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Henderson TO, Allen MA, Mim R, Egleston B, Fleisher L, Elkin E, Oeffinger K, Krull K, Ofidis D, Mcleod B, Griffin H, Wood E, Cacioppo C, Weinberg M, Brown S, Howe S, McDonald A, Vukadinovich C, Alston S, Rinehart D, Armstrong GT, Bradbury AR. The ENGAGE study: a 3-arm randomized hybrid type 1 effectiveness and implementation study of an in-home, collaborative PCP model of remote telegenetic services to increase uptake of cancer genetic services in childhood cancer survivors. BMC Health Serv Res 2024; 24:253. [PMID: 38414045 PMCID: PMC10900774 DOI: 10.1186/s12913-024-10586-z] [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] [Accepted: 01/09/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Germline cancer genetic testing has become a standard evidence-based practice, with established risk reduction and screening guidelines for genetic carriers. Access to genetic services is limited in many places, which leaves many genetic carriers unidentified and at risk for late diagnosis of cancers and poor outcomes. This poses a problem for childhood cancer survivors, as this is a population with an increased risk for subsequent malignant neoplasms (SMN) due to cancer therapy or inherited cancer predisposition. The ENGaging and Activating cancer survivors in Genetic services (ENGAGE) study evaluates the effectiveness of an in-home, collaborative PCP model of remote telegenetic services to increase uptake of cancer genetic testing in childhood cancer survivors compared to usual care options for genetic testing. METHODS The ENGAGE study is a 3-arm randomized hybrid type 1 effectiveness and implementation study within the Childhood Cancer Survivor Study population which tests a clinical intervention while gathering information on its delivery during the effectiveness trial and its potential for future implementation among 360 participants. Participants are randomized into three arms. Those randomized to Arm A receive genetic services via videoconferencing, those in Arm B receive these services by phone, and those randomized to Arm C will receive usual care services. DISCUSSION With many barriers to accessing genetic services, innovative delivery models are needed to address this gap and increase uptake of genetic services. The ENGAGE study evaluates the effectiveness of an adapted model of remote delivery of genetic services to increase the uptake of recommended genetic testing in childhood cancer survivors. This study assesses the uptake in remote genetic services and identify barriers to uptake to inform future recommendations and a theoretically-informed process evaluation which can inform modifications to enhance dissemination beyond this study population and to realize the benefits of precision medicine. TRIAL REGISTRATION This protocol was registered at clinicaltrials.gov (NCT04455698) on July 2, 2020.
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Affiliation(s)
- Tara O Henderson
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA.
| | - Mary Ashley Allen
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA
| | - Rajia Mim
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Demetrios Ofidis
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Briana Mcleod
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Griffin
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Wood
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Cacioppo
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Weinberg
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Brown
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Howe
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Aaron McDonald
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chris Vukadinovich
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shani Alston
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Dayton Rinehart
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela R Bradbury
- Abramson Cancer Center and Division of Hematology-Oncology, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, The University of Pennsylvania, Philadelphia, PA, USA
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Culver JO, Bertsch NL, Kurz RN, Cheng LL, Pritzlaff M, Rao SK, Stasi SM, Stave CD, Sharaf RN. Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling. Genet Med 2024; 26:100980. [PMID: 37688462 DOI: 10.1016/j.gim.2023.100980] [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: 01/27/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Genetic counseling (GC) is standard of care in genetic cancer risk assessment (GCRA). A rigorous assessment of the data reported from published studies is crucial to ensure the evidence-based implementation of GC. METHODS We conducted a systematic review and meta-analysis of 17 patient-reported and health-services-related outcomes associated with pre- and post-test GC in GCRA in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS Twenty-five of 5393 screened articles met inclusion criteria. No articles reporting post-test GC outcomes met inclusion criteria. For patient-reported outcomes, pre-test GC significantly decreased worry, increased knowledge, and decreased perceived risk but did not significantly affect patient anxiety, depression, decisional conflict, satisfaction, or intent to pursue genetic testing. For health-services outcomes, pre-test GC increased correct genetic test ordering, reduced inappropriate services, increased spousal support for genetic testing, and expedited care delivery but did not consistently improve cancer prevention behaviors nor lead to accurate risk assessment. The GRADE certainty in the evidence was very low or low. No included studies elucidated GC effect on mortality, cascade testing, cost-effectiveness, care coordination, shared decision making, or patient time burden. CONCLUSION The true impact of GC on relevant outcomes is not known low quality or absent evidence. Although a meta-analysis found that pre-test GC had beneficial effects on knowledge, worry, and risk perception, the certainty of this evidence was low according to GRADE methodology. Further studies are needed to support the evidence-based application of GC in GCRA.
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Affiliation(s)
- Julie O Culver
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
| | | | - Raluca N Kurz
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Linda L Cheng
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | | | | | | | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine and Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Fear of cancer recurrence in patients undergoing germline genome sequencing. Support Care Cancer 2021; 29:7289-7297. [PMID: 34036439 DOI: 10.1007/s00520-021-06311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Fear of cancer recurrence/occurrence (FCR/O) is prevalent and associated with poorer psychological outcomes but can also motivate individuals to pursue genomic information about cancer risk. Guided by Protection Motivation Theory, this study investigated FCR/O prevalence and associated factors among probands previously diagnosed with a cancer of likely heritable origin, and their relatives, who had agreed to have germline genome sequencing. METHODS Three hundred and forty-eight probands and 167 relatives completed the Concerns about Recurrence Questionnaire (adapted for occurrence for some relatives) within 1 month of agreeing to undertake genome sequencing. Linear regressions investigated demographic, disease, attitude and behavioral associations with FCR/O. RESULTS Probands demonstrated greater FCR compared to relatives. In probands, greater FCR was associated with being female, non-English speaking at home, less time since diagnosis, greater intention to change behavior if gene variant found, lower perceived ability to cope with results, higher perceived susceptibility to having a recurrence, and more negative attitudes towards uncertainty. For relatives with cancer, greater FCR was associated with being male, greater intention to change behavior if a gene variant found, and higher perceived susceptibility to recurrence. In relatives without cancer, greater FCO was associated with not having had genetic testing prior to this study, lower perceived ability to cope with results, and higher perceived susceptibility to developing cancer. CONCLUSION Current findings on FCR/O prevalence and associated demographic and attitudinal variables in those who pursue genomic risk information might be used to target interventions that can prevent adverse psychological outcomes in vulnerable patients.
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Arrick BA, Bloch KJ, Colello LS, Woloshin S, Schwartz LM. Visual Representations of Risk Enhance Long-Term Retention of Risk Information: A Randomized Trial. Med Decis Making 2019; 39:100-107. [DOI: 10.1177/0272989x18819493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bradley A. Arrick
- Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH
| | - Katarzyna J. Bloch
- Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH
| | - Laura Stein Colello
- Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH
| | - Steven Woloshin
- Center for Medicine and the Media, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Lisa M. Schwartz
- Center for Medicine and the Media, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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Development and Evaluation of a Telephone Communication Protocol for the Delivery of Personalized Melanoma Genomic Risk to the General Population. J Genet Couns 2017; 27:370-380. [DOI: 10.1007/s10897-017-0183-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
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Silverman KR, Ohman-Strickland PA, Christian AH. Perceptions of Cancer Risk: Differences by Weight Status. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:357-363. [PMID: 26553326 PMCID: PMC4861687 DOI: 10.1007/s13187-015-0942-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite the strong link between obesity and cancer development, individuals are less likely to identify obesity as a risk factor for cancer than family history. Family history of cancer has been documented to influence perceived risk of developing cancer, yet it is unclear if excess weight impacts cancer risk perceptions. The purpose of this study was to examine absolute and relative risk perceptions for cancer by weight status. Cross-sectional data were obtained from the National Cancer Institute's 2011 Health Information National Trends Survey (n = 2585). Demographics, anthropometric data, family history of cancer, health behaviors, and absolute and relative cancer risk perceptions were evaluated. The effect of weight and family history on absolute and relative cancer risk perceptions was analyzed through weighted descriptive and logistic regression analyses. 22.8 and 28.6 % of subjects reported that they were very unlikely/unlikely to develop cancer in their lifetime (absolute risk) and when compared to others their age (relative risk), respectively. Findings indicated differences in risk perceptions between those with and without a family history of cancer (p < 0.0001). No significant differences were found between BMI categories for absolute cancer risk perceptions despite stratification by family history. Obese subjects were more likely to have an increased relative risk perception of cancer compared to healthy weight subjects (p = 0.0066); this association remained significant when stratified by family history (p = 0.0161). Educating individuals, especially those who are overweight/obese, about the impact of excess weight on cancer risk may improve risk accuracy and promote cancer risk reduction through weight management.
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Affiliation(s)
- Kerry R Silverman
- Department of Health Education & Behavioral Science, School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08903, USA
| | - Pamela A Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Allison H Christian
- Department of Health Education & Behavioral Science, School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08903, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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Screening Mammography: Patient Perceptions and Preferences Regarding Communication of Estimated Breast Cancer Risk. AJR Am J Roentgenol 2017; 208:1163-1170. [DOI: 10.2214/ajr.16.16779] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Genetic Counseling for Alcohol Addiction: Assessing Perceptions and Potential Utility in Individuals with Lived Experience and Their Family Members. J Genet Couns 2017; 26:963-970. [PMID: 28176155 DOI: 10.1007/s10897-017-0075-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/18/2017] [Indexed: 02/04/2023]
Abstract
Though addictions to substances including alcohol are highly heritable, there have been no studies regarding the possible applicability of genetic counseling to this set of conditions. Adults (≥18 years old) with a personal and/or family history of alcohol addiction were recruited to participate in an online survey-based study comprising 43 questions about beliefs/concern about recurrence risk and etiology of alcohol addiction and its impact on childbearing decisions, and perceptions of potential utility of genetic counseling for alcohol addiction. We applied primarily descriptive statistics, but also tested the hypotheses that perceiving genetic counseling to be useful would be associated with: 1) increasing importance attributed to genetics in the etiology of alcohol addiction, and 2) greater concern about recurrence of alcohol addiction (in self and/or children). Overall, the 113 participants recognized the multifactorial nature of alcohol addiction but reported a wide range of estimated recurrence risks for first-degree relatives. Overall, 62% perceived genetic counseling for alcohol addiction to be potentially beneficial. Participants were more likely to perceive a benefit from genetic counseling if they were concerned about recurrence for themselves (p = .021) or perceived genetics to be etiologically important in alcohol addiction (p = .024). Future studies are warranted to evaluate the outcomes of genetic counseling for addictions with respect to patient understanding, lifestyle modifications and psychological adaptation.
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Abstract
Using the results of a study to investigate women’s accounts of risks for breast cancer as a case study, this article examines the phenomenological, social and political implications of prevailing discourses on risk. The study is situated within the critical social science literature that argues that ‘risk’ has become one of the defining cultural characteristics of western society. As in other areas of life, the notion of risk has become central to discourses related to individual health; that is, ‘risk’ has become a common construct around which health in western society is described, organized and practised, both personally and professionally. This article argues that women’s health experiences, and the discourses on risk that shape those experiences, are produced within the same ideological context within which particular diagnostic/screening technologies are developed and deployed. Using governmentality as a framework, it is argued that current discourses on risk both make possible and are made possible by particular diagnostic/screening technologies. These discourses on risk also both reflect and reproduce notions of the ‘entrepreneurial subject’ and are, thus, consistent with a prevailing neo-liberal political rationality. The article concludes with a discussion of some of the questions for further research which are raised by this analysis.
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Foster C, Watson M, Moynihan C, Ardern-jones A, Eeles R. Genetic Testing for Breast and Ovarian Cancer Predisposition: Cancer Burden and Responsibility. J Health Psychol 2016; 7:469-84. [DOI: 10.1177/1359105302007004627] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to explore experiences of cancer in the family and motivation for predictive genetic testing among women at increased risk of developing breast and/or ovarian cancer due to their family history. Fifteen women were interviewed prior to receiving their genetic test results. A grounded theory approach was adopted to analyse the interview transcripts. The findings indicated that experiences of cancer in the family play an important role in formulating beliefs about one’s own risk and motivation for predictive genetic testing. A sense of responsibility for one’s own health and the need to take action either to prevent cancer or detect cancer at as early a stage as possible, as well as a feeling of responsibility towards children and other family members was apparent. The findings raise the question of whether there is any real choice available to these women and whether there is a negative impact on family dynamics.
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Affiliation(s)
- Claire Foster
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK,
| | - Maggie Watson
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
| | - Clare Moynihan
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
| | - Audrey Ardern-jones
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
| | - Rosalind Eeles
- Psychology Research Group & Section of Cancer Genetics, The Institute of Cancer Research & Royal Marsden NHS Trust, UK
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Gorini A, Masiero M, Pravettoni G. Patient decision aids for prevention and treatment of cancer diseases: are they really personalised tools? Eur J Cancer Care (Engl) 2016; 25:936-960. [DOI: 10.1111/ecc.12451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- A. Gorini
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
| | - M. Masiero
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
| | - G. Pravettoni
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
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McGregor BA, Dolan ED, Murphy KM, Sannes TS, Highland KB, Albano DL, Ward AA, Charbonneau AM, Redman MW, Ceballos RM. Cognitive Behavioral Stress Management for Healthy Women at Risk for Breast Cancer: a Novel Application of a Proven Intervention. Ann Behav Med 2015; 49:873-84. [PMID: 26290001 PMCID: PMC4739817 DOI: 10.1007/s12160-015-9726-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Women at risk for breast cancer report elevated psychological distress, which has been adversely associated with cancer-relevant behaviors and biology. PURPOSE The present study sought to examine the effects of a 10-week cognitive behavioral stress management (CBSM) group intervention on distress among women with a family history of breast cancer. METHODS Participants were randomly assigned to CBSM (N = 82) or a wait-list comparison group (N = 76). Baseline to postintervention effects of CBSM on depressive symptoms and perceived stress were examined using hierarchical regression. RESULTS CBSM participants reported significantly lower posttreatment depressive symptoms (β = -0.17, p < 0.05) and perceived stress (β = -0.23, p < 0.05) than wait-list comparison participants. Additionally, greater relaxation practice predicted lower distress. CONCLUSIONS Group-based CBSM intervention is feasible and can reduce psychological distress among women with a family history of breast cancer. The present findings represent an encouraging avenue for the future application of CBSM. ( Clinicaltrials.gov number NCT00121160).
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Affiliation(s)
- Bonnie A McGregor
- Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA.
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA.
| | - Emily D Dolan
- Shelter Research and Development, American Society for the Prevention of Cruelty to Animals, New York, NY, USA
| | - Karly M Murphy
- Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA
| | - Timothy S Sannes
- Anschutz Medical Campus, University of Colorado Denver, Denver, CO, USA
| | | | - Denise L Albano
- Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA
| | - Alison A Ward
- Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA
| | - Anna M Charbonneau
- Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA
| | - Mary W Redman
- Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA
| | - Rachel M Ceballos
- Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, USA
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
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Quinlivan JA, Battikhi Z, Petersen RW. What Factors Impact upon a Woman's Decision to Undertake Genetic Cancer Testing? Front Oncol 2014; 3:325. [PMID: 24432248 PMCID: PMC3880931 DOI: 10.3389/fonc.2013.00325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/19/2013] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The advent of human genome project has lead to genetic tests that identify high-risk states for certain cancers. Many are privately marketed on the Internet. Despite the availability of tests, limited data has evaluated factors that lead to test uptake. The aim of the present study was to explore the attitudes of a cohort of new mothers toward uptake of a genetic cancer test with a 50% predictive value of cancer. METHODS A cross-sectional survey was undertaken. The project targeted women who had recently given birth at an Australian tertiary referral hospital. Women were asked about a theoretical blood test that detected an increased risk for the development of cancer. Attitudes and knowledge questionnaires were completed. RESULTS Of 232 consecutive women approached, 32 declined, giving a response rate of 86.2%. Only 63 (31.5%) women stated they would have the test. Absence of religious belief, higher level of education, better knowledge of terms used in genetics, an absence of concern over emotional, employment, and insurance discrimination, and previous acceptance of Down syndrome screening in pregnancy were each associated with significantly higher rate of test uptake in univariate analysis (all p < 0.03). In multivariate analysis, a lack of concern over discrimination and a history of having accepted Down syndrome screening in the previous pregnancy remained significantly associated with test uptake (all p < 0.0001). CONCLUSION Concern over discrimination and having made a prior decision to have genetic testing were the principal factors associated with decision-making.
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Affiliation(s)
- Julie A. Quinlivan
- North Metropolitan Health Service, Western Australian Department of Health, Perth, WA, Australia
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Zain Battikhi
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Rodney W. Petersen
- Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia
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Wiering BM, Albada A, Bensing JM, Ausems MGEM, van Dulmen AM. The influence of dispositional optimism on post-visit anxiety and risk perception accuracy among breast cancer genetic counselees. Psychooncology 2013; 22:2419-27. [PMID: 23630180 DOI: 10.1002/pon.3292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/10/2013] [Accepted: 03/24/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Much is unknown about the influence of dispositional optimism and affective communication on genetic counselling outcomes. This study investigated the influence of counselees' optimism on the counselees' risk perception accuracy and anxiety, while taking into account the affective communication during the first consultation for breast cancer genetic counselling. METHODS Counselees completed questionnaires measuring optimism, anxiety and the perceived risk that hereditary breast cancer runs in the family before, and anxiety and perceived risk after the first consultation. Consultations were videotaped. The duration of eye contact was measured, and verbal communication was rated using the Roter Interaction Analysis System. RESULTS Less-optimistic counselees were more anxious post-visit (β = -.29; p = .00). Counsellors uttered fewer reassuring statements if counselees were more anxious (β = -.84; p = .00) but uttered more reassurance if counselees were less optimistic (β = -.76; p = .01). Counsellors expressed less empathy if counselees perceived their risk as high (β = -1.51; p = .04). An increase in the expression of reassurance was related to less post-visit anxiety (β = -.35; p = .03). More empathy was related to a greater overestimation of risk (β = .92; p = .01). CONCLUSIONS Identification of a lack of optimism as a risk factor for high anxiety levels enables the adaptation of affective communication to improve genetic counselling outcomes. Because reassurance was related to less anxiety, beneficial adaptation is attainable by increasing counsellors' reassurance, if possible. Because of a lack of optimally adapted communication in this study, further research is needed to clarify how to increase counsellors' ability to adapt to counselees.
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Affiliation(s)
- B M Wiering
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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Pujol JL, Plassot C, Mérel JP, Arnaud E, Launay M, Daurès JP, Boulze I. Post-Traumatic Stress Disorder and Health-Related Quality of Life in Patients and Their Significant Others Facing Lung Cancer Diagnosis: Intrusive Thoughts as Key Factors. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/psych.2013.46a1001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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O'Mahony N, McCarthy E, McDermott R, O'Keeffe S. Who's the doctor? Patients' perceptions of the role of the breast radiologist: a lesson for all radiologists. Br J Radiol 2012; 85:e1184-9. [PMID: 22932065 DOI: 10.1259/bjr/74006772] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore patients' perceptions of the role of the radiologist in their care. METHODS The questionnaire used was designed in conjunction with a psychologist who had an interest in oncology, and piloted. The final questionnaires were distributed to patients attending the breast clinic at St James's Hospital, Dublin, Ireland, from 1 March to 1 July 2011. Patients requiring imaging (mammography and/or ultrasound) were asked to complete the same questionnaire again after imaging procedures were performed. Paired t-tests were used to assess for changes in parameters, including ranking of members of the breast care team in order of perceived importance and levels of anxiety pre and post consultation with the radiologist. RESULTS 306 patients were recruited. 76% of patients thought that radiologists were radiographers and only 14% knew that radiologists were medical doctors. Nearly 40% of patients did not consider that radiologists had a role to play in their care. There was no statistically significant difference in the ranking of team members pre and post consultation. There was a significant improvement in patient anxiety levels after consultation with the breast radiologist, which is likely to be due to the patient learning the outcome of tests performed. CONCLUSION There is a lack of awareness amongst patients and amongst our colleagues in paramedical disciplines regarding the roles and responsibilities of the modern radiologist. ADVANCES IN KNOWLEDGE Radiology must act to increase public awareness so that future changes in the health service will reflect the scope and importance of the speciality.
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Affiliation(s)
- N O'Mahony
- Department of Radiology, St. James's Hospital, Dublin, Ireland.
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Kasparian NA, Sansom-Daly U, McDonald RP, Meiser B, Butow PN, Mann GJ. The nature and structure of psychological distress in people at high risk for melanoma: a factor analytic study. Psychooncology 2012; 21:845-56. [PMID: 21612004 DOI: 10.1002/pon.1976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 03/14/2011] [Accepted: 03/16/2011] [Indexed: 12/16/2023]
Abstract
OBJECTIVE This study examined the psychometric properties of two commonly used measures of psychological distress, the Hospital Anxiety and Depression Scale (HADS) and the Impact of Events Scale (IES) in a sample of individuals at high risk of developing melanoma due to strong family history. METHODS One hundred thirty-two individuals with a known family-specific CDKN2A mutation (74% response rate) completed a mailed, self-administered questionnaire including the HADS and the IES. Initial correlational analyses were followed by both exploratory and confirmatory factor analyses, according to a predetermined procedure for order of analyses. RESULTS Exploratory factor analyses found that neither a two-, three- or four-factor solution satisfactorily accounted for all IES items in the present sample. By contrast, a unidimensional account of the data emerged to best account for all IES items, leaving no items unaccounted for. In contrast, the traditional two-factor (anxiety and depression) structure of the HADS appeared to fit the data well. CONCLUSIONS The traditional, two-factor (intrusion and avoidance) structure of the IES was not borne out within this familial melanoma cohort. Assessment of a single dimension of emotional distress in response to melanoma risk may facilitate more meaningful explorations of psychological adjustment in this context. These findings also raise questions about whether a post-traumatic stress framework is indeed the most appropriate framework to capture the unique nature of melanoma- or cancer-related distress.
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Affiliation(s)
- Nadine A Kasparian
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
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Phelps C, Bennett P, Hood K, Brain K, Murray A. A self-help coping intervention can reduce anxiety and avoidant health behaviours whilst waiting for cancer genetic risk information: results of a phase III randomised trial. Psychooncology 2012; 22:837-44. [PMID: 22473731 DOI: 10.1002/pon.3072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 02/15/2012] [Accepted: 02/24/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Ceri Phelps
- School of Psychology and Counselling; Swansea Metropolitan University; Wales UK
| | - Paul Bennett
- Psychology Department; Swansea University; Wales UK
| | - Kerenza Hood
- South East Wales Trials Unit, School of Medicine; Cardiff University; Wales UK
| | - Kate Brain
- Institute of Medical Genetics, School of Medicine; Cardiff University; Wales UK
| | - Alexandra Murray
- Institute of Medical Genetics; Cardiff and Vale University Health Board; UK
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Vos J, Oosterwijk JC, Gómez-García E, Menko FH, Jansen AM, Stoel RD, van Asperen CJ, Tibben A, Stiggelbout AM. Perceiving cancer-risks and heredity-likelihood in genetic-counseling: how counselees recall and interpret BRCA 1/2-test results. Clin Genet 2010; 79:207-18. [DOI: 10.1111/j.1399-0004.2010.01581.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Ochoa EM, Gómez-Acebo I, Rodríguez-Cundín P, Navarro-Córdoba M, Llorca J, Dierssen-Sotos T. Relationship between family history of breast cancer and health-related behavior. Behav Med 2010; 36:123-9. [PMID: 21186435 DOI: 10.1080/08964289.2010.516783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article explores the relationship between family history of breast cancer (FHBC) and health-related behavior and medical management, using a cross-sectional analysis of 685 women, based on self-report. The influence of FHBC on lifestyle (alcohol use, physical activity, weight and diet) and medical management decisions (screening for chronic diseases) was assessed using odds ratios (OR) and 95% confidence interval (CI). Adjustment for confounders was performed using unconditional logistic regression. Sixty five women (9.5%) reported relatives with breast cancer. Women with FHBC are more likely to have had a mammography and colonoscopy or sigmoidoscopy. These women have about twice the probability of performing more intense physical exercise, contrasting with high-risk women whose consumption of fibre is lower and sweets is higher. No significant association was found between alcohol consumption or Body Mass Index and family history. Spontaneous behavioral change to a more preventive lifestyle in relatives of cancer patients is very low.
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Hicken B, Tucker D. Impact of genetic risk feedback: Perceived risk and motivation for health protective behaviours. PSYCHOL HEALTH MED 2010. [DOI: 10.1080/13548500120101531] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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22
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Metcalfe KA, Poll A, Llacuachaqui M, Nanda S, Tulman A, Mian N, Sun P, Narod SA. Patient satisfaction and cancer-related distress among unselected Jewish women undergoing genetic testing for BRCA1 and BRCA2. Clin Genet 2010; 78:411-7. [DOI: 10.1111/j.1399-0004.2010.01499.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Bennett P, Parsons E, Brain K, Hood K. Long-term cohort study of women at intermediate risk of familial breast cancer: experiences of living at risk. Psychooncology 2010; 19:390-8. [PMID: 19514016 DOI: 10.1002/pon.1588] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS To identify how women adjusted to living at intermediate risk of breast cancer six years following risk assessment, and what factors contributed to health service usage. METHOD Two studies are reported. Both report data from a cohort of women found at intermediate risk of breast cancer six years previously. In the first, 30 women with a range of Cancer Worry Scale (Lerman et al. Health Psychol 1991;10:259-267) scores were interviewed about how they lived with their risk of cancer and their use of health resources. The generalisability of these findings was tested in a sample of 387 women from the same cohort using psychometrically appropriate measures. FINDINGS In study 1, women scoring above the median baseline BCWS scale score were most likely to perceive their family history as a burden, exaggerate their susceptibility to breast cancer, not be reassured by genetic counselling, be focussed on the need for mammographic screening, and have a low reliance on breast self-examination. Key findings of the second study were that over a quarter of the cohort were experiencing at least moderate levels of intrusive worries. Worries were associated with perceptions of high personal vulnerability to and severity of cancer and breast cancer being highly salient. Women aged over 50 years with high levels of worry-related distress were most likely to request a mammogram. CONCLUSION The high levels of distress in this cohort reinforce the need to provide appropriate interventions for vulnerable women following risk assessment.
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Affiliation(s)
- P Bennett
- Health and Social Care Research Centre, University of Cardiff, Cardiff, UK.
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Objective and subjective breast cancer risk: relationships with natural killer cell activity and psychological distress in healthy women. Cancer Nurs 2010; 33:411-20. [PMID: 20562616 DOI: 10.1097/ncc.0b013e3181dc37a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast cancer (BC) risk, based on either known risk factors (objective) or self-assessment (subjective), may influence natural killer cell activity (NKCA) directly or through psychological distress. OBJECTIVE The main objective of this study was to examine the relationships of objective and subjective BC risks with NKCA and a mediating role of psychological distress in a community sample of healthy women. METHODS In a cross-sectional descriptive study, a convenience sample of 117 healthy women (mean age, 36.5 years) completed questionnaires for BC risk and psychological distress and provided blood for NKCA measurement. RESULTS Objective and subjective BC risks were positively correlated (P < .001). Regression analyses revealed that objective BC risk had a significant negative relationship with NKCA at the 12.5:1 effector-to-target cell ratio (P = .011), whereas subjective risk was not associated with NKCA at any effector-to-target cell ratio tested. Only subjective risk had a positive association with both BC-specific (P = .002) and general (P < .001) psychological distress. Psychological distress failed to mediate the relationship between subjective risk and NKCA. CONCLUSIONS Objective BC risk had a limited but significant relationship with NKCA. Subjective risk was highly associated with psychological distress but was not associated with NKCA. IMPLICATIONS FOR PRACTICE Despite the limited relationships between BC risk and NKCA, the impact of BC risk on other tumor defense mechanisms needs to be further explored. Collective findings in this area will suggest early preventive strategies for monitoring BC risk and maintaining better tumor defense in healthy women.
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van Dooren S, Duivenvoorden HJ, Passchier J, Bannink M, Tan MBM, Oldenmenger WH, Seynaeve C, van der Rijt CCD. The Distress Thermometer assessed in women at risk of developing hereditary breast cancer. Psychooncology 2009; 18:1080-7. [DOI: 10.1002/pon.1451] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Hamilton JG, Lobel M, Moyer A. Emotional distress following genetic testing for hereditary breast and ovarian cancer: a meta-analytic review. Health Psychol 2009; 28:510-8. [PMID: 19594276 DOI: 10.1037/a0014778] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Meta-analysis was used to synthesize results of studies on emotional consequences of predictive genetic testing for BRCA1/2 mutations conferring increased risk of breast and ovarian cancer. DESIGN Studies assessing anxiety or cancer-specific distress before and after provision of test results (k = 20) were analyzed using a random-effects model. Moderator variables included country of data collection and personal cancer history of study participants. MAIN OUTCOME MEASURES Standardized mean gain effect sizes were calculated for mutation carriers, noncarriers, and those with inconclusive results over short (0-4 weeks), moderate (5-24 weeks), or long (25-52 weeks) periods of time after testing. RESULTS Distress among carriers increased shortly after receiving results and returned to pretesting levels over time. Distress among noncarriers and those with inconclusive results decreased over time. Some distress patterns differed in studies conducted outside the United States and for individuals with varying cancer histories. CONCLUSION Results underscore the importance of time; changes in distress observed shortly after test-result disclosure frequently differed from the pattern of distress seen subsequently. Although emotional consequences of this testing appear minimal, it remains possible that testing may affect cognitive and behavioral outcomes, which have rarely been examined through meta-analysis. Testing may also affect understudied subgroups differently.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
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Abstract
Genetic testing for adult-onset diseases is now available. One such test is for the mutations present in the BRCA gene that result in a significantly higher risk for the development of breast cancer or ovarian cancer. Women who have one of these mutations face difficult choices in terms of increased surveillance or prophylactic surgeries. Examining experiences of women with BRCA mutations can serve as an exemplar for other populations at risk for genetically associated adult-onset diseases.
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Affiliation(s)
- Rebekah Hamilton
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Lidén A, Berglund G, Hansson MG, Rosenquist R, Sjödén PO, Nordin K. Genetic counselling for cancer and risk perception. Acta Oncol 2009; 42:726-34. [PMID: 14690158 DOI: 10.1080/02841860310011023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The main aim was to investigate risk perception and psychological distress in individuals attending genetic counselling. A consecutive series of 86 individuals with a diagnosis and/or family history of breast, ovarian or colorectal cancer was included. Risk assessments were performed before and immediately after genetic counselling and at a one-year follow-up. Psychological distress was assessed 1 week before, and 6 weeks, 6 months and 1 year after genetic counselling. The number of individuals who correctly-estimated the general risk in the population increased significantly from 35%, before to 82% after counselling (p < 0.001). One year later, data on general risk estimates showed a significant reduction of the number of correct estimations to 51%, compared with directly after the counselling (p < 0.005). In total, 54% estimated their own lifetime risk correctly after the counselling, compared with 17% before (p < 0.001) (those with a cancer diagnosis estimated the risk of their children developing cancer). One year later, the number of correct estimations had dropped to 28%. Before the counselling, the majority of the participants overestimated both the general risk and their own/children's risk. The participants experienced moderate levels of psychological distress before the counselling and a decrease of anxiety afterwards (p < 0.02). However, half of the participants reported moderate or high distress. There were no differences in psychological distress between those who estimated their risk/ children's risk as low, moderate or high or between those who over-, under- or correctly estimated their own/children's risk. Further investigations are needed to develop and adjust the risk information provided to the individual in order to avoid misunderstanding, especially as this information is going to be revealed to family members Counselling support should be offered to those individuals who experience psychological distress.
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Affiliation(s)
- Annika Lidén
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Park K, Chang SJ, Kim HC, Park EC, Lee ES, Nam CM. Big gap between risk perception for breast cancer and risk factors: nationwide survey in Korea. PATIENT EDUCATION AND COUNSELING 2009; 76:113-119. [PMID: 19157765 DOI: 10.1016/j.pec.2008.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 11/12/2008] [Accepted: 12/06/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore perceived risk of breast cancer among Korean women and to investigate factors associated with perceived risk of breast cancer. METHODS A telephone survey using random digit dialing was conducted with an age- and region-stratified random sample of women in Korea. The study population consisted of 1000 women who participated in telephone surveys in which a 21-item questionnaire was administered. RESULTS This study showed a significant level of comparative optimism in breast cancer risk perception in Korean women with an average risk of breast cancer. According to the multivariate analysis, younger age, family history of breast cancer, and history of benign breast disease were the factors associated with higher perceived comparative risk of breast cancer. CONCLUSION The finding that a limited number of breast cancer risk factors were related to perceived risk of breast cancer is worrying because women with other risk factors for breast cancer may believe themselves to be at lower risk. PRACTICE IMPLICATIONS It is necessary for women to understand their risk factor profiles to avoid biased optimism or pessimism.
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Affiliation(s)
- Keeho Park
- Cancer Information and Education Branch, National Cancer Center, Republic of Korea
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30
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Pilarski R. Risk Perception Among Women at Risk for Hereditary Breast and Ovarian Cancer. J Genet Couns 2009; 18:303-12. [DOI: 10.1007/s10897-009-9227-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 02/18/2009] [Indexed: 01/28/2023]
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Dickson MR, Carter CL, Carpenter MJ, McClure RL, McGee DA, Zapka JG, Strange C. Barriers to genetic testing among persons at risk for alpha-1 antitrypsin deficiency. ACTA ACUST UNITED AC 2009; 12:501-5. [PMID: 19072562 DOI: 10.1089/gte.2008.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The alpha coded testing (ACT) study offers free and confidential testing for alpha-1 antitrypsin deficiency (AATD) and includes surveys to provide data to study the psychosocial correlates of genetic testing. The purpose of the current study is to better understand reasons why some individuals complete genetic testing while others do not. Survey measures were compared between participants who requested and returned a genetic test for AATD (n = 703), and a random sample of individuals who requested a test kit, but did not return it within 3 months of their request (n = 83). Increasing decile of age (odds ratio [OR] = 0.74 [95% confidence interval = 0.60-0.82]) and fingerstick fear (OR = 0.74 [0.60-0.93]) were associated with a decreased likelihood of returning the test, while assurance of confidentiality was associated with an increased likelihood (OR = 1.26 [1.01-1.57]) of returning the genetic test. General anxiety as measured by the Beck Anxiety Inventory, family functioning as measured by the general functioning subscale of the Family Assessment Device, and stress induced by genetic testing as measured by the Impact of Events Scale did not significantly differ between responder groups (p = not significant). Results of this study help characterize factors driving genetic testing in AATD and may offer insight into population responses with other genetic tests.
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Affiliation(s)
- Marguerite R Dickson
- Department of Epidemiology and International Health, University of Alabama at Birmingham , Birmingham, Alabama 35294-0022, USA.
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Finch A, Metcalfe K, Lui J, Springate C, Demsky R, Armel S, Rosen B, Murphy J, Elit L, Sun P, Narod S. Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in theBRCA1orBRCA2gene. Clin Genet 2009; 75:220-4. [DOI: 10.1111/j.1399-0004.2008.01117.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bennett P, Wilkinson C, Turner J, Edwards RT, France B, Griffin G, Gray J. Factors associated with intrusive cancer-related worries in women undergoing cancer genetic risk assessment. Fam Cancer 2008; 8:159-65. [DOI: 10.1007/s10689-008-9221-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 10/25/2008] [Indexed: 02/02/2023]
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Genetic testing for BRCA1: effects of a randomised study of knowledge provision on interest in testing and long term test uptake; implications for the NICE guidelines. Fam Cancer 2008; 8:5-13. [PMID: 18679829 DOI: 10.1007/s10689-008-9201-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Interest in searching for mutations in BRCA1 and BRCA2 is high. Knowledge regarding these genes and the advantages and limitations of genetic testing is limited. It is unknown whether increasing knowledge about breast cancer genetic testing alters interest in testing. METHODS Three hundred and seventy nine women (260 with a family history of breast cancer; 119 with breast cancer) from The Royal Marsden NHS Foundation Trust were randomised to receive or not receive written educational information on cancer genetics. A questionnaire was completed assessing interest in BRCA1 testing and knowledge on breast cancer genetics and screening. Actual uptake of BRCA1 testing is reported with a six year follow-up. RESULTS Eighty nine percent of women at risk of breast cancer and 76% of women with breast cancer were interested in BRCA1 testing (P < 0.0001). Provision of educational information did not affect level of interest. Knowledge about breast cancer susceptibility genes was poor. According to the NICE guidelines regarding eligibility for BRCA1 and BRCA2 testing, the families of 66% of the at risk group and 13% of the women with breast cancer would be eligible for testing (probability of BRCA1 mutation >or=20%). Within six years of randomisation, genetic testing was actually undertaken on 12 women, only 10 of whom would now be eligible, on the NICE guidelines. CONCLUSIONS There is strong interest in BRCA1 testing. Despite considerable ignorance of factors affecting the inheritance of breast cancer, education neither reduced nor increased interest to undergo testing. The NICE guidelines successfully triage those with a high breast cancer risk to be managed in cancer genetics clinics.
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de Snoo FA, Riedijk SR, van Mil AM, Bergman W, ter Huurne JA, Timman R, Bertina W, Gruis NA, Vasen HF, van Haeringen A, Breuning MH, Tibben A. Genetic testing in familial melanoma: uptake and implications. Psychooncology 2008; 17:790-6. [DOI: 10.1002/pon.1377] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Health Behaviors and Psychological Distress in Women Initiating BRCA1/2 Genetic Testing: Comparison with Control Population. J Genet Couns 2008; 17:314-26. [DOI: 10.1007/s10897-008-9150-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
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CLEMENTS A, HENDERSON B, TYNDEL S, EVANS G, BRAIN K, AUSTOKER J, WATSON E. Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study. Eur J Cancer Care (Engl) 2008; 17:245-52. [DOI: 10.1111/j.1365-2354.2007.00837.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Henderson BJ, Tyndel S, Brain K, Clements A, Bankhead C, Austoker J, Watson E, Duffy S, Evans G, Fielder H, Gray J, Mackay J, Macmillan D. Factors associated with breast cancer-specific distress in younger women participating in a family history mammography screening programme. Psychooncology 2008; 17:74-82. [PMID: 17410528 DOI: 10.1002/pon.1201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This multi-centre study examined factors associated with breast cancer-specific distress in 2321 women under 50 who are on a mammographic screening programme on account of their family history. Women were recruited from 21 UK centres, and completed a questionnaire one month before their screening appointment. The transactional theory of stress, appraisal, and coping provided the theoretical framework for the study. Factors measured included screening history, family history, perceived risk, cognitive appraisals, coping, optimism, and cancer worry. The findings indicate that the majority of women appraise their family history as being relevant and somewhat threatening to personal well-being, but something they can deal with emotionally. Acceptance was the most commonly used coping strategy. Hierarchical regression analysis identified that the factors most significantly associated with distress were an appraisal of high relevance and threat, increased risk perception, low dispositional optimism, and the use of both avoidant and task-orientated coping strategies. Women with children and those with relatives who have died from breast cancer were also more distressed. To conclude, most women appraised their situation positively but there is a potential profile of risk factors which may help clinicians identify those women who need extra psychological support as they progress through screening.
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Affiliation(s)
- B J Henderson
- Institute of Medical and Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd LL57 2PX, UK.
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Edwards A, Gray J, Clarke A, Dundon J, Elwyn G, Gaff C, Hood K, Iredale R, Sivell S, Shaw C, Thornton H. Interventions to improve risk communication in clinical genetics: systematic review. PATIENT EDUCATION AND COUNSELING 2008; 71:4-25. [PMID: 18207694 DOI: 10.1016/j.pec.2007.11.026] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 10/12/2007] [Accepted: 11/24/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Effective risk communication may enable clients to participate effectively in decision-making about their health and health care. A systematic review of existing literature on risk communication in genetics, and its effects on key outcomes for clients, was undertaken. METHOD Systematic searching of six electronic databases and data extraction from included studies; narrative synthesis of results. RESULTS Twenty-eight studies were included, principally from cancer genetics. Sixteen communication interventions have been evaluated, generally showing improvements in cognitive outcomes for users, such as knowledge, understanding and risk perception, and without adverse effects on anxiety, cancer-related worry and depression. However, often it was the supportive or emotional elements of counselling that provided benefits to users, rather than the informational or educational elements. Similar results were found in 12 further studies of decision aids which also appear to achieve shorter consultations that can focus more on the supportive elements of counselling. CONCLUSION For both communication models and decision aids, the supportive or emotional elements of counselling provided more benefits to users than the informational or educational elements. PRACTICE IMPLICATIONS Debate is required on how to strike a balance between the medical model, its agenda and perceived requirements to disclose or discuss a range of issues and the sometimes competing goals of addressing users' concerns, needs for support, issues of loss and relationship problems.
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Affiliation(s)
- A Edwards
- Department of Primary Care & Public Health, Cardiff University, and University Hospital of Wales, Cardiff, UK.
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van Oostrom I, Meijers-Heijboer H, Duivenvoorden HJ, Bröcker-Vriends AHJT, van Asperen CJ, Sijmons RH, Seynaeve C, Van Gool AR, Klijn JGM, Tibben A. The common sense model of self-regulation and psychological adjustment to predictive genetic testing: a prospective study. Psychooncology 2008; 16:1121-9. [PMID: 17328098 DOI: 10.1002/pon.1178] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This prospective study explored the contribution of illness representations and coping to cancer-related distress in unaffected individuals undergoing predictive genetic testing for an identified mutation in BRCA1/2 (BReast CAncer) or an HNPCC (Hereditary Nonpolyposis Colorectal Cancer)-related gene, based on the common sense model of self-regulation. Coping with hereditary cancer (UCL), illness representations (IPQ-R) and risk perception were assessed in 235 unaffected applicants for genetic testing before test result disclosure. Hereditary cancer distress (IES) and cancer worry (CWS) were assessed before, 2 weeks after and 6 months after result disclosure. Timeline (r = 0.30), consequences (r = 0.25), illness coherence (r = 0.21) and risk perception (r = 0.20) were significantly correlated to passive coping. Passive coping predicted hereditary cancer distress and cancer worry from pre-test (beta = 0.46 and 0.42, respectively) up to 6 months after result disclosure (beta = 0.32 and 0.19, respectively). Illness coherence predicted hereditary cancer distress up to 6 months after result disclosure (beta = 0.24), too. The self-regulatory model may be useful to predict the cognitive and emotional reactions to genetic cancer susceptibility testing. Identifying unhelpful representations and cognitive restructuring may be appropriate interventions to help distressed individuals undergoing genetic susceptibility testing for a BRCA1/2 or a HNPCC-related mutation.
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Affiliation(s)
- Iris van Oostrom
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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41
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Ugalde A, Martin P, Rees G. Psychological impact of receiving genetic risk information for breast cancer, with and without lifestyle information. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2008. [DOI: 10.1080/00049530701449497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Anna Ugalde
- Peter MacCallum Cancer Centre, Department of Nursing and Supportive Care Research,
| | - Paul Martin
- Monash University, Monash Medical Centre, Clayton
| | - Gwyneth Rees
- Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, East Melbourne, Victoria, Australia
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Mertens WC, Katz D, Quinlan M, Barham R, Hubbard S, Hyder P, Pineau MJ, Makari-Judson G. Effect of oncologist-based counseling on patient-perceived breast cancer risk and psychological distress. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1548-5315(11)70441-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kasparian NA, Meiser B, Butow PN, Simpson JM, Mann GJ. Predictors of psychological distress among individuals with a strong family history of malignant melanoma. Clin Genet 2007; 73:121-31. [DOI: 10.1111/j.1399-0004.2007.00949.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bresser PJC, Van Gool AR, Seynaeve C, Duivenvoorden HJ, Niermeijer MF, van Geel AN, Menke M, Klijn JGM, Tibben A. Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy? Ann Oncol 2007; 18:1641-5. [PMID: 17660493 DOI: 10.1093/annonc/mdm274] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The present study aimed to assess predictors of distress after 'prophylactic mastectomy (PM) and salpingo-ovariectomy (PSO), in order to enable the early identification of patients who could benefit from psychological support. PATIENTS AND METHODS General distress and cancer-related distress were assessed in 82 women at increased risk of hereditary breast and/or ovarian cancer undergoing PM and/or PSO, before and 6 and 12 months after prophylactic surgery. Neurotic lability and coping were assessed before surgery. RESULTS Cancer-related distress and general distress at both follow-up moments were best explained by the level of cancer-related and general distress at baseline. Being a mutation carrier was predictive of increased cancer-related distress at 6-month follow-up (but not at 12 months), and of lower general distress 12 months after prophylactic surgery. Also, coping by having comforting thoughts was predictive of less cancer-related distress at 6-month follow-up. CONCLUSIONS Genetically predisposed women who are at risk of post-surgical distress can be identified using one or more of the predictors found in this study. Exploration of and/or attention to cancer-related distress and coping style before prophylactic surgery may help physicians and psychosocial workers to identify women who might benefit from additional post-surgical support.
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Affiliation(s)
- P J C Bresser
- Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Leiden, The Netherlands
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Domanska K, Nilbert M, Soller M, Silfverberg B, Carlsson C. Discrepancies between estimated and perceived risk of cancer among individuals with hereditary nonpolyposis colorectal cancer. ACTA ACUST UNITED AC 2007; 11:183-6. [PMID: 17627391 DOI: 10.1089/gte.2007.9999] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Communicating cancer risk and recommending adequate control programs is central for genetic counseling. Individuals affected by hereditary nonpolyposis colorectal cancer (HNPCC) are at about 80% life-time risk of colorectal cancer and for female carriers 40-60% risk of endometrial cancer and 10-15% risk of ovarian cancer. The perceived risk among mutation carriers may, however, deviate from the risk communicated and has been demonstrated to influence adherence to control programs. We investigated the perceived cancer risk among HNPCC mutation carriers (n = 47) and correlated the findings to individual characteristics. A perceived risk of colorectal cancer above 60% was reported by 22/45 individuals, and only one out of five mutation carriers reported a perceived risk > 80%. Female mutation carriers, individuals below age 50, and individuals who received their oncogenetic counseling within 1 year prior to the study reported higher, albeit not significantly, perceived risks of colorectal cancer. Higher perceived risks were also reported by individuals who had lost a parent to HNPCC-related cancer at early age, whereas individuals with a personal history of cancer did not report a higher perceived risk. Regarding gynecological cancer, 6/18 females reported a perceived risk of 40-60% for endometrial cancer, whereas the remaining women both underestimated and overestimated their risk, and none of the women referred to the risk of ovarian cancer. We conclude that despite educational efforts and an increasing amount of data on the cancer risk in HNPCC, a minority of the mutation carriers report a perceived risk at the same level as that communicated during oncogenetic counseling.
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Kasparian NA, Wakefield CE, Meiser B. Assessment of Psychosocial Outcomes in Genetic Counseling Research: An Overview of Available Measurement Scales. J Genet Couns 2007; 16:693-712. [PMID: 17694397 DOI: 10.1007/s10897-007-9111-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/18/2007] [Indexed: 11/24/2022]
Abstract
The aim of the present paper was to describe and evaluate many of the measurement scales currently used in genetic counseling outcomes research. A team of three researchers reviewed the available literature and selected a variety of validated instruments suitable for measurement of genetic counseling outcomes. There are numerous scales to assess each of the following outcomes among counselees: satisfaction with genetic counseling; knowledge; decision-making; psychological adjustment; coping; perceived personal control; perceptions of disease risk; and family communication about genetic risk. However, the strengths and limitations inherent to each instrument warrant careful consideration prior to implementation. In the genetic counseling context, scale selection should be undertaken with thought directed towards the characteristics of the research sample (e.g. levels of literacy, culture, medical condition), the practicalities of the research setting (e.g. available funding and resources, time restrictions, researcher expertise), the purpose of the research (i.e. the specific aspect of the genetic counseling experience to be studied), and the science underlying the scale (e.g. theoretical framework, psychometric properties).
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Affiliation(s)
- Nadine A Kasparian
- Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Level 3 Dickinson Building, 2031, Randwick, Australia.
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Allen H, Maxwell L, Dibley N, Bradley A, Baker R, Thomas P, McBride D. Patient perspectives on the Poole PCT cancer genetics service. Fam Cancer 2007; 6:231-9. [PMID: 17520348 DOI: 10.1007/s10689-007-9135-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 04/04/2007] [Indexed: 02/05/2023]
Abstract
Focussing on the primary care aspects of the Kenilworth model, the Poole Primary Care Trust (PCT) cancer genetics service has aimed to develop a high quality primary care-led service for the assessment and counselling of people concerned about their genetic risk of cancer. The service has been available through General Practitioner (GP) surgeries within the PCT since early 2006, and is delivered by Community Cancer Nurses as part of their role to provide proactive care and support to cancer patients, their families and the local population. Acting as a point of reference for cancer genetics at each practice, the nurses have supplied basic education to both health professionals and lay staff about the aims of the service and the genetic risk of cancer. Feedback from service users is one of the key elements of the Poole evaluation. This article is based on the views of some of the first patients referred. The patients consulted one of the cancer nurses between June and December 2006, and were interviewed by a researcher about their experience. The interviews focussed on the psychosocial aspects of the patients' experiences, which are less accessible through quantitative methods. The patients were encouraged to talk specifically and generally about their experiences, and described some of the feelings and emotions from the time of their referral onwards.
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Affiliation(s)
- Helen Allen
- Dorset RDSU, Cornelia House, Poole Hospital NHS Trust, Longfleet Road, Poole, BH15 2JB, UK.
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Posluszny DM, McFeeley S, Hall L, Baum A. Stress, Breast Cancer Risk, and Breast Self-Examination: Chronic Effects of Risk and Worry1. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-9861.2004.tb00094.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lobb EA, Butow PN, Moore A, Barratt A, Tucker K, Gaff C, Kirk J, Dudding T, Butt D. Development of a communication aid to facilitate risk communication in consultations with unaffected women from high risk breast cancer families: a pilot study. J Genet Couns 2007; 15:393-405. [PMID: 16967332 DOI: 10.1007/s10897-006-9023-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED The literature on risk perception in women from high-risk breast cancer families reveals persistent over-estimation of risk, even after counseling. In this study, a communication aid was designed to facilitate discussion of risk between clinical geneticists and genetic counselors and women from this high-risk population. METHOD Stage 1. The aid was developed by an expert panel of clinical geneticists, genetic counselors, psychologists, an epidemiologist, an oncologist, linguists and a consumer. It was guided by the international literature on risk communication and a large multi-centre Australian study of risk communication. The 13 page full-color communication aid used varying formats of words, numbers, graphs and pie-charts to address (a) the woman's subjective risk; (b) the population risk of breast cancer; c) the risk of inherited breast cancer; (d) the cumulative risk for women with BRCA1 and BRCA2 mutations; (e) family risk factors; (f) the woman's suitability for genetic testing; (h) screening and management recommendations, and (i) a re-assessment of the woman's subjective risk. Stage 2: A before-after pilot study of 38 women who were unaffected with breast cancer and were attending four Australian familial cancer clinics was undertaken. Baseline and follow-up questionnaires were completed by 27 women. Outcomes were compared to those observed in 107 similar women undergoing genetic counseling without the communication aid in 2001. RESULTS The risk communication aid appears to be beneficial; breast cancer genetics knowledge improved in some areas and importantly, risk perceptions improved in the cohort receiving the communication aid. Psychological measures showed no difference in anxiety or depression between the group receiving the communication aid and the comparison cohort. Women and clinicians were very positive about the usefulness of the communication aid as an adjunct to the genetic counseling consultation.
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Affiliation(s)
- E A Lobb
- Western Australian Centre for Cancer and Palliative Care, Edith Cowan University, Churchlands, Perth, WA 6018, Australia.
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Eckert SL, Katzen H, Roberts JS, Barber M, Ravdin LD, Relkin NR, Whitehouse PJ, Green RC. Recall of disclosed apolipoprotein E genotype and lifetime risk estimate for Alzheimer's disease: the REVEAL Study. Genet Med 2007; 8:746-51. [PMID: 17172937 DOI: 10.1097/01.gim.0000250197.44245.a3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine whether individuals recall their apolipoprotein E genotype and numeric lifetime risk estimates after undergoing a risk assessment for Alzheimer's disease. METHODS One-hundred and four participants underwent Alzheimer's disease risk assessment that included disclosure of apolipoprotein E genotype and a numeric lifetime risk estimate. RESULTS At six weeks and one year post-disclosure, 59% and 48% of participants, respectively, recalled their lifetime risk estimate, and 69% and 63% recalled their apolipoprotein E genotype. Participants were more likely to remember their genotype than numeric lifetime risk estimate at one year (P < 0.05). Apolipoprotein E epsilon4-positive participants had better recall of their genotype at both time points (P < 0.05). Participants were more likely to recall whether they carried the "risk-enhancing form of apolipoprotein E" than their specific genotype (P < 0.05). CONCLUSIONS These data suggest that apolipoprotein E genotype, especially the presence of an epsilon4 allele, is more memorable than a numeric risk estimate for Alzheimer's disease. Participants recalled genotype information in a more simplified, binary form. Health professionals testing for complex disorders such as Alzheimer's disease must find an appropriate balance between communicating risk in an understandable format and addressing the probabilistic nature of the information.
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Affiliation(s)
- Susan LaRusse Eckert
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
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