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Phillips A, Vears DF, Van Hoyweghen I, Borry P. Clinician perspectives on policy approaches to genetic risk disclosure in families. Fam Cancer 2024; 23:177-186. [PMID: 38548926 PMCID: PMC11233314 DOI: 10.1007/s10689-024-00375-2] [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: 10/24/2023] [Accepted: 03/12/2024] [Indexed: 06/06/2024]
Abstract
Genomic sequencing has emerged as a powerful tool with significant implications for patients and their relatives, however, empirical evidence suggests that effective dissemination of risk information within families remains a challenge. Policy responses to address this issue vary across countries, with Belgium notably lacking specific regulations governing nondisclosure of genetic risk. In this study, we conducted semi-structured interviews with clinicians from Belgian clinical genetics centers to gain insight into their perspectives on policy approaches to the disclosure of genetic risk within families. Using real-world examples of legislation and court rulings from France, Australia, and the UK, we explored clinician viewpoints on the roles and responsibilities of both patients and clinicians in the family communication process. Clinicians expressed confusion regarding what was legally permissible regarding contacting at-risk relatives. While there was a consensus among participants that patients have a responsibility to inform their at-risk relatives, participants were hesitant to support the legal enforcement of this duty. Clinicians mostly recognized some responsibility to at-risk relatives, but the extent of this responsibility was a subject of division. Our findings highlight the need for a comprehensive policy that clarifies the roles and responsibilities of clinicians and patients to inform at-risk relatives. Furthermore, the study underscores the practical challenges clinicians face in supporting patients through the complex process of family communication, suggesting a need for additional resources and the exploration of alternative approaches to communication.
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Affiliation(s)
- Amicia Phillips
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium.
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Melbourne Law School, University of Melbourne, Parkville, Australia
| | - Ine Van Hoyweghen
- Life Sciences and Society Lab, Center for Sociological Research, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, Belgium
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2
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Hofmann B, Wiesing U. Kairos in diagnostics. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:99-108. [PMID: 38324112 PMCID: PMC10959829 DOI: 10.1007/s11017-023-09657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
Kairos has been a key concept in medicine for millennia and is frequently understood as "the right time" in relation to treatment. In this study we scrutinize kairos in the context of diagnostics. This has become highly topical as technological developments have caused diagnostics to be performed ever earlier in the disease development. Detecting risk factors, precursors, and predictors of disease (in biomarkers, pre-disease, and pre-pre-disease) has resulted in too early diagnoses, i.e., overdiagnoses. Nonetheless, despite vast advances in science and technology, diagnoses also come too late. Accordingly, timing diagnostics right is crucial. In this article we start with giving a brief overview of the etymology and general use of the concepts of kairos and diagnosis. Then we delimit kairos in diagnostics by analysing "too early" and "too late" diagnosis and by scrutinizing various phases of diagnostics. This leads us to define kairos of diagnostics as the time when there is potential for sufficient information for making a diagnosis that is most helpful for the person. It allows us to conclude that kairos is as important in diagnostics as in therapeutics.
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Affiliation(s)
- Bjørn Hofmann
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, PO Box 1130, Oslo, N-0318, Norway.
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | - Urban Wiesing
- Institute for Ethics and History of Medicine, University of Tübingen, Tübingen, Germany
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Wheater K. No time like the present: Mindfulness, temporality and the therapeutics of
kairos. ANTHROPOLOGY TODAY 2022. [DOI: 10.1111/1467-8322.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petersson J, Backman C. Patient-accessible online health records: Reconfigurations of clinical rhythms and doctors' front- and backstage spaces. Soc Sci Med 2021; 292:114635. [PMID: 34891029 DOI: 10.1016/j.socscimed.2021.114635] [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: 07/06/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
With patients' increasing online access to medical information traditionally contained within healthcare institutions, researchers have argued that the spaces of medicine are increasingly becoming blurred, allowing patients to sidestep their doctors and challenge their prior information dominance. In this context, Sweden has recently been spotlighted as it allows its inhabitants to continually access medical record content online. Based on an interview study on Swedish doctors' clinical experiences of the patient-accessible online health record, this paper expands on the theme of emergent medical information spaces accessible to laypersons online by arguing that this not only may challenge the traditional spaces of medicine but can impose on its temporal orders too. We detail doctors' attitudes toward the patient-accessible online health record, patients as continually updated record readers, and how this may transform clinical work rhythms and affect doctors' perceptions of the boundary between front- and backstage spaces. We moreover show how doctors can avoid "inappropriate intrusion" into the record by delaying patient access, but also that doctors can experience patients opposing to adapt to doctors' preferred pace and instead attempting to control the clinical rhythm. By intertwining clinical rhythms with doctors' front- and backstage, this paper contributes with an extended analysis of the emergent spaces of online medical information, adding a temporal layer. The paper furthermore enlarges the existing sociological body on historical developments of medical records and adds a piece to the so-far piecemeal social science literature on how online records may affect the medical profession.
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Affiliation(s)
- Jesper Petersson
- University of Gothenburg, Department of Sociology and Work Science, PO Box 720, SE40530, Gothenburg, Sweden.
| | - Christel Backman
- University of Gothenburg, Department of Sociology and Work Science, PO Box 720, SE40530, Gothenburg, Sweden.
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Dean M, Tezak AL, Johnson S, Pierce JK, Weidner A, Clouse K, Pal T, Cragun D. Sharing genetic test results with family members of BRCA, PALB2, CHEK2, and ATM carriers. PATIENT EDUCATION AND COUNSELING 2021; 104:720-725. [PMID: 33455826 PMCID: PMC8005459 DOI: 10.1016/j.pec.2020.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 12/05/2020] [Accepted: 12/22/2020] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study explored motivators and challenges/barriers to sharing personal genetic test results (GTR) with family members (FM). METHODS Semi-structured, in-depth interviews were conducted with 62 women who had a pathogenic or likely pathogenic (P/LP) variant in aBRCA, PALB2, CHEK2, or ATM gene. Selective qualitative data analysis focused on eliciting motivators and challenges/barriers identified by participants when sharing their GTR with FM. RESULTS Motivators to sharing personal GTR with FM included: health protection and prevention; moral obligation; decisional empowerment; familial ties; written resources; and contextualization for a familial cause for cancer. Challenges/barriers to family sharing included: concern for FM reactions; complexities of information; lack of closeness; perceived relevance; and emotional impact. CONCLUSIONS All motivators and challenges/barriers were identified across BRCA and non-BRCA carriers, demonstrating commonalities in family sharing of GTR among high- to moderate-penetrance hereditary BC (breast cancer) genes. Despite challenges/barriers, participants disclosed their GTR with most close FM, yet restrictions in communication and/or strain on the timing, manner of disclosing, and strategies used varied across certain FM. PRACTICE IMPLICATIONS These findings offer healthcare providers and researchers preliminary practical implications for broadly improving family sharing interventions across P/LP variants in BC risk genes by demonstrating important elements to include in family sharing letters.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL, USA.
| | - Ann L Tezak
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sabrina Johnson
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Joy K Pierce
- Cleveland Clinic, Indian River Hospital, Vero Beach, FL, USA
| | - Anne Weidner
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kate Clouse
- Department of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
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Communicating genetic information to family members: analysis of consent forms for diagnostic genomic sequencing. Eur J Hum Genet 2020; 28:1160-1167. [PMID: 32341470 PMCID: PMC7608457 DOI: 10.1038/s41431-020-0627-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/28/2020] [Accepted: 03/31/2020] [Indexed: 11/08/2022] Open
Abstract
Communicating results from genomic sequencing to family members can play an essential role allowing access to surveillance, prevention, treatment or prophylactic measures. Yet, many patients struggle with communication of these results and it is unclear to what extent this is discussed during the consent process. We conducted an online systematic search and used content analysis to explore how consent forms for genomic sequencing address communication of genetic information to family members. Our search yielded 68 consent forms from 11 countries. Although 57 forms alluded to the familial nature of results, forms varied in their discussion of the potential familial implications of results. Only 11 addressed communication of genetic information with family members, with differences in who would be responsible for this process. Several forms offered patients options regarding communication, even in countries where national guidelines and legislation allow for the disclosure of results in the absence of patient consent. These findings are concerning because they show how forms may potentially mislead patients and health care professionals about whether communication is permissible in cases where the patient does not consent. We suggest that providers and health care professionals reconsider how consent forms address communicating genetic information to family members.
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Derbez B, de Pauw A, Stoppa-Lyonnet D, Galactéros F, de Montgolfier S. Familial disclosure by genetic healthcare professionals: a useful but sparingly used legal provision in France. JOURNAL OF MEDICAL ETHICS 2019; 45:811-816. [PMID: 31462451 DOI: 10.1136/medethics-2018-105212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 06/17/2019] [Accepted: 08/03/2019] [Indexed: 05/25/2023]
Abstract
Familial disclosure of genetic information is an important, long-standing ethical issue that still gives rise to much debate. In France, recent legislation has created an innovative and unprecedented procedure that allows healthcare professionals (HCPs), under certain conditions, to disclose relevant information to relatives of a person carrying a deleterious genetic mutation. This article will analyse how HCPs in two medical genetics clinics have reacted to these new legal provisions and show how their reticence to inform the patients' relatives on their behalf leads them to use this option sparingly.
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Affiliation(s)
- Benjamin Derbez
- Faculte de Medecine et des sciences de la sante, Universite de Bretagne Occidentale Faculte de Medecine et des Sciences de la Sante de Brest, Brest, France
- LABERS - Laboratoire d'études et de recherches sociologiques, Brest, France
| | | | - Dominique Stoppa-Lyonnet
- Génétique oncologique, Institut Curie, Paris, France
- Faculte de Medecine, Universite Paris Descartes, Paris, France
| | - Frédéric Galactéros
- UMGGR, Hopital Henri Mondor, Creteil, France
- Faculte de Medecine, Universite Paris-Est Creteil Val de Marne, Creteil, France
| | - Sandrine de Montgolfier
- Faculte de Medecine, Universite Paris-Est Creteil Val de Marne, Creteil, France
- Institut de recherche interdiscipplinaire sur les enjeux sociaux, Paris, France
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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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Ersig AL, Werner-Lin A, Hoskins L, Young J, Loud JT, Peters J, Greene MH. Legacies and Relationships: Diverse Social Networks and BRCA1/2 Risk Management Decisions and Actions. JOURNAL OF FAMILY NURSING 2019; 25:28-53. [PMID: 30537877 PMCID: PMC6581043 DOI: 10.1177/1074840718815844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In families with hereditary breast/ovarian cancer, complex disease histories challenge established patterns of family communication and influence decision-making for clinical surveillance, genetic testing, and risk management. An interdisciplinary team examined longitudinal interview data from women with identified BRCA1/2 mutations to assess interactions within family and social networks about risk information communication and management. We used interpretive description to identify motivation, content, and derived benefit of these interactions. Participants discussed risk information and management strategies with biological and nonbiological network members for multiple purposes: discharging responsibility for risk information dissemination, protecting important relationships, and navigating decision trajectories. Evolving interactions with loved ones balanced long-standing family communication patterns with differing personal preferences for privacy or open sharing, whereas interactions with nonbiological network members expanded participants' range of choices for sources of risk management information. Ongoing assessment of social networks may help support engagement with risk management by aligning with patient social needs.
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Affiliation(s)
| | | | | | | | | | - June Peters
- National Institutes of Health, Bethesda, MD, USA
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[Prevention of genetic diseases : the return of the family practitioner ?]. Rev Epidemiol Sante Publique 2018; 69:30-38. [PMID: 30219572 DOI: 10.1016/j.respe.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 06/14/2018] [Accepted: 07/16/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Information to kin is one of the major ethical problems of the new genetics. In France, the revised bioethics law in 2011 created the possibility for patients to authorize professionals, under certain conditions, to directly contact their relatives at risk. Beyond this, other actors, such as GPs, could however play a role in this process. METHODS Our article is based on an ethnographic-type sociological study by observations and semi-structured interviews with patients (n=59) and genetic professionals (n=16) that took place from 2014 to 2016 in three genetic hospital wards in France and Canada. It focuses particularly on genetic predispositions to breast and ovarian cancers as well as genetic hemochromatosis. RESULTS Because of its position as a primary care specialist, the general practitioner can play a decisive role in the process of informing relatives about genetic disorders. Upstream of the genetic test, the generalist, thanks to his knowledge of the family context of his patients, can play a referral role towards a specialized consultation. Downstream, it can also ensure a more effective follow-up of the information procedures undertaken by its patients thanks to the medical follow-up that it carries out. CONCLUSION The data collected during our study highlight the unprecedented place that could be that of the general practitioner in the field of prevention in genetics. At the articulation between primary care and highly specialized care, it is the figure of the "family" doctor who seems to be called here to be renewed by genetics.
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