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Torrisi C, Wareg NK, Anbari AB. Decision-making for bilateral risk-reducing mastectomy for an increased lifetime breast cancer risk: A qualitative metasynthesis. Psychooncology 2024; 33:e6311. [PMID: 38429973 DOI: 10.1002/pon.6311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk-reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision-making process for BRRM among previvors. METHODS A theory-generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk-reduction surgery. RESULTS A theory and corresponding model emerged, comprised of seven themes addressing the decision-making process for or against BRRM. While some factors to decision-making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision-making for a period of time. CONCLUSIONS Regardless of the decision previvors make about BRRM, physical and psychosocial well-being should be considered and promoted through shared decision-making in the clinical setting.
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Affiliation(s)
- Christa Torrisi
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Nuha K Wareg
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Allison Brandt Anbari
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
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Martin SC, Scott AM, Stone AM. Women's Metaphors About BRCA Gene Testing and How They Can Inform Health Communication Theory and Practice. HEALTH COMMUNICATION 2024; 39:603-615. [PMID: 36775863 DOI: 10.1080/10410236.2023.2178051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Genetic testing can detect whether an individual carries a harmful variant in the BRCA1 or BRCA2 (Breast Cancer 1 or 2) gene which, if present, drastically increases a woman's risk for breast and ovarian cancer. The experience of BRCA gene testing can be an emotionally laden process yielding significant uncertainty. In this study, we examined women's experiences of BRCA gene testing by exploring how participants communicatively framed and made sense of this process through the use of metaphors. Comparing uncertain and unfamiliar experiences to familiar references through metaphor can help people in challenging health-related situations with sense-making and communicating complex emotions. Furthermore, metaphors can be employed as a therapeutic tool by health care professionals, but their use has not often been studied regarding experiences of genetic testing, including BRCA gene testing. We conducted in-depth interviews with 42 women who have undergone BRCA gene testing (regardless of results), and analyzed data using constant comparative techniques. Eight categories of metaphors that women used surrounding BRCA gene testing were evident in the data, including those related to (a) knowledge is power; (b) gambling; (c) a journey; (d) a rollercoaster; (e) battle, disaster, or wreckage; (f) Pandora's box or a can of worms; (g) doom and gloom; and (h) the release or placing of a weight. Results enhance our understanding of women's experiences related to the uncertainty-inducing process of BRCA gene testing and lead to valuable theoretical implications and practical recommendations, including regarding the potential use of metaphors in patient-provider communication about BRCA genetic risk.
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Affiliation(s)
- Summer C Martin
- Department of Human Communication Studies, California State University, Fullerton
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3
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Wollney EN, Bylund CL, Kastrinos AL, Campbell-Salome G, Sae-Hau M, Weiss ES, Fisher CL. Understanding parents uncertainty sources and management strategies while caring for a child diagnosed with a hematologic cancer. PEC INNOVATION 2023; 3:100198. [PMID: 37662692 PMCID: PMC10468798 DOI: 10.1016/j.pecinn.2023.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Rationale Parents of a child or adolescent (CA) or young adult (YA) diagnosed with a hematologic cancer often face uncertainty. Managing uncertainty is critical to reduce the psychosocial burden of illness-related stressors. Objective This study sought to identify: 1) sources of uncertainty among parents of a child diagnosed with a hematologic cancer, 2) strategies used by parents to manage uncertainty, and 3) clinicians' responses to parents' online information-seeking approach to managing uncertainty. Methods Parents of CAs/YAs diagnosed with a hematologic cancer within the past 1-18 months and living in the U.S. participated in an in-depth, semi-structured phone interview (n = 20). Data were analyzed thematically. Results Parents reported uncertainty about treatment (options, efficacy, and side effects or risks) and uncertainty about the future (recurrence, whether worry would subside, and how to approach the child's future). Parents managed uncertainty by seeking information online, talking to clinicians, and joining support groups. Clinicians' responses to online information-seeking were described as supportive and unsupportive. Conclusion Parents described struggling with uncertainty across the cancer continuum (from primary treatment to survivorship). Parents' psychosocial health may benefit from individual and systems level interventions that help address and manage uncertainty, especially interventions focusing on parent caregiver-clinician communication.
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Affiliation(s)
- Easton N. Wollney
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
- Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States of America
| | - Amanda L. Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Department of Population Health Sciences, Geisinger, Danville, PA, United States of America
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States of America
| | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States of America
| | - Carla L. Fisher
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
- Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States of America
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Wellman ML, Holton AE, Kaphingst KA. "Where do I go? Who do I go to?": BRCA Previvors, genetic counselors and family planning. PEC INNOVATION 2023; 2:100157. [PMID: 37214521 PMCID: PMC10194322 DOI: 10.1016/j.pecinn.2023.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Objective We sought to understand BRCA previvors' perceptions of communication with genetic counselors and other healthcare providers. Methods We conducted 16 qualitative interviews and utilized thematic analysis to develop patterns present in the narratives of previvors. Results Interviews with previvors suggest genetic counselors and other providers often make assumptions about previvors' family planning and treatment needs based on perceived gender, age, and sexual orientation. Conclusion BRCA patients require individualized attention when planning for their future and making healthcare decisions and we argue that implementing patient-centered care practices into the communication process can provide a higher quality of care. Innovation This study offers an innovative lens through which scholars and healthcare providers may examine the experiences of BRCA previvors as they seek adequate care. Asking previvors to explain their perceptions of conversations with genetic counselors and healthcare providers offers insight into the communicative process of seeking care rather than the health outcomes of the care itself. Our findings suggest biases among providers related to gender, age, and sexual orientation are concerning elements of family planning communication that potentially interrupt previvors' abilities to express their care needs in a safe environment. We argue for an increased awareness of, and advocacy for, more inclusive conversations regarding treatment and family planning decisions.
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Affiliation(s)
- Mariah L. Wellman
- Department of Communication, University of Illinois Chicago, 1007 W. Harrison St., Chicago, IL, 60607, United States of America
| | - Avery E. Holton
- Department of Communication, University of Utah, United States of America
| | - Kimberly A. Kaphingst
- Department of Communication, Huntsman Cancer Institute, University of Utah, United States of America
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Dean M, Tezak AL, Johnson S, Weidner A, Almanza D, Pal T, Cragun DL. Factors that differentiate cancer risk management decisions among females with pathogenic/likely pathogenic variants in PALB2, CHEK2, and ATM. Genet Med 2023; 25:100945. [PMID: 37515473 DOI: 10.1016/j.gim.2023.100945] [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: 04/13/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Following disclosure of pathogenic or likely pathogenic variants in hereditary cancer genes, patients face cancer risk management decisions. Through this mixed-methods study, we investigated cancer risk management decisions among females with pathogenic or likely pathogenic variants in PALB2, CHEK2, and ATM to understand why some patients follow National Comprehensive Cancer Network guidelines, whereas others do not. METHODS Survey and interview data were cross-analyzed using a 3-stage approach. Identified factors were used to conduct coincidence analysis and differentiate between combinations of factors that result in following or not following guidelines. RESULTS Of the 13 participants who underwent guideline inconsistent prophylactic surgery, 12 fit 1 of 3 unique patterns: (1) cancer-related anxiety in the absence of trust in care, (2) provider recommending surgery inconsistent with National Comprehensive Cancer Network guidelines, or (3) surgery occurring before genetic testing. Two unique patterns were found among 18 of 20 participants who followed guidelines: (1) anxiety along with trust in care or (2) lack of anxiety and no prophylactic surgery before testing. CONCLUSION Health care provider recommendations and trust in care may influence whether individuals receive care that is congruent with risk levels conferred by specific genes. Interventions are needed to improve provider knowledge, patient trust in non-surgical care, and patient anxiety.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL
| | - Ann L Tezak
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Anne Weidner
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Deanna Almanza
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, FL
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Deborah L Cragun
- College of Public Health, University of South Florida, Tampa, FL.
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Wellman ML, Holton AE, Kaphingst KA. Previvorship Posting: Why Breast Cancer Previvors Share Their Stories on Social Media. HEALTH COMMUNICATION 2023; 38:2441-2449. [PMID: 35582752 DOI: 10.1080/10410236.2022.2074780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research on previvors, individuals with a genetic predisposition to develop hereditary breast and ovarian cancer but who have not yet been diagnosed with breast or other cancers, examines online information gathering and community support to alleviate uncertainty. However, research exploring online content published by previvors themselves is limited. We examined content published to Instagram and TikTok to explore how breast cancer previvors discussed their lived experience which included, but was not limited to, genetic testing, diagnosis with a BRCA1/2 pathogenic (i.e. risk-increasing) variant, the decision to undergo preventative measures like surgery and/or reconstruction, and how they cope after diagnosis and surgical procedures. In the findings, we explicate how many previvors feel a responsibility to share their authentic experience on social media in order to help others and mitigate their own feelings of uncertainty. This study offers a snapshot of how women are sharing breast cancer previvorship and building social connections with each other online.
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Boumis JK, Dean M. The BRCA1/2 Previvor Information Journey: Understanding What Helps or Hinders. HEALTH COMMUNICATION 2023:1-13. [PMID: 37622341 DOI: 10.1080/10410236.2023.2248677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BRCA1/2 previvors - individuals who have a genetic mutation that increases their lifetime risk of developing breast or ovarian cancer - have unique information needs. Previvors can experience distress and uncertainty when these needs are not met, which can have negative consequences on their physical and psychological health. Previous research suggests meeting previvors' information needs is one way to combat these potential harmful effects. However, limited past research has examined previvors' perceptions of the helpfulness of information. Therefore, through surveying 101 previvors, this study explored previvors' perceptions of the (un)helpfulness of information, what (lack of) barriers previvors face to finding desired information, and the information sources they utilized. A thematic analysis revealed that previvors generally viewed information as helpful (through empowerment, coping, camaraderie, and action) but not always (evident in information overload). Previvors also reported several barriers (such as "the healthcare system in general", exclusivity, and uncertainty), while others reported a lack of resistance to finding desired information. Additionally, frequencies were calculated to find that various healthcare providers, support groups, and friends and family were common information sources. Taken together, these results offer a psychosocial model for understanding the previvor information journey, displaying how the themes are interconnected and unique for each previvor.
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Affiliation(s)
| | - Marleah Dean
- Department of Communication, University of South Florida
- Health Outcomes and Behavior Program, Moffitt Cancer Center
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Warner NZ, Groarke A. "There's gonna be a lot more heartache". Coping with a BRCA1/2 alteration: A qualitative reflexive thematic analysis. Eur J Oncol Nurs 2023; 64:102328. [PMID: 37141664 DOI: 10.1016/j.ejon.2023.102328] [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: 03/03/2022] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND This examines the coping needs of individuals with a BRCA1/2 alteration in Ireland. This study examined coping and information needs in this cohort, and was nested within a larger study in order to develop an online tool to promote positive adaptation following the identification of a BRCA1/2 alteration. METHOD A total of 18 participants took part in individual, semi-structured online interviews. A reflexive thematic analysis was employed to analyse data. A public and patient involvement panel of six individuals with a BRCA1/2 alteration provided input on terminology and study design. RESULTS Two key themes were identified. "Adjusting to a new perspective" was the first, referring to how individuals readjusted to their life after finding out about their BRCA1/2 genetic status. This theme had two subthemes (i) "emotional aspects", reflecting how participants navigated the emotive aspects of their BRCA1/2 alteration status and (ii) "relationships changing", which encompassed the ways in which interpersonal relationships were impacted by BRCA1/2. The second theme, "making sense of BRCA" had two subthemes, (i) "meaning making", depicting how participants found meaning through their BRCA1/2 alteration status, and (ii) "hope", which details the frequent reliance on hope as a means to cope with their genetic status. CONCLUSIONS Individuals with a BRCA1/2 alteration require specialised psychological support to assist with navigating their situation, with a focus on how to prepare for the emotional and relationship changes that the identification of BRCA1/2 alteration in the family can elicit. Providing decisional aids and informational tools may assist in meeting this need.
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Affiliation(s)
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Ireland
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Isselhard A, Lautz Z, Rhiem K, Stock S. Assessing Psychological Morbidity in Cancer-Unaffected BRCA1/2 Pathogenic Variant Carriers: A Systematic Review. Curr Oncol 2023; 30:3590-3608. [PMID: 37185387 PMCID: PMC10136916 DOI: 10.3390/curroncol30040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Female BRCA1/2 pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic variant may experience psychological distress because of imminent health threat. No comprehensible review on psychological morbidity in cancer-unaffected BRCA1/2 pathogenic variant carriers is currently available. This review aims to give an overview about all available the studies in which psychological outcomes have been assessed in cancer-unaffected BRCA1/2 pathogenic variant carriers, whether as a primary outcome or secondary measurement. A systematic search across four databases (Web of Science, PubMed, ScienceDirect, and EBSCO) was conducted. Studies had to report on cancer-unaffected pathogenic variant carriers (exclusively or separately) and use a validated measure of psychological morbidity to be eligible. Measures were only included if they were used in at least three studies. The final review consisted of 45 studies from 13 countries. Distress measures, including anxiety and cancer worry, were most often assessed. Most studies found a peak of distress immediately after genetic test result disclosure, with a subsequent decline over the following months. Only some studies found elevated distress in carriers compared to non-carriers in longer follow-ups. Depression was frequently investigated but largely not found to be of clinical significance. Quality of life seemed to be largely unaffected by a positive genetic test result, although there was some evidence that younger women, especially, were less satisfied with their role functioning in life. Body image has been infrequently assessed so far, but the evidence suggested that there may be a decrease in body image after genetic test result disclosure that may decrease further for women who opt for a prophylactic mastectomy. Across all the outcomes, various versions of instruments were used, often limiting the comparability among the studies. Hence, future research should consider using frequently used instruments, as outlined by this review. Finally, while many studies included cancer-unaffected carriers, they were often not reported on separately, which made it difficult to draw specific conclusions about this population.
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Isselhard A, Lautz Z, Töpper M, Rhiem K, Schmutzler R, Vitinius F, Fischer H, Berger-Höger B, Steckelberg A, Beifus K, Köberlein-Neu J, Stock S. Coping Self-Efficacy and Its Relationship with Psychological Morbidity after Genetic Test Result Disclosure: Results from Cancer-Unaffected BRCA1/2 Mutation Carriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1684. [PMID: 36767056 PMCID: PMC9914784 DOI: 10.3390/ijerph20031684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Women who are found to carry a BRCA1/2 pathogenic variant experience psychological distress due to an increased risk of breast and ovarian cancer. They may decide between different preventive options. In this secondary analysis of data collected alongside a larger randomized controlled trial, we are looking at 130 newly found BRCA1/2 pathogenic variant carriers and how their coping self-efficacy immediately after genetic test result disclosure is related to their psychological burden and status of preventive decision making. Participants received the Coping Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the Decisional Conflict Scale, and the Stage of Decision-Making Scale after positive genetic test result disclosure. We found that women with higher coping self-efficacy showed fewer symptoms of anxiety or depression and were less affected by receiving the genetic test result in terms of post-traumatic stress. However, coping self-efficacy had no relationship with any decision-related criteria, such as decisional conflict or stage of decision making. This shows that despite its buffering capacity on psychological burden, possessing coping self-efficacy does not lead to more decisiveness in preference-sensitive decisions.
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Affiliation(s)
- Anna Isselhard
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50924 Cologne, Germany
| | - Zoe Lautz
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50924 Cologne, Germany
| | - Maren Töpper
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50924 Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50924 Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50924 Cologne, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, 50924 Cologne, Germany
| | - Hannah Fischer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, 50924 Cologne, Germany
| | - Birte Berger-Höger
- Institute for Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
- Institute for Health and Nursing Science, Faculty of Medicine Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Faculty of Medicine Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Karolina Beifus
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, 42119 Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, 42119 Wuppertal, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50924 Cologne, Germany
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Simonovic N, Taber JM, Scherr CL, Dean M, Hua J, Howell JL, Chaudhry BM, Wain KE, Politi MC. Uncertainty in healthcare and health decision making: Five methodological and conceptual research recommendations from an interdisciplinary team. J Behav Med 2022. [DOI: 10.1007/s10865-022-00384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dason ES, Drost L, Greenblatt EM, Scheer AS, Han J, Sobel M, Allen L, Jacobson M, Doshi T, Wolff E, McMahon E, Jones CA. Providers' perspectives on the reproductive decision-making of BRCA-positive women. BMC Womens Health 2022; 22:506. [PMID: 36482357 PMCID: PMC9730610 DOI: 10.1186/s12905-022-02093-2] [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: 06/22/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Reproductive decision-making is difficult for BRCA-positive women. Our objective was to assess the complexities of decision-making and identify decisional supports for patients and providers when discussing reproductive options prior to risk-reducing salpingo-oophorectomy (RRSO). METHODS This study was of qualitive design, using data collection via semi-structured interviews conducted from November 2018 to October 2020. Individuals were included if they were identified to provide care to BRCA-positive women. In total, 19 providers were approached and 15 consented to participate. Providers were recruited from three clinics in Toronto, Ontario located at academic centers: [1] A familial ovarian cancer clinic, [2] A familial breast cancer clinic and [3] A fertility clinic, all of which treat carriers of the BRCA1/BRCA2 genetic mutation. The interview guide was developed according to the Ottawa Decision Support Framework and included questions regarding reproductive options available to patients, factors that impact the decision-making process and the role of decisional support. Interviews were transcribed and transcripts were analyzed thematically using NVIVO 12. RESULTS Providers identified three major decisions that reproductive-aged women face when a BRCA mutation is discovered: [1] "Do I want children?"; [2] "Do I want to take the chance of passing on this the mutation?"; and [3] "Do I want to carry a child?" Inherent decision challenges that are faced by both providers and patients included difficult decision type, competing options, scientifically uncertain outcomes, and challenging decision timing. Modifiable decisional needs included: inadequate knowledge, unrealistic expectations, unclear values and inadequate support or resources. Identified clinical gaps included counselling time constraints, lack of reliable sources of background information for patients or providers and need for time-sensitive, geographically accessible, and centralized care. CONCLUSION Our study identified a need for a patient information resource that can be immediately provided to patients who carry a BRCA genetic mutation. Other suggestions for clinical practice include more time during consultation appointments, adequate follow-up, value-centric counseling, access to psychosocial support, and a specialized decisional coach.
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Affiliation(s)
- E. S. Dason
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,Mount Sinai Fertility, 7th Floor, 250 Dundas St. W, Toronto, ON M5T 2Z5 Canada
| | - L. Drost
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. M. Greenblatt
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - A. S. Scheer
- grid.415502.7Department of General Surgery, St. Michaels Hospital, Unity Health Network, Toronto, ON M5B 1W8 Canada
| | - J. Han
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - M. Sobel
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - L. Allen
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - M. Jacobson
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - T. Doshi
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. Wolff
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. McMahon
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8 Canada
| | - C. A. Jones
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
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Conley CC, Davidson LG, Scherr CL, Dean M. Developing theory-driven narrative messages with personal stories: A step-by-step guide. Psychooncology 2022; 31:2113-2121. [PMID: 36205027 DOI: 10.1002/pon.6047] [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: 04/21/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Narratives are commonly utilized in health promotion and behavior change interventions due to their efficacy over didactic or expository interventions. While grounding narratives in behavioral theory may render them more effective, balancing the integration of theoretical and creative aspects of the narrative development process while maintaining authenticity is challenging. Thus, this manuscript describes a rigorous process through which researchers can intentionally integrate theory and personal stories for health interventions. METHODS The process for creating theory-driven narratives involves the following steps: (1) defining the purpose of the narratives, (2) selecting a guiding theory, (3) collecting personal testimonials, (4) immersing self into testimonials, (5) identifying central narratives and important variations, (6) considering additional theories, (7) piecing quotes into cohesive stories, (8) filling in the gaps, and (9) checking for resonance. RESULTS To exemplify this step-by-step process, we provide a case study from our research involving the development of a psychoeducational intervention to model information seeking strategies for managing cancer-related uncertainty among women who have recently tested positive for pathogenic genetic variants that increase risk for hereditary breast and ovarian cancer. CONCLUSIONS We discuss special considerations for developing theory-driven narrative interventions and reflect on how this rigorous step-by-step process can be adapted by other researchers.
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Affiliation(s)
- Claire C Conley
- Georgetown University, Washington, District of Columbia, USA
| | | | | | - Marleah Dean
- University of South Florida, Tampa, Florida, USA.,Moffitt Cancer Center, Tampa, Florida, USA
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McNamara N, Feeney M, Giltenane M, Dowling M. Breast cancer genetic mutation: Synthesis of women's experience. J Clin Nurs 2022. [PMID: 36016506 DOI: 10.1111/jocn.16498] [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: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify and synthesise the experiences reported by women with a breast cancer mutation who do not have cancer as reported in qualitative research published between 2013 and 2020. BACKGROUND Women carrying a BReast CAncer (BRC) genetic mutation have an increased risk for breast and ovarian cancer. They must engage in emotional decision-making regarding risk management strategies to prevent cancer, including risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy. DESIGN AND METHODS The ENTREQ statement guided this review. Eight databases were systematically searched (CINAHL, Pubmed, Embase, Psychinfo [Ovid], Web of Science, Scopus, Proquest and Lenus). Synthesis was guided by "best fit" framework. The Critical Appraisal Skills Programme guided assessment of methodological limitations and confidence in the review findings was informed by GRADE-CERQual. RESULTS Twenty studies met the inclusion criteria for synthesis. Six themes were synthesised from the included studies (anxiety; family planning; it's a family affair; empowerment; actions; pragmatic adjustments). CONCLUSIONS The multidimensional experiences of women living with a BRCA1/2 mutation require an individualised response based on women's needs at their life stages. A decision coaching model adopted during consultations could support women to guide decision-making regarding cancer risk-reducing strategies.
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Affiliation(s)
- Nichola McNamara
- Symptomatic Breast Unit, University Hospital Limerick, Limerick, Ireland
| | - Meghan Feeney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martina Giltenane
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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15
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Warner NZ, Groarke A. A qualitative reflexive thematic analysis into the experiences of being identified with a BRCA1/2 gene alteration: "So many little, little traumas could have been avoided". BMC Health Serv Res 2022; 22:1007. [PMID: 35933387 PMCID: PMC9357316 DOI: 10.1186/s12913-022-08372-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background BRCA1/2 alterations increase females’ lifetime breast cancer risk to 40 – 90%, ovarian cancer to 10 – 60%, and males’ lifetime prostate cancer risk to ~ 10 – 25%. Psychosocial issues such as heightened distress can, therefore, occur in this population. This study aimed to explore the subjective experiences and needs of the BRCA1/2 alteration population in navigating cancer risk reduction measures. Method This study aimed to explore the experiences and identify the needs of 18 BRCA1/2 alteration carriers, recruited through strategic sampling. A public and patient panel (N = 6) collaborated on study development. Data were analysed using reflexive thematic analysis. Results Two themes were identified: (i) Healthcare Services as a Burden to Navigate, and (ii) Burden Experienced Through Interactions with Healthcare Professionals. Results indicated uncertainty regarding care pathways, alongside a lack of relevant information. Participants felt unsupported by healthcare professionals, and as though healthcare professionals often perceive them as a burden. Conclusions These findings suggest that the quality of interactions in healthcare systems are of relevance to the BRCA1/2 alteration population, and that uncertainty surrounding access to services and information is prevalent. The establishment of specialist hereditary cancer clinics could reduce such burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08372-w.
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Affiliation(s)
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Ireland
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16
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Dibble KE, Donorfio LK, Britner PA, Bellizzi KM. Stress, anxiety, and health-related quality of life in BRCA1/2-positive women with and without cancer: A comparison of four US female samples. Gynecol Oncol Rep 2022; 42:101033. [PMID: 35769888 PMCID: PMC9234251 DOI: 10.1016/j.gore.2022.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Anxiety and stress were significantly worse in BRCA1/2-positive women compared to comparable US female samples. All health-related quality of life domains were better in BRCA1/2-positive women except energy/vitality, which was lower. Patient-provider training and mental health referrals are needed to lessen psychosocial consequences of genetic testing.
Introduction Women with BRCA1/2 mutations have a 11–72% increased risk of breast/ovarian cancers throughout their lifetime. The current study examines psychosocial differences between the current sample of BRCA1/2-positive women with and without cancer histories and three comparable United States (US) female samples without BRCA1/2 mutations. Methods Sixty BRCA1/2-positive women (with and without cancer histories) were recruited through multiple private online support groups in the US. Participants completed an online survey outlining sociodemographic and genetic counseling information, and anxiety, stress, and health-related quality of life (HRQoL) outcomes. Outcomes were compared to three similar US female normative samples via independent samples t-test analyses. Results State and trait anxiety (p = 0.00) and stress (p = 0.001) were significantly worse in the current sample of BRCA1/2-positive women compared comparable US female samples. All HRQoL domains were significantly better in the current sample except energy/vitality, which was significantly lower (p = 0.02) in the current sample. Results were stratified by cancer and recurrence status. Conclusions This study provides insight into how a sample of BRCA1/2-positive women both with and without cancer fare post-genetic counseling as compared to three normative female populations. Results infer the need for additional education, patient-provider training, and mental health referrals to support this population in order to circumvent unintended consequences and to improve psychosocial health in those being tested for, and those who test positive for, BRCA1/2 genetic mutations.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
- Corresponding author at: Johns Hopkins Bloomberg School of Public Health (JHSPH), 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Laura K.M. Donorfio
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
| | - Preston A Britner
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
| | - Keith M Bellizzi
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
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17
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Boardman F, Clark C. 'We're kind of like genetic nomads': Parents' experiences of biographical disruption and uncertainty following in/conclusive results from newborn cystic fibrosis screening. Soc Sci Med 2022; 301:114972. [PMID: 35430463 DOI: 10.1016/j.socscimed.2022.114972] [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: 09/30/2021] [Revised: 03/02/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
Abstract
As whole genome sequencing is being considered as a tool to deliver expanded newborn screening (NBS) globally, the range of equivocal results it could produce are gaining increased attention. For cystic fibrosis (CF) screening, the use of next generation sequencing within existing UK NBS programmes would increase the number of uncertain designations returned within results, including that of Cystic Fibrosis Screen Positive Inconclusive Diagnosis (CFSPID). However, the experiences of families already living with this designation have been under-explored. This study uses in-depth interviews to explore the perspectives of sixteen parents who received positive results from CF NBS, with varying degrees of prognostic un/certainty; parents with a child diagnosed with CF (n = 6), CF carrier status (n = 3) and those with the CFSPID designation (n = 7). The biographically disruptive nature of positive NBS results-regardless of immediate relevance to the child-dominated early experiences of positive results across all groups. For those with CF, biographical reparation involved becoming 'a CF family', underscoring biological kinship bonds and reinforcing familial identity. For those with uncertain results, biographical re-calibration was more complex. Diagnostic and prognostic uncertainty posed a barrier to entry for both the 'CF world' and the 'healthy kid' world, leading parents to attempt to minimise its role, either through rejection, or re-interpretation of their child's result. Other parents, however, experienced biographical reparation more dynamically. The concept of 'genetic nomadism' captures accounts of oscillation between the two worlds; movements that were responsive to evolving health experiences, as well as social, environmental and temporal factors. Through the concept of genetic nomadism, this paper delineates both the productive, as well as divisive, nature of uncertainty for biographical reparation in the aftermath of NBS, as well as the strategies parents use to harness it, in order to successfully navigate the world with a child with an ambiguous genetic future.
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Affiliation(s)
- Felicity Boardman
- Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom.
| | - Corinna Clark
- Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom
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18
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Dibble KE, K. M. Donorfio L, Britner PA, Bellizzi KM. Perceptions and Care Recommendations from Previvors: Qualitative Analysis of Female BRCA1/2 Mutation Carriers’ Experience with Genetic Testing and Counseling. Gynecol Oncol Rep 2022; 41:100989. [PMID: 35540028 PMCID: PMC9079684 DOI: 10.1016/j.gore.2022.100989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
BRCA1/2-positive women listed negative and positive aspects of testing/counseling. A wide range of emotions concerning healthcare experiences existed post-testing. Improved patient-oriented care and communication was recommended.
Introduction It is estimated that 12.5% of women will be diagnosed with breast cancer and 1.10% with ovarian cancer during their lifetime. Although less common, women with these mutations have a 11–72% increased risk of breast/ovarian cancers and are hereditary. Genetic testing/counseling presents the opportunity to identify carriers of BRCA1/2 genetic mutations before a cancer diagnosis. Methods Thirty-four BRCA1/2-positive women (with and without histories of breast/ovarian cancers) were recruited through online national support groups to gain a better understanding of their genetic testing/counseling perceptions and experiences. After confirming eligibility, they were invited to participate in either a telephone or webcam interview. Interview transcripts were analyzed using qualitative thematic text analysis and descriptive coding techniques. Results Six major themes emerged, capturing the perceptions and experiences of genetic testing/counseling for these women: 1) Emotional Reactions to Results and Genetic Counseling, 2) Future Recommendations, 3) Family Solidarity and Support, 4) Experiences with the Healthcare System, 5) Preventive Concerns and Decisions, and 6) Sources Affecting Perceived Risk. Two subthemes also emerged within the first theme, which are termed “Pre-vivor,” and “Testing Intuition.” Conclusions Participants indicated that genetic testing/counseling improvements would be helpful for women in this population surrounding quality care, including sensitivity training for healthcare professionals involved in testing/counseling, additional educational resources, and increased emotional and financial support. Although these recommendations may be beneficial, more widespread research with greater generalizability to disparate groups may be necessary prior to implementation.
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Bartley N, Best MC, Biesecker BB, Fisher A, Goldstein D, Meiser B, Thomas DM, Ballinger ML, Butow P. Effectively communicating comprehensive tumor genomic profiling results: Mitigating uncertainty for advanced cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:452-459. [PMID: 34016496 DOI: 10.1016/j.pec.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To understand advanced cancer patients' experience of uncertainty when receiving comprehensive tumor genomic profiling (CTGP) results, and their perceptions of how healthcare provider (HCP) communication impacts uncertainty. METHODS Thirty-seven semi-structured interviews with advanced cancer patients were conducted within two weeks of patients receiving CTGP results. Transcripts were thematically analyzed, using an inductive approach. RESULTS We identified three themes that illustrate patient experience of uncertainties when receiving CTGP results: 1. Type and degree of uncertainty fluctuates along with changing illness circumstances and the nature of the CTGP results; 2. HCPs' co-ordination of care and communication shapes uncertainty, with immediate, clearer and simpler information promoting certainty; and 3. Patients felt that communicating results to reduce relatives' uncertainty is important, with patients choosing the time and process for achieving this and desiring HCPs support. CONCLUSION Oncology patients are confronted with an array of uncertainties. Clear, simple communication from HCPs about results and their implications, and support to manage uncertainty, will be of benefit. PRACTICE IMPLICATIONS If CTGP is to become routine clinical practice, clear communication will be crucial in reducing uncertainty. Awareness of potential uncertainties experienced by patients when receiving results, will assist HCPs to address uncertainties, reduce uncertainty where possible, and offer targeted support to patients struggling with uncertainty.
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Affiliation(s)
- Nicci Bartley
- School of Psychology, The University of Sydney, Sydney, Australia.
| | - Megan C Best
- School of Psychology, The University of Sydney, Sydney, Australia; Institute of Ethics and Society, The University of Notre Dame, Sydney, Australia.
| | | | - Alana Fisher
- School of Psychology, The University of Sydney, Sydney, Australia.
| | - David Goldstein
- Prince of Wales Clinical School, University of NSW, Sydney, Australia.
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, Australia.
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Clinical School, University of NSW, Sydney, Australia.
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Clinical School, University of NSW, Sydney, Australia.
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, Australia.
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20
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Lee K, Kim DR. Self-Concept and Psychosocial Well-Being among Korean Women with BRCA1/2 Gene Mutations. ASIAN ONCOLOGY NURSING 2022. [DOI: 10.5388/aon.2022.22.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kyunghwa Lee
- Assistant Professor, College of Nursing, Konyang University, Daejeon, Korea
| | - Doo Ree Kim
- Associate Professor, College of Nursing, Konyang University, Daejeon, Korea
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21
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Pienaar K, Petersen A. Searching for diagnostic certainty, governing risk: Patients' ambivalent experiences of medical testing. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:25-40. [PMID: 34713910 PMCID: PMC9298388 DOI: 10.1111/1467-9566.13391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 05/13/2023]
Abstract
Diagnosis is pivotal to medicine's epistemic system: it serves to explain individual symptoms, classify them into recognizable conditions and determine their prognosis and treatment. Medical tests, or investigative procedures for detecting and monitoring disease, play a central role in diagnosis. While testing promises diagnostic certainty or a definitive risk assessment, it often produces uncertainties and new questions which call for yet further tests. In short, testing, regardless of its specific application, is imbued with meaning and emotionally fraught. In this article, we explore individuals' ambivalent experiences of testing as they search for diagnostic certainty, and the anxieties and frustrations of those for whom it remains elusive. Combining insights from sociological work on ambivalence and the biopolitics of health, and drawing on qualitative interviews with Australian healthcare recipients who have undergone testing in the context of clinical practice, we argue that these experiences are explicable in light of the contradictory impulses and tensions associated with what we term 'bio-subjectification'. We consider the implications of our analysis in light of the development of new tests that produce ever finer delineations between healthy and diseased populations, concluding that their use will likely multiply uncertainties and heighten rather than lessen anxieties.
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Affiliation(s)
- Kiran Pienaar
- Sociology DepartmentSchool of Social Sciences and HumanitiesDeakin UniversityGeelongVic.Australia
- Sociology ProgramSchool of Social SciencesMonash UniversityClaytonVic.Australia
| | - Alan Petersen
- Sociology ProgramSchool of Social SciencesMonash UniversityClaytonVic.Australia
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22
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Torrisi C. Body Image in BRCA-Positive Young Women Following Bilateral Risk-Reducing Mastectomy: A Review of the Literature. Front Psychol 2021; 12:778484. [PMID: 34975666 PMCID: PMC8716694 DOI: 10.3389/fpsyg.2021.778484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Significance: The presence of a breast cancer (BRCA) gene mutation increases a woman’s lifetime risk of developing breast cancer. Bilateral risk-reducing mastectomy is a proactive treatment option which lowers that risk. However, breast removal can create a change in physical appearance. It is unclear if BRCA-positive women undergoing this surgery in young adulthood, a life stage where intimate relationships, families, and careers are being established, have the same experience with body image as women in later stages of life.Purpose: The aim of this literature review is to assess how bilateral risk-reducing mastectomy impacts body image in young BRCA-positive women less than 40 years of age, with no history of breast cancer.Methods: Database searches were performed, yielding 402 results. Studies were considered if participants had an increased lifetime breast cancer risk/BRCA-positive diagnosis and history of bilateral risk-reducing mastectomy, body image was evaluated, and mean age was less than 40 years. A total of three qualitative studies and three quantitative studies were identified as relevant for this review.Results: A dearth of information exists on body image in young women following bilateral risk-reducing mastectomy. It was found in this review that some women experienced a decline in body image following surgery, while in others body image was maintained or improved.Conclusion: Understanding factors that impact body image following this risk-reducing surgery will allow clinicians to support this unique population. Open and informative discussion should be encouraged with young women considering, or who have undergone, bilateral risk-reducing mastectomy.
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Zimmermann BM, Shaw DM, Elger B, Koné I. The use of heuristics in genetic testing decision-making: A qualitative interview study. PLoS One 2021; 16:e0260597. [PMID: 34847204 PMCID: PMC8631642 DOI: 10.1371/journal.pone.0260597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Decision-making concerning predictive genetic testing for hereditary cancer syndromes is inherently complex. This study aims to investigate what kind of complexities adults undergoing genetic counseling in Switzerland experience, how they deal with them, and what heuristics they use during the decision-making process. METHODS Semi-structured qualitative interviews with eighteen Swiss adults seeking genetic counseling for hereditary cancer syndrome genetic testing and two counseling physicians were conducted and analyzed using a grounded theory approach. RESULTS Counselees stated that once they were aware of their eligibility for genetic testing they perceived an inevitable necessity to make a decision in a context of uncertainties. Some counselees perceived this decision as simple, others as very complex. High emotional involvement increased perceived complexity. We observed six heuristics that counselees used to facilitate their decision: Anticipating the test result; Focusing on consequences; Dealing with information; Interpreting disease risk; Using external guidance; and (Re-)Considering the general uncertainty of life. LIMITATIONS Our findings are limited to the context of predictive genetic testing for hereditary cancer syndromes. This qualitative study does not allow extrapolation of the relative frequency of which heuristics occur. CONCLUSIONS The use of heuristics is an inherent part of decision-making, particularly in the complex context of genetic testing for inherited cancer predisposition. However, some heuristics increase the risk of misinterpretation or exaggerated external influences. This may negatively impact informed decision-making. Thus, this study illustrates the importance of genetic counselors and medical professionals being aware of these heuristics and the individual manner in which they might be applied in the context of genetic testing decision-making. Findings may offer practical support to achieve this, as they inductively focus on the counselees' perspective.
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Affiliation(s)
- Bettina Maria Zimmermann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - David Martin Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Stracke C, Lemmen C, Rhiem K, Schmutzler R, Kautz-Freimuth S, Stock S. Medical knowledge and information needs among women with pathogenic variants in moderate-risk genes for hereditary breast cancer attending genetic counseling at an academic hospital in Germany-A qualitative approach. J Genet Couns 2021; 31:698-712. [PMID: 34837291 DOI: 10.1002/jgc4.1536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/20/2022]
Abstract
With 69,000 newly diagnosed cases every year, breast cancer (BC) is the most frequent cancer disease among women in Germany. Familial clustering is seen in about 30% of newly diagnosed cases. Besides the high-risk genes BRCA1/2, there are also moderate-risk BC genes (MBCG) that are associated with a 20%-50% risk of BC, such as CHEK2, ATM, and PALB2. In Germany, carriers of pathogenic variants in MBCG receive specific information on their test results, individual risks, and preventive options during genetic counseling for the disclosure of the results in a specialized center. Little is known about the medical knowledge that women have after attending counseling. This study aims to identify the medical knowledge, further information needs, and the possible impact of a lack of information on dealing with everyday life for women with pathogenic variants in MBCG who have attended genetic counseling at an academic hospital in Germany. Problem-centered, guided, individual interviews were conducted with twelve women carrying pathogenic variants in MBCG. The interview guide was developed based on the methods of the problem-centered interview according to Witzel. The interview analysis was based on Mayring's qualitative content analysis. The women were between 29 and 59 years old and carried pathogenic variants in the risk genes CHEK2 (n = 8), ATM (n = 1), or PALB2 (n = 3). Several medical uncertainties and information needs emerged from the data, concerning (a) medical terms, (b) risk perception, (c) BC therapy for hereditary BC, (d) lifestyle advice and risk factors, and (e) family planning and risk-reducing mastectomy. Women with pathogenic variants in MBCG might develop their own conceptions regarding the onset of disease and inheritance. In order to meet the need for information and address the uncertainties that may still exist after genetic counseling, structured, evidence-based and comprehensible written information in German should be developed for this group.
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Affiliation(s)
- Claudia Stracke
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Clarissa Lemmen
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Rita Schmutzler
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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25
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Liu Y, Calzone K, Fasaye GA, Quillin J. CDH1 variants leading to gastric cancer risk management decision-making experiences in emerging adults: 'I am not ready yet'. J Genet Couns 2021; 30:1091-1104. [PMID: 33655597 PMCID: PMC8358785 DOI: 10.1002/jgc4.1393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/10/2022]
Abstract
Pathogenic/likely pathogenic variants (PLPV) in CDH1 are associated with a significantly increased lifetime risk for diffuse gastric cancer, with an average age of onset of 47 years. CDH1 PLPV carriers are recommended to have prophylactic total gastrectomy (PTG) or routine endoscopy surveillance. Emerging adults (EAs) may have unique circumstances that affect their medical management decision-making about PTG versus endoscopy. The study aim was to use qualitative interpretative phenomenological analysis method to understand the lived experience and medical management decision-making process for EAs carrying a CDH1 PLPV. Eligible participants were unaffected CDH1 PLPV carriers, ages 18 to 29, who had not undergone PTG and had discussed CDH1 medical management with a health provider. Semi-structured telephone interviews were transcribed verbatim and analyzed for major themes. Results show EAs wanted to avoid developing diffuse gastric cancer, but most do not feel they are ready for PTG. They had worries about PTG related to their identity exploration, financial stability, and careers. Most did not want to pass the PLPV to their children; however, the cost of preimplantation genetic testing with in vitro fertilization was a concern. Family medical history and self-understanding of endoscopy and PTG highly influenced medical management decision-making. Understanding of diffuse gastric cancer detection rate using endoscopy was inconsistent among participants. Body image was not a concern for most, but they worry about dietary restrictions after PTG. Lastly, connection to peers having the same experience was important. These findings increase our understanding of the medical management decision-making challenges for EA CDH1 carriers. EAs may take an extended time to decide what option is right for them. Thus, genetic counseling for CDH1 PLPV EA carriers requires long-term support and education.
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Affiliation(s)
- Yi Liu
- Genetic Counseling Program, Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- National Cancer Institute, Center for Cancer Research, Genetics Branch, 37 Convent Drive, Building 37, Bethesda, MD 20892
| | - Kathleen Calzone
- National Cancer Institute, Center for Cancer Research, Genetics Branch, 37 Convent Drive, Building 37, Bethesda, MD 20892
| | - Grace-Ann Fasaye
- National Cancer Institute, Center for Cancer Research, Genetics Branch, 37 Convent Drive, Building 37, Bethesda, MD 20892
| | - John Quillin
- Genetic Counseling Program, Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Stanley BL, Zanin AC, Avalos BL, Tracy SJ, Town S. Collective Emotion During Collective Trauma: A Metaphor Analysis of the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2021; 31:1890-1903. [PMID: 33980096 DOI: 10.1177/10497323211011589] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study provides insight into lived experiences of the COVID-19 pandemic in the United States. Participant metaphors of the pandemic were collected by conducting in-depth semi-structured interviews (N = 44). Participants were asked to compare the pandemic with an animal and with a color, and to provide contextual sensemaking about their metaphors. A metaphor analysis revealed four convergent mental models of participants' pandemic experiences (i.e., uncertainty, danger, grotesque, and misery) as well as four primary emotions associated with those mental models (i.e., grief, disgust, anger, and fear). Through metaphor, participants were able to articulate deeply felt, implicit emotions about their pandemic experiences that were otherwise obscured and undiscussable. Theoretical and practical implications of these collective mental models and associated collective emotions related to the unprecedented collective trauma of the COVID-19 pandemic are discussed.
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Affiliation(s)
| | | | | | | | - Sophia Town
- Fordham University, New York City, New York, USA
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27
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McGrath SP, Peabody AE, Walton D, Walton N. Legal Challenges in Precision Medicine: What Duties Arising From Genetic and Genomic Testing Does a Physician Owe to Patients? Front Med (Lausanne) 2021; 8:663014. [PMID: 34381794 PMCID: PMC8349980 DOI: 10.3389/fmed.2021.663014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
Precision medicine is increasingly incorporated into clinical practice via three primary data conduits: environmental, lifestyle, and genetic data. In this manuscript we take a closer look at the genetic tier of precision medicine. The volume and variety of data provides a more robust picture of health for individual patients and patient populations. However, this increased data may also have an adverse effect by muddling our understanding without the proper pedagogical tools. Patient genomic data can be challenging to work with. Physicians may encounter genetic results which are not fully understood. Genetic tests may also lead to the quandary of linking patients with diseases or disorders where there are no known treatments. Thus, physicians face a unique challenge of establishing the proper scope of their duty to patients when dealing with genomic data. Some of those scope of practice boundaries have been established as a result of litigation, while others remain an open question. In this paper, we map out some of the legal challenges facing the genomic component of precision medicine, both established and some questions requiring additional guidance. If physicians begin to perceive genomic data as falling short in overall benefit to their patients, it may detrimentally impact precision medicine as a whole. Helping to develop guidance for physicians working with patient genomic data can help avoid this fate of faltering confidence.
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Affiliation(s)
- Scott P McGrath
- CITRIS and the Banatao Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Arthur E Peabody
- Hooper, Lundy & Bookman, Professional Corporation, Washington, DC, United States
| | - Derek Walton
- Walton Legal Professional Limited Liability Company, Salt Lake City, UT, United States
| | - Nephi Walton
- Intermountain Healthcare, Salt Lake City, UT, United States
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28
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Reyes KG, Clark C, Gerhart M, Newson AJ, Ormond KE. "I wish that there was more info": characterizing the uncertainty experienced by carriers of pathogenic ATM and/or CHEK2 variants. Fam Cancer 2021; 21:143-155. [PMID: 33855648 DOI: 10.1007/s10689-021-00251-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/04/2021] [Indexed: 12/29/2022]
Abstract
Little is known about what uncertainties patients experience after being identified to carry a pathogenic variant in a moderate-risk cancer gene as a result of undergoing multigene panel testing for cancer susceptibility. Data regarding cancer risk estimates and effectiveness of risk management strategies for these variants continues to evolve, which has the potential to evoke uncertainty. Acknowledging uncertainty during pre- and post-test discussions is imperative to helping individuals to adapt to their results. A better understanding of this population's experience of uncertainty is needed to facilitate such discussions and is the aim of the current study. Semi-structured interviews (30-60 min in length), informed by Han and colleagues' taxonomy of uncertainty in clinical genomic sequencing, were conducted to assess motivations to pursue genetic testing, areas of perceived uncertainty, and strategies for managing uncertainty among 20 carriers of pathogenic variants in two moderate-risk genes, ATM and CHEK2. We found that participants pursue genetic testing with the expectation that results will clarify cancer risks and approaches to management. Participants experience uncertainties aligning with Han's taxonomy relating to the ambiguity of specific cancer risk estimates and effectiveness of certain risk management strategies. These uncertainties influenced decisions around the uptake of risk management strategies, which were additionally impacted by clinicians' uncertainty towards such strategies. Participants employ a variety of uncertainty management approaches to cope with their anxieties. Clinicians may wish to use these findings to facilitate patient adaptation to the implications of multigene panel testing for cancer susceptibility during both pre- and post-test counseling sessions.
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Affiliation(s)
- Kathryn G Reyes
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheyla Clark
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Gerhart
- Cancer Genetics and Genomics, Stanford Health Care, Stanford, CA, USA
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA. .,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
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29
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Martins RG, Carvalho IP. Genetic testing for pheochromocytoma and paraganglioma: SDHx carriers' experiences. J Genet Couns 2021; 30:872-884. [PMID: 33604970 DOI: 10.1002/jgc4.1390] [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: 08/14/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
Pheochromocytoma and paraganglioma are frequently hereditary tumors commonly associated with succinate dehydrogenase (SDHx) pathogenic variants (PV). Genetic testing is recommended to relatives of patients carrying SDHx PV. This study aims to explore the experiences associated with genetic testing for this hereditary condition. Semi-structured interviews with 38 SDHx PV (tumor-affected and non-affected) carriers were transcribed and content-analyzed. Four ways of living with this genetic alteration emerged from the interviews: 'living as if not knowing', 'preventing others from going through this', 'feeling privileged', and 'still suffering'. Within each, negative, neutral, and positive reactions to the actual test result emerged initially, in addition to blame and guilt. Recognition of the importance of the genetic test and of the follow-up occurred in all four, but views on fecundity were divided between having and not having children. Consideration for the four different meanings of carrying an SDHx PV can improve participants' experiences and clinical practice.
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Affiliation(s)
- Raquel Gomes Martins
- Department of Endocrinology, Portuguese Oncology Institute of Coimbra, Porto, Portugal.,Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Oporto, Porto, Portugal.,Research Centre, Portuguese Oncology Institute of Oporto, Porto, Portugal
| | - Irene Palmares Carvalho
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Oporto, Porto, Portugal.,CINTESIS, School of Medicine, University of Oporto, Porto, Portugal
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30
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Campbell-Salome G, Buchanan AH, Hallquist MLG, Rahm AK, Rocha H, Sturm AC. Uncertainty management for individuals with Lynch Syndrome: Identifying and responding to healthcare barriers. PATIENT EDUCATION AND COUNSELING 2021; 104:403-412. [PMID: 32782180 DOI: 10.1016/j.pec.2020.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/24/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine the uncertainty management process of individuals with Lynch syndrome (LS). METHODS 19 phone interviews were conducted with individuals with LS. The interview guide included questions on family communication, risk perceptions, and uncertainty management. Data were analyzed using the constant comparison method to code for emergent themes. RESULTS Qualitative analysis found individuals with LS tried to manage their uncertainty through preventive care, but were often confounded by healthcare barriers. Healthcare barriers included cost and insurance issues, absence of coordinated care, insufficient provider knowledge, and lack of patient-centered communication. Participants reported increased uncertainty and anxiety due to these barriers and used alternative uncertainty management strategies such as advocating for themselves with providers, seeking information online, and communicating with family for emotional support. CONCLUSION Healthcare barriers identified in this study exacerbated uncertainty and anxiety for individuals with LS and challenged their ability to engage in preventive care. In response, participants used alternative uncertainty management strategies to reduce their uncertainty, which may have unintended negative consequences. PRACTICE IMPLICATIONS Findings support the need for providers to partner with specialists in genetics and/or LS to better care for individuals with LS. Findings highlight opportunities for interventions in healthcare to better support individuals with LS.
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Affiliation(s)
| | | | | | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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31
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Waltz M, Prince AER, O’Daniel JM, Foreman AKM, Powell BC, Berg JS. Referencing BRCA in hereditary cancer risk discussions: In search of an anchor in a sea of uncertainty. J Genet Couns 2020; 29:949-959. [PMID: 31967382 PMCID: PMC7374021 DOI: 10.1002/jgc4.1219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 01/14/2023]
Abstract
As panel testing and exome sequencing are increasingly incorporated into clinical care, clinicians must grapple with how to communicate the risks and treatment decisions surrounding breast cancer genes beyond BRCA1 and BRCA2. In this paper, we examine clinicians' practice of employing BRCA1 and BRCA2 to help contextualize less certain genetic information regarding cancer risk and the possible implications of this practice for patients within the context of an exome sequencing study, NCGENES. We audio-recorded return of results appointments for 14 women who participated in NCGENES, previously had breast cancer, and were suspected of having a hereditary cancer predisposition. These patients were also interviewed four weeks later regarding their understanding of their results. We found that BRCA1 and BRCA2 were held as the gold standard, where clinicians compared what is known about BRCA to the limited understanding of other breast cancer-related genes. BRCA1 and BRCA2 were used as anchors to shape patients' understandings of genetic knowledge, risk, and management, illustrating how the information clinicians provide to patients may work as an external anchor. Yet, presenting BRCA1 and BRCA2 as a means of scientific reassurance can run the risk of patients conflating knowledge about certainty of risk with degree of risk after receiving a result for a moderate penetrance gene. This can be further complicated by misperceptions of the precision of cancer predictability attributed to these or other described 'cancer genes' in public media.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ann Katherine M. Foreman
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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32
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Getachew-Smith H, Ross AA, Scherr CL, Dean M, Clements ML. Previving: How Unaffected Women with a BRCA1/2 Mutation Navigate Previvor Identity. HEALTH COMMUNICATION 2020; 35:1256-1265. [PMID: 31163995 DOI: 10.1080/10410236.2019.1625002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Receiving a positive result for a BRCA1/2 (BRCA) mutation - indicating a high lifetime risk to develop hereditary breast and ovarian cancer - can significantly alter a woman's identity. BRCA-positive women who have not been diagnosed with cancer may be labeled "previvors," which distinguishes those at-risk for developing cancer, but have not had cancer. Using semi-structured interviews (N = 25), this study explored how unaffected BRCA-positive women navigate the previvor identity. Women in this sample differed on their definitions of previvor, views of acceptance, rejection, or ambivalence toward the label, and identification as a previvor. Understanding how women interpret and embrace the previvor identity may help inform communication for those with BRCA genetic mutations, but whom have not been diagnosed with cancer.
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Affiliation(s)
| | - Amy A Ross
- Department of Communication Studies, Northwestern University
| | | | - Marleah Dean
- Department of Communication, University of South Florida
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33
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Patient experience of uncertainty in cancer genomics: a systematic review. Genet Med 2020; 22:1450-1460. [PMID: 32424175 PMCID: PMC7462749 DOI: 10.1038/s41436-020-0829-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
While genomics provides new clinical opportunities, its complexity generates uncertainties. This systematic review aimed to summarize what is currently known about the experience of uncertainty for adult patients undergoing cancer genomic testing. A search of five databases (2001 to 2018) yielded 6508 records. After removing duplicates, abstract/title screening, and assessment of full articles, ten studies were included for quality appraisal and data extraction. Qualitative studies were subjected to thematic analysis, and quantitative data were summarized using descriptive statistics. Cancer genomic results reduced uncertainty for patients regarding treatment decisions but did not reduce uncertainty in the risk context. Qualitative and quantitative data synthesis revealed four themes: (1) coexisting uncertainties, (2) factors influencing uncertainty, (3) outcomes of uncertainty, and (4) coping with uncertainty. Uncertainty can motivate, or be a barrier to, pursuing cancer genomic testing. Appraisal of uncertainty influences the patient experience of uncertainty, the outcome of uncertainty for patients, as well as the coping strategies utilized. While this systematic review found that appraisal of uncertainty is important to the patients' experience of uncertainty in the cancer genomic context, more mixed methods longitudinal research is needed to address the complexities that contribute to patient uncertainty across the process.
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34
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Possick C, Kestler-Peleg M. BRCA and Motherhood: A Matter of Time and Timing. QUALITATIVE HEALTH RESEARCH 2020; 30:825-835. [PMID: 31814509 DOI: 10.1177/1049732319885113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The threat of cancer and the effects of risk-reducing surgery can have a significant impact on family planning and family life. In this qualitative study, we examine intersecting experiences of BRCA carrier status, subsequent risk-reducing surgery, and motherhood by analyzing in-depth interviews with 16 Jewish, Israeli mothers (ages 36-57) who underwent risk-reducing mastectomies and/or oophorectomies. Time emerged as a prism through which the BRCA motherhood experience could be viewed. In the "Findings" section, we present concepts of BRCA time and maternal time through three subthemes: (a) objective and subjective fertility clocks and BRCA: the child who won't be born; (b) synchronizing the clocks: the "correct" tempo and chronology; and (c) back to the future: intergenerational coalescence of time. We discuss the notions of time and existential health threats and subjective time in the primary mother-infant relational system within the context of the cultural ideal of the "motherhood myth."
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35
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Hong SJ. Uncertainty in the Process of Communicating Cancer-related Genetic Risk Information with Patients: A Scoping Review. JOURNAL OF HEALTH COMMUNICATION 2020; 25:251-270. [PMID: 32271688 DOI: 10.1080/10810730.2020.1745963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the era of precision medicine, patients must manage the uncertainty caused by ambiguous genetic information. To aid health practitioners in effectively communicating genetic information, this study classified the types of uncertainty involved in these communication processes. A search of recent literature turned up 64 articles that measured and/or discussed patients' perceptions and/or feelings of uncertainty related to the communication process of cancer-related genetic information. In reviewing these papers, six types of uncertainty regarding cancer-related genetic information were identified: (1) uncertainty about understanding genetic information (n = 25; 39.1%); (2) uncertainty about future cancer risks (n = 34; 53.1%); (3) uncertainty about managing known genetic information or mutation status (n = 33; 51.6%); (4) uncertainty about the utility of genetic information (n = 5; 7.8%); (5) uncertainty about genetic test results before undergoing testing or receiving the results (n = 10; 15.6%); and (6) uncertainty about the impact of genetic results on family and life (n = 11; 17.2%). These six types of uncertainty serve as a helpful taxonomy for developing, validating, and utilizing future measures of uncertainty in the context of cancer-related genetic risk communication.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
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36
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Solsky I, Chen J, Rebbeck TR. Precision prophylaxis: Identifying the optimal timing for risk-reducing salpingo-oophorectomy based on type of BRCA1 and BRCA2 cluster region mutations. Gynecol Oncol 2020; 156:363-376. [PMID: 31918993 DOI: 10.1016/j.ygyno.2019.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Current risk-reducing salpingo-oophorectomy (RRSO) guidelines for individuals with BRCA1/2 mutations do not account for risk variability due to BRCA1/2 cluster region mutations that are associated with varying risks for the development of breast and ovarian cancer. We assessed whether current recommendations are appropriate for individual patients considering mutation-specific risks. METHODS Using a hypothetical cohort of patients with BRCA1/2 mutations, we constructed Markov models allowing for the estimation of mean life expectancy based upon BRCA1/2 mutation, the presence of a cluster region mutation (Ovarian Cancer Cluster Region (OCCR), Breast Cancer Cluster Region (BCCR), or non-BCCR/OCCR), age at time of BRCA1/2 diagnosis (20-65), and age at time of RRSO (21-80). RESULTS For all BRCA1/2 mutation types, the optimal strategy was to undergo RRSO as early as possible. For BRCA1/2 carriers who delayed RRSO or who were identified with a mutation later in life, the OCCR mutation tended to be associated with lower life expectancy estimates than the BCCR and non-BCCR/OCCR mutations. Minimal delays in RRSO (i.e., neighboring 5-year intervals) were associated with minor losses in life expectancy. Variables associated with greatest impact on life expectancy included ovarian cancer risk after RRSO, breast cancer mortality rate, non-cancer mortality associated with RRSO, and breast cancer stage distribution. CONCLUSIONS BRCA1/2 cluster regions may provide more precise estimates of life expectancy in counselling and shared decision-making. The most appropriate timing for RRSO is a complex decision and must be individualized for each patient.
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Affiliation(s)
- Ian Solsky
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Jinbo Chen
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States of America
| | - Timothy R Rebbeck
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Dana Farber Cancer Institute, Boston, MA, United States of America.
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37
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Rauscher EA, Dean M, Campbell-Salome G, Barbour JB. "How do we rally around the one who was positive?" Familial uncertainty management in the context of men managing BRCA-related cancer risks. Soc Sci Med 2019; 242:112592. [PMID: 31629161 DOI: 10.1016/j.socscimed.2019.112592] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE Men with BRCA-related cancer risks face increased disease risk as well as the prospect of passing on their risk to children. OBJECTIVE This study investigates men's communicative appraisal and management of uncertainty related to BRCA-related cancer risks and decision-making. METHODS Guided by uncertainty management theory (UMT), a directed content analysis approach was utilized to analyze interviews with 25 men who either carry a pathogenic BRCA variant or have a 50% chance of carrying a variant but have not yet been tested. RESULTS Participants appraised their individual uncertainty as irrelevant or dangerous but appraised their familial uncertainty as dangerous. Men appraising their uncertainty as a danger exhibited more proactive information seeking healthcare behaviors-such as genetic testing and following recommended screenings-than men who appraised their uncertainty as irrelevant. Participants appraised familial uncertainty as a danger and were engaged in information management with family members, as well as encouraging family members to engage in proactive healthcare decision-making. CONCLUSIONS Men with BRCA-related cancer risks lack understanding about their risks and how to manage them. Increased attention should be paid to the development of interventions tailored specifically to men. Further, interventions focusing on strategically developing proactive family communication behaviors would also be beneficial to men and their families.
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Affiliation(s)
- Emily A Rauscher
- Department of Communication, University of Utah, 255 S Central Campus Dr, Salt Lake City, UT, 84112, USA.
| | - Marleah Dean
- Department of Communication, University of South Florida, 4202 E. Fowler Ave, Tampa, FL, 33620, USA.
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Geisinger, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Joshua B Barbour
- Department of Communication, University of Texas, Austin, 2504A Whitis Ave. (A1105), Austin, TX, 78712-0115, USA.
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38
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Wöhlke S, Schaper M, Schicktanz S. How Uncertainty Influences Lay People's Attitudes and Risk Perceptions Concerning Predictive Genetic Testing and Risk Communication. Front Genet 2019; 10:380. [PMID: 31080458 PMCID: PMC6497735 DOI: 10.3389/fgene.2019.00380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/09/2019] [Indexed: 12/11/2022] Open
Abstract
The interpretation of genetic information in clinical settings raises moral issues about adequate risk communication and individual responsibility about one's health behavior. However, it is not well-known what role numeric probabilities and/or the conception of disease and genetics play in the lay understanding of predictive genetic diagnostics. This is an important question because lay understanding of genetic risk information might have particular implications for self-responsibility of the patients. Aim: Analysis of lay attitudes and risk perceptions of German lay people on genetic testing with a special focus on how they deal with the numerical information. Methods: We conducted and analyzed seven focus group discussions (FG) with lay people (n = 43). Results: Our participants showed a positive attitude toward predictive genetic testing. We identified four main topics: (1) Anumeric risk instead of statistical information; (2) Treatment options as a factor for risk evaluation; (3) Epistemic and aleatory uncertainty as moral criticism; (4) Ambivalence as a sign of uncertainty. Conclusion: For lay people, risk information, including the statistical numeric part, is perceived as highly normatively charged, often as an emotionally significant threat. It seems necessary to provide lay people with a deeper understanding of risk information and of the limitations of genetic knowledge with respect to one's own health responsibility.
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Affiliation(s)
- Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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39
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Dean M, Rauscher EA. Men's and Women's Approaches to Disclosure About BRCA-Related Cancer Risks and Family Planning Decision-Making. QUALITATIVE HEALTH RESEARCH 2018; 28:2155-2168. [PMID: 30051759 DOI: 10.1177/1049732318788377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known about how men and women who test positive for a BRCA gene mutation or have a strong family history of carrying a BRCA mutation manage disclosures about their BRCA-related cancer risks and family planning decision-making. By conducting interviews with 25 men and 20 women, this study investigated men's and women's approaches to disclosing their BRCA-related cancer risks and family planning decision-making. Guided by the Disclosure Decision-Making Model (DD-MM), this study demonstrates that men and women assess both information and the recipients of disclosures when making disclosure decisions. Theoretical implications for the DD-MM are discussed along with practical implications for hereditary cancer risk and family planning.
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40
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Certainty within uncertainty: a qualitative study of the experience of metastatic melanoma patients undergoing pembrolizumab immunotherapy. Support Care Cancer 2018; 27:1845-1852. [DOI: 10.1007/s00520-018-4443-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/23/2018] [Indexed: 12/17/2022]
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41
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"I Am Uncertain About What My Uncertainty Even Is": Men's Uncertainty and Information Management of Their BRCA-Related Cancer Risks. J Genet Couns 2018; 27:1417-1427. [PMID: 29971606 DOI: 10.1007/s10897-018-0276-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/21/2018] [Indexed: 12/27/2022]
Abstract
Men with a germline pathogenic BRCA1 or BRCA2 variant have increased risks for developing breast, pancreatic, prostate, and melanoma cancers, but little is known about how they understand and manage their cancer risks. This study examines how men with BRCA-related cancer risks manage uncertainty and information about their risks. Twenty-five men who were either a BRCA carrier or have a BRCA-positive first-degree family member that put the participant at 50% chance of also being a BRCA carrier were interviewed for this study. Using uncertainty management theory as a theoretical framework, this study demonstrates that men manage uncertainty by seeking information from female family members, websites, and healthcare providers, and are under-informed about their cancer risks. Further, in handling their information, men prefer information about cancer risk percentages and screening recommendations in the form of lists presented to them via websites, printed literature, proactive healthcare providers, and an identifiable male spokesperson. Finally, men used BRCA-related cancer risk information to make decisions about whether or not to engage in screening and prevention, manage their BRCA-related cancer risks, and overall family well-being-yet often at the expense of their own individual risks. Implications for genetic counseling and family conversations are discussed.
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42
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Ross E, Broer T, Kerr A, Cunningham-Burley S. Identity, community and care in online accounts of hereditary colorectal cancer syndrome. NEW GENETICS AND SOCIETY 2018; 37:117-136. [PMID: 29875617 PMCID: PMC5964445 DOI: 10.1080/14636778.2018.1469974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically "at risk" are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers' accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.
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Affiliation(s)
- Emily Ross
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - Tineke Broer
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - Anne Kerr
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Sarah Cunningham-Burley
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
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43
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Derbez B. Is there a "right time" for bad news? Kairos in familial communication on hereditary breast and ovarian cancer risk. Soc Sci Med 2018; 202:13-19. [PMID: 29500986 DOI: 10.1016/j.socscimed.2018.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 10/18/2022]
Abstract
Time has long been considered as an important dimension of the process of disclosure of information about genetic risk to kin. The question of the "right time to tell" has been frequently noticed but seldom placed at the centre of the analyses of social scientists. Based on an ethnographical fieldwork in a French cancer genetics clinic, this article aims to show that many dimensions of the practical issues of disclosure to family can be fruitfully addressed through the temporal lens of kairos. Relying on the case of hereditary breast and ovarian cancer risk, it firstly highlights the existence of a mismatch between the "chronological" time of prevention proposed by professionals and the "kairological" time of disclosure lived by informants. Secondly, it emphasizes the problematic nature of the pragmatic approach of time associated with kairos. On the one hand one can draw some benefits from seeking the right time to inform relatives, but on the other hand waiting on uncertain opportunities to disclose such information can make communication even more difficult.
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Affiliation(s)
- Benjamin Derbez
- LABERS, Université de Bretagne Occidentale, 22 boulevard Camille Desmoulins, 29238 Brest, France.
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44
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Glassey R, O'Connor M, Ives A, Saunders C, Hardcastle SJ. Influences on decision-making for young women undergoing bilateral prophylactic mastectomy. PATIENT EDUCATION AND COUNSELING 2018; 101:318-323. [PMID: 28870441 DOI: 10.1016/j.pec.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/26/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to explore the influences on decision-making of younger women (<35) undergoing or considering bilateral prophylactic mastectomy (BPM). METHODS Qualitative interviews guided by interpretative phenomenological analysis (IPA) were conducted with forty-six women who had a strong family history of breast cancer (BC) who had either undergone (n=26) or were considering (n=20) BPM. Participants were recruited from Australia and New Zealand (NZ) via hospitals, a genetics clinic, a research cohort, a registry and online. RESULTS Four themes underpinning the influences on decision-making were identified: fear and anxiety, children, personal experiences with BC, health professional's influence. CONCLUSIONS The decision to undergo BPM for younger women (<35) was multifaceted, however, it appeared that fear and anxiety were the main influence. Younger women appear more anxious than previous research with older women. There appears to be few differences between those with confirmed BRCA1/2 mutations and those with no known mutation and this is clinically significant. PRACTICE IMPLICATIONS These findings have important practice implications, particularly improving communication of risk statistics, especially to those with no known mutation. Health professionals need to take into account the way younger women perceive information given to them when discussing risk.
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Affiliation(s)
- Rachael Glassey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.
| | - Moira O'Connor
- WA Centre for Cancer & Palliative Care, School of Psychology, Curtin University, Perth, Australia
| | - Angela Ives
- CaPCREU, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Christobel Saunders
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Australia
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45
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Dean M, Davidson LG. Previvors' Uncertainty Management Strategies for Hereditary Breast and Ovarian Cancer. HEALTH COMMUNICATION 2018; 33:122-130. [PMID: 27976925 DOI: 10.1080/10410236.2016.1250187] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Individuals with a genetic predisposition to develop hereditary breast and ovarian cancer (HBOC), but who have not been diagnosed with cancer, are referred to as previvors. Although genetic testing may reduce previvors' worries about whether or not they have a high genetic cancer risk, testing positive produces negative emotions and long-term uncertainty-thus requiring the management of uncertainty. Existing research indicates family, friends, and social support networks are limited in their assistance for previvors' uncertainty management. Therefore, this study examined how health care providers may assist previvors in uncertainty management by asking: What strategies do BRCA-positive previvors enact with their health care providers to help manage their uncertainty about HBOC? Purposive sampling was employed to recruit participants via online social media. The final sample consisted of 34 BRCA-positive women. Interviews revealed four uncertainty management strategies-seeking health care providers as informational sources, seeking health care providers as partners for decision making, seeking health care providers for supportive communication, and seeking referrals from health care providers for social support networks. Findings indicate that health care providers who are knowledgeable about BRCA, provide information, answer questions, check understanding, and provide additional resources assist previvors in managing their uncertainties by distinguishing options and fostering meaning.
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Affiliation(s)
- Marleah Dean
- a Department of Communication , University of South Florida
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46
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Peipins LA, Rodriguez JL, Hawkins NA, Soman A, White MC, Hodgson ME, DeRoo LA, Sandler DP. Communicating with Daughters About Familial Risk of Breast Cancer: Individual, Family, and Provider Influences on Women's Knowledge of Cancer Risk. J Womens Health (Larchmt) 2018; 27:630-639. [PMID: 29377785 DOI: 10.1089/jwh.2017.6528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Women facing complex and uncertain situations such as cancer in their families may seek information from a variety of sources to gain knowledge about cancer risk and reduce uncertainty. We describe and assess the relative importance of information sources about familial breast cancer at the individual, family, and healthcare provider levels influencing women's reporting they had enough information to speak with daughters about breast cancer. This outcome we refer to as being informed about breast cancer. MATERIALS AND METHODS Sister Study participants, a cohort of women with a family history of breast cancer, were surveyed on family cancer history, family communication, social support, and interactions with healthcare providers (n = 11,766). Adjusted percentages and 95% confidence intervals for being informed about breast cancer versus not being informed were computed for individual-, family-, and provider-level characteristics in three steps using multivariate logistic regression models. RESULTS We found 65% of women reported being informed about breast cancer while 35% did not. Having a trusted person with whom to discuss cancer concerns, having a lower versus higher perceived risk of breast cancer, having undergone genetic counseling, and being satisfied with physician discussions about breast cancer in their families were predictors of being informed about breast cancer. CONCLUSIONS Although acquiring objective risk information, such as through genetic counseling, may contribute to a basic level of understanding, communication with providers and within other trusted relationships appears to be an essential component in women's reporting they had all the information they need to talk with their daughters about breast cancer.
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Affiliation(s)
- Lucy A Peipins
- 1 Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Juan L Rodriguez
- 1 Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Nikki A Hawkins
- 2 National Center for Chronic Disease Prevention and Disease Promotion, Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Ashwini Soman
- 3 Northrop Grumman Corporation , Information Systems, Atlanta, Georgia
| | - Mary C White
- 1 Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | - Lisa A DeRoo
- 5 Department of Global Public Health and Primary Care, University of Bergen , Bergen, Norway
| | - Dale P Sandler
- 6 Epidemiology Branch, National Institute of Environmental Health Sciences , Durham, North Carolina
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Padamsee TJ, Muraveva A, Yee LD, Wills CE, Paskett ED. Experiencing the cancer of a loved one influences decision-making for breast cancer prevention. J Health Psychol 2017; 25:1064-1075. [PMID: 29243522 DOI: 10.1177/1359105317746480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Prior research demonstrates that family history influences breast cancer prevention decisions among healthy women at elevated risk of the disease. Drawing on in-depth interviews with 50 African American and White women, this study reveals an important psychological mechanism of this relationship: exposure to cancer among loved ones. Four distinct categories of cancer exposure (Abstract, Generalized, Practical, and Traumatic), distinguished by the characteristics of women's experiences with cancer among family members and close friends, are associated with differences in knowledge and decisions about breast cancer prevention options. Racial differences and distinct experiences among those with BRCA mutations are also discussed.
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Affiliation(s)
| | | | - Lisa D Yee
- City of Hope National Medical Center, USA
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Rauscher EA. Investigating Uncertainty in Genetic Counseling Encounters: Managing Information About Genetic Cancer Risk. JOURNAL OF HEALTH COMMUNICATION 2017; 22:896-904. [PMID: 29125386 DOI: 10.1080/10810730.2017.1373875] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Theory of Motivated Information Management (TMIM) was used to investigate how individuals at increased risk of developing hereditary cancer seek information from genetic counselors. Results show the TMIM model fit the data well in predicting participants' intentions to seek information from genetic counselors. Participants felt an uncertainty discrepancy that elicited feelings of anxiety, which in turn negatively predicted both outcome expectancies and efficacy assessments. Efficacy assessments, but not anxiety, significantly predicted participants' intentions to seek information from a genetic counselor in the future. Findings showed no significant relationship between outcome expectancies and efficacy assessments. One implication for genetic counselors is the need to more closely monitor emotional response to genetic disease risk-whether that emotional response be positive or negative-as that response may influence information-seeking intentions. Further, genetic counselors might also pay more attention to building efficacy for themselves (making patients feel the counselor is more credible) and their patients (increasing patient ability to communicate effectively about genetic disease risk). Analysis also extends TMIM theory by showing that in a relationship where information exchange is the primary function the model still showed good fit. However, outcome expectancies functioned differently than in previous tests of the model.
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Affiliation(s)
- Emily A Rauscher
- a Department of Communication , Texas A&M University , College Station , Texas , USA
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49
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Glassey R, Hardcastle SJ, O'Connor M, Ives A, Saunders C. Perceived influence of psychological consultation on psychological well-being, body image, and intimacy following bilateral prophylactic mastectomy: A qualitative analysis. Psychooncology 2017; 27:633-639. [PMID: 28945295 DOI: 10.1002/pon.4558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study explored whether psychological consultation offered to women prior to bilateral prophylactic mastectomy (BPM) appeared to provide psychosocial benefit to younger women (<35 years) at high risk of developing breast cancer due to a mutation or family history. METHODS Qualitative interviews guided by interpretative phenomenological analysis were conducted retrospectively with 26 women who had undergone BPM. Participants were recruited from New Zealand and Australia, via a genetics clinic, registry, research cohort, and online. RESULTS Three themes were identified: psychological well-being and adjustment, satisfaction with intimacy, and body image. Participants that had seen a psychologist reported being more prepared for BPM and appeared to adjust positively post-surgery. They appeared to have improved psychological well-being, reported satisfaction with intimacy, and a more positive body image, compared with those who had no support. CONCLUSIONS Women who undergo psychological consultation prior to BPM appear to adjust positively after surgery. Implications for practice include standard psychological consultation for younger women (>35 years) considering BPM.
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Affiliation(s)
- Rachael Glassey
- Medical School, The University of Western Australia, Perth, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Australia
| | - Moira O'Connor
- Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Australia
| | - Angela Ives
- Medical School, The University of Western Australia, Perth, Australia
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- kConFab, Research Department, Peter MacCallum Cancer Center, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia
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50
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Dean M, Scherr CL, Clements M, Koruo R, Martinez J, Ross A. "When information is not enough": A model for understanding BRCA-positive previvors' information needs regarding hereditary breast and ovarian cancer risk. PATIENT EDUCATION AND COUNSELING 2017; 100:1738-1743. [PMID: 28385363 DOI: 10.1016/j.pec.2017.03.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate BRCA-positive, unaffected patients' - referred to as previvors - information needs after testing positive for a deleterious BRCA genetic mutation. METHODS 25 qualitative interviews were conducted with previvors. Data were analyzed using the constant comparison method of grounded theory. RESULTS Analysis revealed a theoretical model of previvors' information needs related to the stage of their health journey. Specifically, a four-stage model was developed based on the data: (1) pre-testing information needs, (2) post-testing information needs, (3) pre-management information needs, and (4) post-management information needs. Two recurring dimensions of desired knowledge also emerged within the stages-personal/social knowledge and medical knowledge. CONCLUSIONS While previvors may be genetically predisposed to develop cancer, they have not been diagnosed with cancer, and therefore have different information needs than cancer patients and cancer survivors. PRACTICE IMPLICATIONS This model can serve as a framework for assisting healthcare providers in meeting the specific information needs of cancer previvors.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL, USA.
| | - Courtney L Scherr
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
| | - Meredith Clements
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Rachel Koruo
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Jennifer Martinez
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Amy Ross
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
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