dulmen S, Bensing JM, Chapman C, Ausems MGEM, Metcalfe A. Breast cancer genetic counselling referrals: how comparable are the findings between the UK and the Netherlands? J Community Genet 2011; 2:233-47. [PMID: 22109876 PMCID: PMC3215784 DOI: 10.1007/s12687-011-0061-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022] Open
Abstract
Counselees from different countries may differ in demographic and medical characteristics and this could affect their pre-counselling cognitions and psychosocial variables. Research outcomes may therefore not be easily transferable between countries. To examine this, a cross-national comparison of UK (West Midlands: WM) and Dutch (Middle Netherlands: MN) counselees in breast cancer genetic counselling was conducted. Two hundred thirty-eight WM and 156 MN proband counselees were compared on demographics, breast cancer history and referral pathways. Multivariate logistic regression analyses were performed to check whether national differences in knowledge of breast cancer and heredity, risk perception, worry and information needs persisted when corrected for the background characteristics. About half of the Dutch compared to 8% of UK counselees were affected by breast cancer. More UK than Dutch counselees were at high risk from hereditary breast cancer. UK counselees had higher risk perceptions and more knowledge about breast cancer prevalence, but these differences lost significance when corrected for counselees' risk levels and other background characteristics. Counselees from the UK might report higher levels of worry than Dutch counselees and this could not be explained by their background characteristics. Comparisons of findings between the UK and the Netherlands show that the UK seems to have a higher percentage of high-risk referrals and these counselees seem to have higher risk perceptions. Irrespective of their actual risk level, UK counselees might be more worried. Comparing findings between the different countries raises questions about how transferable research findings are from one culture to another.
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Affiliation(s)
- Akke Albada
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, the Netherlands,
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Effect of pre-test genetic counseling for deaf adults on knowledge of genetic testing. J Genet Couns 2011; 21:256-72. [PMID: 21818696 PMCID: PMC3313024 DOI: 10.1007/s10897-011-9398-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 07/21/2011] [Indexed: 11/24/2022]
Abstract
Empirical data on genetic counseling outcomes in the deaf population are needed to better serve this population. This study was an examination of genetics knowledge before and after culturally and linguistically appropriate pre-test genetic counseling in a diverse deaf adult sample. Individuals ≥18 years old with early-onset sensorineural deafness were offered connexin-26/30 testing and genetic counseling. Participants completed questionnaires containing 10 genetics knowledge items at baseline and following pre-test genetic counseling. The effects of genetic counseling, prior beliefs about etiology, and participant’s preferred language on genetics knowledge scores were assessed (n = 244). Pre-test genetic counseling (p = .0007), language (p < .0001), prior beliefs (p < .0001), and the interaction between counseling and beliefs (p = .035) were predictors of genetics knowledge. American Sign Language (ASL)-users and participants with “non-genetic/unknown” prior beliefs had lower knowledge scores than English-users and participants with “genetic” prior beliefs, respectively. Genetics knowledge improved after genetic counseling regardless of participants’ language; knowledge change was greater for the “non-genetic/unknown” beliefs group than the “genetic” beliefs group. ASL-users’ lower knowledge scores are consistent with evidence that ethnic and cultural minority groups have less genetics knowledge, perhaps from exposure and access disparities. Culturally and linguistically appropriate pre-test genetic counseling significantly improved deaf individuals’ genetics knowledge. Assessing deaf individuals’ prior beliefs is important for enhancing genetics knowledge.
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González-Concepción M, Castejón V, Blanco I, Blasco T. Adaptación española de la Escala de Control Personal Percibido ("Perceived Personal Control") en Consejo Genético. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.59172] [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
Objetivo: Analizar la validez y la fiabilidad de la adaptación de la escala Perceived Personal Control (PPC) en el contexto español para pacientes portadoras de mutación en los genes BRCA1/2 responsables del cáncer de mama y ovario hereditario (CMOH). Método: Adaptación transcultural y validación de la escala Perceived Personal Control (PPC) desarrollada por Shiloh y colaboraradores mediante traducción, retrotraducción y validación a través de un análisis factorial exploratorio con rotación Oblimin en una muestra de 176 mujeres portadoras de genes BRCA 1/2 para CMOH. Resultados: La versión española de la PPC reduce a seis los nueve ítems de la escala original, dado que esta estructura es la que ofrece una solución factorial más satisfactoria. El análisis factorial mostró un solo factor que explica el 51,07% de la varianza, en el que todos los ítems tenían cargas factoriales por encima de 0,4. El coeficiente α de Cronbach fue de 0,84 para el conjunto de la escala, la cual permite obtener valores que oscilan entre 0 (bajo grado de percepción de control) y 2 (alto grado de percepción de control). Conclusiones: La adaptación española de la Escala de Percepción de Control (PPC6) posee propiedades psicométricas satisfactorias en la versión de 6 ítems con un solo factor, por lo que su utilización en contexto español Consejo Genético para cáncer hereditario parece adecuada.
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