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Kimura M, Matsuzaki S, Ishii K, Ogawa M, Kato K. Individual experiences and issues in predictive genetic testing for untreatable hereditary neuromuscular diseases in Japan. Eur J Med Genet 2022; 66:104667. [PMID: 36410650 DOI: 10.1016/j.ejmg.2022.104667] [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: 01/03/2022] [Revised: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
Predictive genetic testing (PT) for hereditary diseases that do not have effective treatment or prevention strategies places a psychological burden on parties and their families. There has been little research on the psychosocial aspects of PT in Japan, nor are there any guidelines. To address this gap, we conducted a questionnaire survey of parties at genetic risk for untreatable hereditary neuromuscular diseases, and the National Liaison Conference of Genetic Medicine Departments (GMDs). Of the 63 parties who responded to the survey, 10 (15.9%) had undergone PT. Of the 67 GMDs, only 18 facilities (26.9%) were conducting PT with written procedures. At least two of the six parties with such results felt that some follow-up would be helpful. One party had taken PT for preimplantation genetic testing for monogenic (PGT-M); four, who had no experience, provided free text responses indicating that PGT-M or prenatal genetic testing was chosen as a motivation. Eight were unaware of PT, and six were unaware of their blood relatives' diseases being "hereditary." The results highlighted the need to: 1) develop guidelines for PT in untreatable hereditary diseases; 2) provide access to PT information; and 3) share the "heritability" of diseases with family and relatives.
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Affiliation(s)
- Midori Kimura
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Sawako Matsuzaki
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kanako Ishii
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanobu Ogawa
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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2
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Shibata Y, Matsushima M, Kato M, Chang H, Nakamura K, Oda K, Yoshida K, Sekijima Y, Toda T, Yabe I. [National survey of presymptomatic genetic testing for adult-onset hereditary neuromuscular diseases-system development for after the establishment of therapies]. Rinsho Shinkeigaku 2022; 62:773-780. [PMID: 36184415 DOI: 10.5692/clinicalneurol.cn-001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As therapies for hereditary neuromuscular diseases are developed, the need for presymptomatic genetic testing and genetic counseling for early treatment is expected to increase. In Japan, there is no uniformly recommended protocol for presymptomatic genetic testing. In order to provide basic data for the establishment of a presymptomatic genetic testing system, we surveyed medical genetics departments in Japan about their current status (response rate: 67.4%). The questionnaire survey revealed that approximately 60% of facilities had established their own procedures for presymptomatic genetic testing, but the approaches used varied from facility to facility. The interview survey enabled us to identify the essential factors for the establishment of a presymptomatic genetic testing system for each case, each facility, and at the overall level. In the future, there is a need to develop a standardized protocol to help establish a presymptomatic genetic testing system.
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Affiliation(s)
- Yuka Shibata
- Division of Clinical Genetics, Hokkaido University Hospital
| | - Masaaki Matsushima
- Division of Clinical Genetics, Hokkaido University Hospital
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Momoko Kato
- Division of Clinical Genetics, Hokkaido University Hospital
| | - Hyangri Chang
- Department of Genomic Medicine, The University of Tokyo Hospital
| | - Katsuya Nakamura
- Center for Medical Genetics, Shinshu University Hospital
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
| | - Katsutoshi Oda
- Department of Genomic Medicine, The University of Tokyo Hospital
| | - Kunihiro Yoshida
- Department of Neurology, Kakeyu Hospital, Kakeyu-Misayama Rehabilitation Center
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
| | - Tatsushi Toda
- Department of Genomic Medicine, The University of Tokyo Hospital
- Department of Neurology, Graduate School of Medicine, University of Tokyo
| | - Ichiro Yabe
- Division of Clinical Genetics, Hokkaido University Hospital
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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3
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Slaoui A, Mahtate M, Lazhar H, Lakhdar A, Baydada A, Kharbach A. Spontaneous uterine rupture revealing vascular Ehlers-Danlos syndrome: An uncommon case report. Int J Surg Case Rep 2022; 92:106840. [PMID: 35202939 PMCID: PMC8881606 DOI: 10.1016/j.ijscr.2022.106840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Vascular Ehlers-Danlos syndrome also referred to as Ehlers-Danlos Type IV is an uncommon autosomal dominant genetic disorder linked to connective tissue abnormality. Its evolution is marked by the occurrence of severe vascular, digestive and obstetrical complications. The current case highlights the importance of early diagnosis and physician awareness about this disorder as it can improve the patient's prognosis. CASE PRESENTATION We present the case of a 34-year-old woman, who presented at 36 weeks of amenorrhea with labor pain. The labor evolution was marked by an increased fluctuating abdominal pain, a sudden loss of the fetal station detected during cervical examination and decelerations to 60 beats per min, leading to an emergency caesarean section. During the laparotomy, the patient presented a spontaneous bilateral extension of the cutaneous incision requiring the realization of stopping stitches. The fetus and placenta had been expelled via a 9 cm long uterine wall rupture also known as an open book uterine rupture. A live male infant weighting 2890 g was promptly delivered and transported to NICU for respiratory distress. Physical features typical of EDS-IV allowed us to suspect this disorder and genetic analysis identified the presence of COL3A1 gene mutation, confirming the diagnosis. CLINICAL DISCUSSION AND CONCLUSIONS Early recognition of Vascular Ehlers-Danlos syndrome is of paramount importance to improve the prognosis of affected patients, who often present themselves with life-threatening situations. Clinicians should maintain a high index of suspicion for the clinical signs of this inherited connective tissue disorder that is characterized by distinctive features.
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Affiliation(s)
- Aziz Slaoui
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco; Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco.
| | - Mariam Mahtate
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Hanaa Lazhar
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Amina Lakhdar
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Aziz Baydada
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Aicha Kharbach
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
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4
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Zhang Y, Yi S, Trace CB, Williams-Brown MY. Understanding the Information Needs of Patients With Ovarian Cancer Regarding Genetic Testing to Inform Intervention Design: Interview Study. JMIR Cancer 2022; 8:e31263. [PMID: 35133282 PMCID: PMC8864522 DOI: 10.2196/31263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Experts in gynecological cancer care recommend that all patients with invasive or high-grade ovarian cancer (OC) undergo genetic testing. However, even patients who intend to take or have taken genetic tests have many unaddressed information needs regarding genetic testing. Existing genetic counseling falls short of adequately addressing this challenge. Objective This study aims to investigate the genetic testing–related information needs of patients with OC to inform the design of interactive technology-based interventions that can enhance communication of genetic testing information to patients. Methods We interviewed 20 patients with OC who had taken genetic tests and gathered genetic testing–related messages from an active OC web-based community. The interview transcripts and web-based community messages were analyzed using the qualitative content analysis method. Results Data analyses produced a comprehensive taxonomy of the genetic testing–related information needs of patients with OC, which included five major topic clusters: knowledge of genetic testing as a medical test, genetic testing process, genetic testing implications for patients, implications for family members, and medical terminology. Findings indicated that patients wanted to receive information that was relevant, understandable, concise, usable, appropriate, sympathetic, and available when needed. They also preferred various channels to receive information, including internet-based technologies, print, and conversations with health care providers. Conclusions Patients with OC need a range of information to address the uncertainties and challenges that they encounter while taking genetic tests. Their preferences for channels to receive information vary widely. A multichannel information delivery solution that combines both provider-led and peer-to-peer education models is needed to supplement existing genetic counseling to effectively meet the genetic testing–related information needs of patients with OC.
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Affiliation(s)
- Yan Zhang
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Siqi Yi
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Ciaran B Trace
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Marian Yvette Williams-Brown
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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5
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Narayanaswami P, Živković S. Molecular and Genetic Therapies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zimmermann BM, Shaw DM, Elger B, Koné I. The use of heuristics in genetic testing decision-making: A qualitative interview study. PLoS One 2021; 16:e0260597. [PMID: 34847204 PMCID: PMC8631642 DOI: 10.1371/journal.pone.0260597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Decision-making concerning predictive genetic testing for hereditary cancer syndromes is inherently complex. This study aims to investigate what kind of complexities adults undergoing genetic counseling in Switzerland experience, how they deal with them, and what heuristics they use during the decision-making process. METHODS Semi-structured qualitative interviews with eighteen Swiss adults seeking genetic counseling for hereditary cancer syndrome genetic testing and two counseling physicians were conducted and analyzed using a grounded theory approach. RESULTS Counselees stated that once they were aware of their eligibility for genetic testing they perceived an inevitable necessity to make a decision in a context of uncertainties. Some counselees perceived this decision as simple, others as very complex. High emotional involvement increased perceived complexity. We observed six heuristics that counselees used to facilitate their decision: Anticipating the test result; Focusing on consequences; Dealing with information; Interpreting disease risk; Using external guidance; and (Re-)Considering the general uncertainty of life. LIMITATIONS Our findings are limited to the context of predictive genetic testing for hereditary cancer syndromes. This qualitative study does not allow extrapolation of the relative frequency of which heuristics occur. CONCLUSIONS The use of heuristics is an inherent part of decision-making, particularly in the complex context of genetic testing for inherited cancer predisposition. However, some heuristics increase the risk of misinterpretation or exaggerated external influences. This may negatively impact informed decision-making. Thus, this study illustrates the importance of genetic counselors and medical professionals being aware of these heuristics and the individual manner in which they might be applied in the context of genetic testing decision-making. Findings may offer practical support to achieve this, as they inductively focus on the counselees' perspective.
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Affiliation(s)
- Bettina Maria Zimmermann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - David Martin Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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7
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Godino L, Turchetti D, Jackson L, Hennessy C, Skirton H. Genetic counselling as a route to enhanced autonomy: using a sequential mixed methods research approach to develop a theory regarding presymptomatic genetic testing for young adults at risk of inherited cancer syndromes. J Community Genet 2021; 12:685-691. [PMID: 34415557 DOI: 10.1007/s12687-021-00548-x] [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: 02/02/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022] Open
Abstract
Undertaking presymptomatic or predictive genetic testing should involve a considered choice. Decisions regarding genetic testing for young adults have to be considered within the context of their key life stage, which may involve developing a career, forming partnerships and/or becoming parents. The aim of this study was to develop a theoretical model regarding the factors involved when young adults (18-30 years) undergo presymptomatic genetic testing for inherited cancer syndromes. The model evolved from synthesis of results of a sequential mixed methods study involving a systematic review, a qualitative study and a quantitative study. The resulting model shows that young adults at risk of inherited cancer syndromes are influenced by others to have testing and come to counselling with their decision already made. However, genetic counselling enhances their feelings of autonomy and integration of their genetic status into their lives. Our theoretical model could be a valid support during the genetic counselling process for young adults and their parents, as it may sensitise professionals to the specific needs of this population, including education and support to autonomous decision-making. Counselling approaches should be modified in this population: an inclusive, multi-step counselling process is needed, with timing and setting set according to the specific features of this sensitive population.
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Affiliation(s)
- Lea Godino
- Division of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. .,School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK. .,Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer, University of Bologna, Bologna, Italy.
| | - Daniela Turchetti
- Division of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | | | - Heather Skirton
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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8
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Alreshq R, Ruberg FL. Clinical approach to genetic testing in amyloid cardiomyopathy: from mechanism to effective therapies. Curr Opin Cardiol 2021; 36:309-317. [PMID: 33605615 PMCID: PMC8221237 DOI: 10.1097/hco.0000000000000841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To highlight the evolving understanding of genetic variants, utility of genetic testing, and the selection of novel therapies for cardiac amyloidosis. RECENT FINDINGS The last decade has seen considerable progress in cardiac amyloidosis recognition given the advancement in cardiac imaging techniques and widespread availability of genetic testing. A significant shift in the understanding of a genetic basis for amyloidosis has led to the development of disease-modifying therapeutic strategies that improve survival. SUMMARY The systemic amyloidoses are disorders caused by extracellular deposition of misfolded amyloid fibrils in various organs. Immunoglobulin light-chain or transthyretin amyloidosis are the most common types associated with cardiac manifestations. Genetic testing plays a central role in the identification of genotypes that are associated with different clinical phenotypes and influence prognosis. Given the emergence of effective therapies, a systematic approach to the diagnosis of cardiac amyloidosis, with the elucidation of genotype when indicated, is essential to select the appropriate treatment.
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Affiliation(s)
- Rabah Alreshq
- Section of Cardiovascular Medicine, Department of Medicine
- Amyloidosis Center
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine
- Amyloidosis Center
- Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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9
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Genetic counseling and testing practices for late-onset neurodegenerative disease: a systematic review. J Neurol 2021; 269:676-692. [PMID: 33649871 PMCID: PMC7920548 DOI: 10.1007/s00415-021-10461-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Objective To understand contemporary genetic counseling and testing practices for late-onset neurodegenerative diseases (LONDs), and identify whether practices address the internationally accepted goals of genetic counseling: interpretation, counseling, education, and support. Methods Four databases were systematically searched for articles published from 2009 to 2020. Peer-reviewed research articles in English that reported research and clinical genetic counseling and testing practices for LONDs were included. A narrative synthesis was conducted to describe different practices and map genetic counseling activities to the goals. Risk of bias was assessed using the Qualsyst tool. The protocol was registered with PROSPERO (CRD42019121421). Results Sixty-one studies from 68 papers were included. Most papers focused on predictive testing (58/68) and Huntington’s disease (41/68). There was variation between papers in study design, study population, outcomes, interventions, and settings. Although there were commonalities, novel and inconsistent genetic counseling practices were identified. Eighteen papers addressed all four goals of genetic counseling. Conclusion Contemporary genetic counseling and testing practices for LONDs are varied and informed by regional differences and the presence of different health providers. A flexible, multidisciplinary, client- and family-centered care continues to emerge. As genetic testing becomes a routine part of care for patients (and their relatives), health providers must balance their limited time and resources with ensuring clients are safely and effectively counseled, and all four genetic counseling goals are addressed. Areas of further research include diagnostic and reproductive genetic counseling/testing practices, evaluations of novel approaches to care, and the role and use of different health providers in practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10461-5.
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10
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Grandis M, Obici L, Luigetti M, Briani C, Benedicenti F, Bisogni G, Canepa M, Cappelli F, Danesino C, Fabrizi GM, Fenu S, Ferrandes G, Gemelli C, Manganelli F, Mazzeo A, Melchiorri L, Perfetto F, Pradotto LG, Rimessi P, Tini G, Tozza S, Trevisan L, Pareyson D, Mandich P. Recommendations for pre-symptomatic genetic testing for hereditary transthyretin amyloidosis in the era of effective therapy: a multicenter Italian consensus. Orphanet J Rare Dis 2020; 15:348. [PMID: 33317601 PMCID: PMC7734774 DOI: 10.1186/s13023-020-01633-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a late-onset, autosomal dominant disease caused by progressive extracellular deposition of transthyretin amyloid fibrils, leading to organ damage and death. For other late-onset fatal diseases, as Huntington’s disease, protocols for pre-symptomatic genetic testing (PST) are available since decades. For ATTRv, limited experience has been reported to date, mostly gathered before the availability of approved therapies. We aimed at developing recommendations for a safe and feasible PST protocol in ATTRv in the era of emerging treatments, taking also into account Italian patients’ characteristics and healthcare system rules. After an initial survey on ongoing approaches to PST for ATTRv in Italy, two roundtable meetings were attended by 24 experts from 16 Italian centers involved in the diagnosis and care of this disease. Minimal requirements for PST offer and potential critical issues were highlighted. By November 2019, 457 families affected by ATTRv with 209 molecularly confirmed pre-symptomatic carriers were counted. The median age at PST was 41.3 years of age, regardless of the specific mutation. Half of the Italian centers had a multidisciplinary team, including a neurologist, an internist, a cardiologist, a medical geneticist and a psychologist, although in most cases not all the specialists were available in the same center. A variable number of visits was performed at each site. Experts agreed that PST should be offered only in the context of genetic counselling to at risk individuals aged 18 or older. Advertised commercial options for DNA testing should be avoided. The protocol should consist of several steps, including a preliminary clinical examination, a pre-test information session, an interval time, the genetic test and a post-test session with the disclosure of the test results, in the context of an experienced multidisciplinary team. Recommendations for best timing were also defined. Protocols for PST in the context of ATTRv can be refined to offer at risk individuals the best chance for early diagnosis and timely treatment start, while respecting autonomous decisions and promoting safe psychological adjustment to the genetic result.
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Affiliation(s)
- M Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - M Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - F Benedicenti
- Medical Genetics, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
| | - G Bisogni
- Centro Clinico Nemo Adulti-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - F Cappelli
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - C Danesino
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - G M Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona and University Hospital GB Rossi, Verona, Italy
| | - S Fenu
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - G Ferrandes
- IRCCS Policlinico San Martino, Genova, Italy
| | - C Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Arenzano, GE, Italy
| | - F Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - A Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - L Melchiorri
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - F Perfetto
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - L G Pradotto
- Department of Neurosciences, University of Turin, Torino, Italy.,Division of Neurology and Neurorehabilitazion, IRCCS Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - P Rimessi
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - G Tini
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - L Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - D Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - P Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy. .,IRCCS Policlinico San Martino, Genova, Italy.
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11
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Zimmermann BM, Shaw D, Heinimann K, Knabben L, Elger B, Koné I. How the "control-fate continuum" helps explain the genetic testing decision-making process: a grounded theory study. Eur J Hum Genet 2020; 28:1010-1019. [PMID: 32203201 PMCID: PMC7381626 DOI: 10.1038/s41431-020-0602-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022] Open
Abstract
Genetic testing decision-making for cancer predisposition is inherently complex. Understanding the mechanisms and influencing factors of the decision-making process is essential for genetic counselling and has not yet been investigated in Switzerland. This study's aim is thus to provide a theory about the individual's decision-making process regarding genetic testing for cancer predispositions in order to provide medical geneticists and genetic counsellors with insights into the needs and expectations of counsellees. We interviewed at-risk individuals who underwent genetic counselling in a clinical setting in Switzerland, using a grounded theory approach. Based on the interview data, we propose that a control-fate continuum, which is part of the individuals' life philosophy, importantly influences the decision-making process. Those in need for control decide differently compared with those leaving their future to fate. Several psychosocial factors influence the position on the control-fate continuum: "looking for certainty"; "anticipating consequences"; "being socially influenced"; "simplifying risks"; and "deciding intuitively vs reflectively". The control-fate continuum theory gives insights into the possible reasons behind decision-making regarding genetic testing for cancer predispositions. It includes both acceptors and decliners of genetic testing. Our theory helps healthcare professionals offering genetic counselling to anticipate problems within at-risk families and adapting their services to people's needs.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Human Genomics, University of Basel, Basel, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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12
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Bordet C, Brice S, Maupain C, Gandjbakhch E, Isidor B, Palmyre A, Moerman A, Toutain A, Akloul L, Brehin AC, Sawka C, Rooryck C, Schaefer E, Nguyen K, Dupin Deguine D, Rouzier C, Billy G, Séné K, Denjoy I, Leheup B, Planes M, Mazzella JM, Staraci S, Hebert M, Le Boette E, Michon CC, Babonneau ML, Curjol A, Bekhechi A, Mansouri R, Raji I, Pruny JF, Fressart V, Ader F, Richard P, Tezenas du Montcel S, Gargiulo M, Charron P. Psychosocial Impact of Predictive Genetic Testing in Hereditary Heart Diseases: The PREDICT Study. J Clin Med 2020; 9:jcm9051365. [PMID: 32384747 PMCID: PMC7290753 DOI: 10.3390/jcm9051365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/16/2022] Open
Abstract
Predictive genetic testing (PGT) is offered to asymptomatic relatives at risk of hereditary heart disease, but the impact of result disclosure has been little studied. We evaluated the psychosocial impacts of PGT in hereditary heart disease, using self-report questionnaires (including the State-Trait Anxiety Inventory) in 517 adults, administered three times to the prospective cohort (PCo: n = 264) and once to the retrospective cohort (RCo: n = 253). The main motivations for undergoing PGT were “to remove doubt” and “for their children”. The level of anxiety increased between pre-test and result appointments (p <0.0001), returned to baseline after the result (PCo), and was moderately elevated at 4.4 years (RCo). Subjects with a history of depression or with high baseline anxiety were more likely to develop anxiety after PGT result (p = 0.004 and p <0.0001, respectively), whatever it was. Unfavourable changes in professional and/or family life were observed in 12.4% (PCo) and 18.7% (RCo) of subjects. Few regrets about PGT were expressed (0.8% RCo, 2.3% PCo). Medical benefit was not the main motivation, which emphasises the role of pre/post-test counselling. When PGT was performed by expert teams, the negative impact was modest, but careful management is required in specific categories of subjects, whatever the genetic test result.
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Affiliation(s)
- Céline Bordet
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
- Correspondence: (C.B.); (P.C.)
| | - Sandrine Brice
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F75013 Paris, France;
| | - Carole Maupain
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
- APHP, department of cardiology, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- ACTION Study Group, Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - Estelle Gandjbakhch
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
- APHP, department of cardiology, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- ACTION Study Group, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- Sorbonne Université, INSERM, UMRS 1166 and ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
| | - Bertrand Isidor
- Department of Genetics, Nantes University Hospital, 44000 Nantes, France;
| | - Aurélien Palmyre
- APHP, department of Genetics, Ambroise Paré University Hospital, 92100 Boulogne-Billancourt, France;
| | - Alexandre Moerman
- Department of Genetics, Lille University Hospital, Jeanne de Flandre Hospital, 59000 Lille, France;
| | - Annick Toutain
- Department of Medical Genetics, Tours University Hospital, 37044 Tours, France;
| | - Linda Akloul
- Department of Medical Genetics, Rennes University Hospital, 35000 Rennes, France;
| | - Anne-Claire Brehin
- Normandie University, UNIROUEN, Inserm U1245 and Rouen University Hospital, Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, F 76000 Rouen, France;
| | - Caroline Sawka
- Medical Genetics Unit, FHU TRANSLAD and GIMI Institute, Dijon University Hospital, 21000 Dijon, France;
| | - Caroline Rooryck
- Department of Medical Genetics, CHU Bordeaux, Bordeaux, France, F-33000 Bordeaux, France;
| | - Elise Schaefer
- Department of Genetics, Strasbourg University Hospital, Institut de Génétique Médicale d’Alsace, 67200 Strasbourg, France;
| | - Karine Nguyen
- Department of Medical Genetics, APHM, Timone Hospital, Marseille Medical Genetics, Aix Marseille University, 13000 Marseille, France;
| | | | - Cécile Rouzier
- Department of Medical Genetics, Université Côte d’Azur, CHU, Inserm, CNRS, IRCAN, 06000 Nice, France;
| | - Gipsy Billy
- Department of Medical Genetics, Centre Hospitalo-Universitaire Grenoble Alpes, 38700 Grenoble, France;
| | - Krystelle Séné
- Clinical Genetics Unit, University Hospital, Guadeloupe University Hospital, 97159 Guadalupe Island, France;
| | - Isabelle Denjoy
- APHP, Department of cardiology, Referral Center for hereditary heart disease, Bichat Hospital, 75018 Paris, France;
| | - Bruno Leheup
- Department of Medical Genetics, University Hospital, 54042 Nancy, France;
| | - Marc Planes
- Department of Medical Genetics, University Hospital Morvan, 29200 Brest, France;
| | - Jean-Michael Mazzella
- APHP, Department of Medical Genetics, Hôpital Européen Georges Pompidou, 75015 Paris, France;
| | - Stéphanie Staraci
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
| | - Mélanie Hebert
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
| | - Elsa Le Boette
- Department of Genetics, Saint Brieuc Hospital, 22000 Saint-Brieuc, France;
| | - Claire-Cécile Michon
- Filière nationale de santé CARDIOGEN, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.-C.M.); (M.-L.B.)
| | - Marie-Lise Babonneau
- Filière nationale de santé CARDIOGEN, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.-C.M.); (M.-L.B.)
| | - Angélique Curjol
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
| | - Amine Bekhechi
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
| | - Rafik Mansouri
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
| | - Ibticem Raji
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
| | - Jean-François Pruny
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
- APHP, Department of cardiology, Referral Center for hereditary heart disease, Bichat Hospital, 75018 Paris, France;
| | - Véronique Fressart
- APHP, UF Molecular Cardiogenetics and Myogenetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (V.F.); (F.A.); (P.R.)
| | - Flavie Ader
- APHP, UF Molecular Cardiogenetics and Myogenetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (V.F.); (F.A.); (P.R.)
- Faculté de Pharmacie Paris Descartes, Département 3, 75006 Paris, France
| | - Pascale Richard
- Sorbonne Université, INSERM, UMRS 1166 and ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
- APHP, UF Molecular Cardiogenetics and Myogenetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (V.F.); (F.A.); (P.R.)
| | - Sophie Tezenas du Montcel
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière—Charles Foix, F75013 Paris, France; (S.T.d.M.); (M.G.)
| | - Marcela Gargiulo
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière—Charles Foix, F75013 Paris, France; (S.T.d.M.); (M.G.)
- Institut of Myologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - Philippe Charron
- APHP, Referral Center for hereditary heart disease, Department of Genetics, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.M.); (E.G.); (S.S.); (M.H.); (A.C.); (A.B.); (R.M.); (I.R.); (J.-F.P.)
- ACTION Study Group, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- Sorbonne Université, INSERM, UMRS 1166 and ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
- APHP, department of Genetics, Ambroise Paré University Hospital, 92100 Boulogne-Billancourt, France;
- Filière nationale de santé CARDIOGEN, Pitié-Salpêtrière University Hospital, 75013 Paris, France; (C.-C.M.); (M.-L.B.)
- Correspondence: (C.B.); (P.C.)
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Hynes J, MacMillan A, Fernandez S, Jacob K, Carter S, Predham S, Etchegary H, Dawson L. Group plus "mini" individual pre-test genetic counselling sessions for hereditary cancer shorten provider time and improve patient satisfaction. Hered Cancer Clin Pract 2020; 18:3. [PMID: 32099586 PMCID: PMC7029530 DOI: 10.1186/s13053-020-0136-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genetic counselling (GC) is an integral component in the care of individuals at risk for hereditary cancer predisposition syndromes (CPS). In many jurisdictions, access to timely counselling and testing is limited by financial constraints, by the shortage of genetics professionals and by labor-intensive traditional models of individual pre and post-test counselling. There is a need for further research regarding alternate methods of GC service delivery and implementation. This quality improvement project was initiated to determine if pretest group GC followed immediately by a 'mini' individual session, would be acceptable to patients at risk for hereditary breast and colon cancer. METHODS Patients on waitlists for GC at the Provincial Medical Genetics Program in St. John's, NL, Canada (n = 112), were contacted by telephone and offered the option of a group counselling session (GGC), followed by a "mini" individual session, versus (TGC) traditional private appointments. GGC sessions consisted of a cancer genetics information session given to groups of 6-20 followed by brief 20 min "mini" individual sessions with the patient and genetic specialist. TGC individual appointments provided the same cancer genetics information and counselling to one patient at a time in the classic model. All but 2 participants selected group+mini session. A de-identified confidential 12-item, Likert scale survey was distributed at the conclusion of mini-sessions to measure perceptions of GGC and satisfaction with this counselling model. RESULTS Sixty participants completed questionnaires. The majority of participants strongly agreed that they were comfortable with the group session (58/60); the explanation of cancer genetics was clear (54/59); they understood their cancer risks (50/60); and they would recommend such a session to others (56/59). 38/53 respondents disagreed or strongly disagreed that they would prefer to wait for a traditional private appointment. All 5 participating genetic counselors reported a preference for this model. At the end of the pilot project, the waitlist for counselling/testing was reduced by 12 months. CONCLUSIONS Group pre-test genetic counselling combined with immediate "mini" individual session is strongly supported by patients and reduces wait times. Additional formal investigation of this approach in larger numbers of patients is warranted.
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Affiliation(s)
- Jaclyn Hynes
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
| | - Andrée MacMillan
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Sara Fernandez
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Karen Jacob
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Shannon Carter
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Sarah Predham
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
| | - Lesa Dawson
- Gynecologic Oncology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
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14
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Rosier M, Guedj M, Calvas P, Julia S, Garnier C, Cambon-Thomsen A, Muñoz Sastre MT. Attitudes of French populations towards the disclosure of unsolicited findings in medical genetics. J Health Psychol 2019; 26:1767-1779. [PMID: 31707852 DOI: 10.1177/1359105319886622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Next-generation sequencing techniques enable unsolicited findings to be detected. This discovery raises ethical questions concerning the return of these findings. Our study aimed to highlight the views of the general public, patients under supervision and health professionals concerning the acceptability of disclosing unsolicited results to patients. In total, 449 participants assessed scenarios, consisted of all combinations of three factors (patient's information and consent, prevention and treatment of the unsolicited disease and doctor's decision). The response profiles were grouped into six clusters. The participants took ethical aspects into account, but health professionals also considered the medical aspects to a greater extent.
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15
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Mendes Á, Paneque M, Clarke A, Sequeiros J. Choosing not to know: accounts of non-engagement with pre-symptomatic testing for Machado-Joseph disease. Eur J Hum Genet 2019; 27:353-359. [PMID: 30573801 PMCID: PMC6460576 DOI: 10.1038/s41431-018-0308-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 11/09/2018] [Accepted: 11/22/2018] [Indexed: 12/18/2022] Open
Abstract
This paper reports accounts from people at-risk for, or affected by, Machado-Joseph disease, and their family members, about their decisions not to seek pre-symptomatic testing, therefore remaining (for the time) uninformed about their genetic status. We draw on individual and family semi-structured interviews with participants recruited through a national patient's association (n = 25). Qualitative thematic analysis revealed three main categories of accounts: (1) justifying the decision "not to know", because either no clinical benefit was expected or predictive knowledge was anticipated as psychologically burdensome; (2) prioritizing everyday life, maintaining hope and the goal of living a valid life; and (3) the wish to know: ambivalence and conflict within the family. Findings suggest the value of genetic information is often questioned when no effective treatment or cure is available; and that people have different tolerance thresholds for predictive information, and this impacts individuals within the family differently. We discuss this in the context of the making of "responsible" decisions, and of the tensions that may arise within families between the best interests or wishes of a person and those of other family members. We hope this will clarify the reasoning of those who opt for non-engagement with medical genetic services and, more specifically, pre-symptomatic testing. Further, we hope it will be relevant for the provision of genetic counselling and psychosocial support to such families.
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Affiliation(s)
- Álvaro Mendes
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - Milena Paneque
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Angus Clarke
- School of Medicine, Institute of Medical Genetics, Cardiff University, Wales, UK
| | - Jorge Sequeiros
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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16
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Conceição I, Damy T, Romero M, Galán L, Attarian S, Luigetti M, Sadeh M, Sarafov S, Tournev I, Ueda M. Early diagnosis of ATTR amyloidosis through targeted follow-up of identified carriers of TTR gene mutations. Amyloid 2019; 26:3-9. [PMID: 30793974 DOI: 10.1080/13506129.2018.1556156] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Diagnosis in the early stages of hereditary transthyretin (ATTR) amyloidosis is imperative to support timely treatment to prevent or delay disease progression. Genetic testing in the setting of genetic counselling enables identification of carriers of a TTR gene mutation who are therefore at risk of developing TTR-associated disease. Knowledge of different genotypes and how they manifest in symptomatic disease should facilitate development of a structured and targeted approach to enable diagnosis of symptomatic disease in ATTR amyloidosis mutation carriers on the first manifestation of the earliest detectable sign or symptom. A group of experts from across Europe, Israel and Japan met to reach a consensus on such an approach. The proposed approach involves establishing a baseline for key clinical parameters, determination of the timing and frequency of follow-up in TTR mutation carriers based on a predicted age of disease onset, and recognition of the likely initial clinical signs and symptoms aligned with the phenotype of the specific TTR gene mutation and family history. Minimum criteria for diagnosis of symptomatic disease have been agreed, which it is hoped will ensure diagnosis of ATTR amyloidosis at the earliest possible stage in people with a known TTR mutation.
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Affiliation(s)
- Isabel Conceição
- a CHLN-Hospital Santa Maria, IMM, Universidade de Lisboa , Lisbon , Portugal
| | - Thibaud Damy
- b Referral Center for Cardiac Amyloidosis, Department of Cardiology, Amyloid Research Institute, DHU A-TVB, Henri Mondor Hospital, APHP, IMRB and UPEC, Créteil, France
| | - Manuel Romero
- c Hospital Universitario Virgen de la Victoria , Malaga , Spain
| | - Lucía Galán
- d Hospital Clinico San Carlos , Madrid , Spain
| | | | - Marco Luigetti
- f UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,g Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stayko Sarafov
- i Clinic of Neurology, Alexandrovska Hospital, Department of Neurology , Medical University , Sofia , Bulgaria
| | - Ivailo Tournev
- i Clinic of Neurology, Alexandrovska Hospital, Department of Neurology , Medical University , Sofia , Bulgaria.,j Department of Cognitive Science and Psychology , New Bulgarian University , Sofia , Bulgaria
| | - Mitsuharu Ueda
- k Department of Neurology , Kumamoto University , Kumamoto , Japan
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17
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Kanga-Parabia A, Gaff C, Flander L, Jenkins M, Keogh LA. Discussions about predictive genetic testing for Lynch syndrome: the role of health professionals and families in decisions to decline. Fam Cancer 2018; 17:547-555. [PMID: 29464398 PMCID: PMC6102092 DOI: 10.1007/s10689-018-0078-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Unaffected relatives of individuals with Lynch syndrome can be offered predictive genetic testing to guide surveillance recommendations. The decision-making process of those who decline testing, particularly those who do not attend a clinical genetics service, is poorly understood. We have addressed this gap by interviewing 33 individuals from Lynch syndrome mutation-carrying families, unaffected by cancer, who declined predictive genetic testing. Here, we analyse the data provided by 20 participants who unequivocally declined testing. Those who indicated they did not have enough information to make a decision or intended to undergo testing in the future were excluded. Analysis revealed that few decliners discussed their decision with general practitioners or genetic counsellors. Family members were commonly involved to varying degrees, with participants either (1) making group decisions with family members, (2) feeling persuaded by family members to either accept or decline testing, (3) discussing the test but making their own decision. A minority did not discuss testing with family members while making their decision. This research reveals the health communication activities of an understudied group, those declining predictive testing, and indicates that for many, health professionals play a minor role in the decision compared to family.
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Affiliation(s)
- Anaita Kanga-Parabia
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Melbourne, VIC, 3010, Australia
| | - Clara Gaff
- Departments of Paediatrics and Medicine, The University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Melbourne, VIC, 3010, Australia.
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18
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Keenan KF, Finnie RM, Simpson WG, McKee L, Dean J, Miedzybrodzka Z. Parents' views of genetic testing and treatment of familial hypercholesterolemia in children: a qualitative study. J Community Genet 2018; 10:129-141. [PMID: 29949065 PMCID: PMC6325044 DOI: 10.1007/s12687-018-0373-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/01/2018] [Indexed: 01/06/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a serious inherited disorder, which greatly increases individuals’ risk of cardiovascular disease (CVD) in adult life. However, medical treatment and lifestyle adjustments can fully restore life expectancy. Whilst European guidance advises that where there is a known family mutation genetic testing is undertaken in early childhood, the majority of the at-risk population remain untested and undiagnosed. To date, only a small number of studies have explored parents’ and children’s experiences of testing and treatment for FH, and little is known about interactions between health professionals, parents, and children in clinic settings. In this study, in-depth interviews were undertaken with parents who had attended a genetics and/or lipid clinic for FH with their children (n = 17). A thematic analysis revealed four main themes: undertaking early prevention, postponing treatment, parental concerns, and the importance of the wider family context. The majority of parents supported genetic testing for FH in childhood. However, although some were very supportive of following early treatment recommendations, others expressed reluctance. Importantly, some parents were concerned that inappropriate information had been shared with their children and wished that more time had been given to discuss how, when, and what to tell in advance. Future research is needed to explore the long-term outcomes for children who undertake genetic testing and early treatment for FH and to trial interventions to improve the engagement, follow-up, and support of children who are at risk, or diagnosed, with this disorder.
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Affiliation(s)
- Karen Forrest Keenan
- Epidemiology Group, University of Aberdeen, First Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK. .,Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.
| | - Robert M Finnie
- Department of Medicine/Care of the Elderly, St. Johns Hospital, Howdon Road West, Livingston, UK.,Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William G Simpson
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Third Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - John Dean
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
| | - Zosia Miedzybrodzka
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
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19
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Hogden A, Crook A. Patient-centered decision making in amyotrophic lateral sclerosis: where are we? Neurodegener Dis Manag 2017; 7:377-386. [DOI: 10.2217/nmt-2017-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Developments in amyotrophic lateral sclerosis research and care delivery have created new arenas, and new dilemmas, for patients’ decision making. This review explores three aspects of amyotrophic lateral sclerosis patient-centered care and decision making: patient-centered service delivery through the expanding multidisciplinary team; decision making for genetic testing and the implications of undergoing testing; and development of user-designed decision support tools to help patients and families make decisions as their choices become more complex. Until a cure is found, well-timed and effective decision making will rely on patient and family preferences to guide them through an increasingly complicated disease landscape.
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Affiliation(s)
- Anne Hogden
- Australian Institute of Health Innovation, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashley Crook
- Department of Clinical Medicine, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Schmidt HHJ, Barroso F, González-Duarte A, Conceição I, Obici L, Keohane D, Amass L. Management of asymptomatic gene carriers of transthyretin familial amyloid polyneuropathy. Muscle Nerve 2017; 54:353-60. [PMID: 27273296 PMCID: PMC5113802 DOI: 10.1002/mus.25210] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 02/06/2023]
Abstract
Transthyretin familial amyloid polyneuropathy (TTR‐FAP) is a rare, severe, and irreversible, adult‐onset, hereditary disorder caused by autosomal‐dominant mutations in the TTR gene that increase the intrinsic propensity of transthyretin protein to misfold and deposit systemically as insoluble amyloid fibrils in nerve tissues, the heart, and other organs. TTR‐FAP is characterized by relentless, progressively debilitating polyneuropathy, and leads to death, on average, within 10 years of symptom onset without treatment. With increased availability of disease‐modifying treatment options for a wider spectrum of patients with TTR‐FAP, timely detection of the disease may offer substantial clinical benefits. This review discusses mutation‐specific predictive genetic testing in first‐degree relatives of index patients diagnosed with TTR‐FAP and the structured clinical follow‐up of asymptomatic gene carriers for prompt diagnosis and early therapeutic intervention before accumulation of substantial damage. Muscle Nerve54: 353–360, 2016
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Affiliation(s)
- Hartmut H-J Schmidt
- Department of Transplant Medicine, University Hospital Münster, Münster, Germany
| | - Fabio Barroso
- Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Alejandra González-Duarte
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Isabel Conceição
- Department of Neurology, Centro Hospitalar Norte-Hospital de Santa Maria, Lisbon, Portugal.,Translational and Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, Lisbon, Portugal
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Crook A, Williams K, Adams L, Blair I, Rowe DB. Predictive genetic testing for amyotrophic lateral sclerosis and frontotemporal dementia: genetic counselling considerations. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:475-485. [PMID: 28585888 DOI: 10.1080/21678421.2017.1332079] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Once a gene mutation that is causal of amyotrophic lateral sclerosis (ALS) and/or frontotemporal dementia (FTD) is identified in a family, relatives may decide to undergo predictive genetic testing to determine whether they are at risk of developing disease. Recent advances in gene discovery have led to a pressing need to better understand the implications of predictive genetic testing. Here we review the uptake of genetic counselling, predictive and reproductive testing, and the factors that impact the decision to undergo testing, for consideration in clinical practice. The literature suggests that the factors impacting the decision to undergo testing are complex due to the nature of these diseases, absence of available preventative medical treatment and variable age of onset in mutation carriers. Gaining further insight into the decision-making process and the impact of testing is critical as we seek to develop best-practice guidelines for predictive testing for familial ALS and FTD.
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Affiliation(s)
- Ashley Crook
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia and
| | - Kelly Williams
- b Centre for MND Research , Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia
| | - Lorel Adams
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia and
| | - Ian Blair
- b Centre for MND Research , Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia
| | - Dominic B Rowe
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia and
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22
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Lêdo S, Leite Â, Souto T, Dinis MA, Sequeiros J. Mid- and long-term anxiety levels associated with presymptomatic testing of Huntington's disease, Machado-Joseph disease, and familial amyloid polyneuropathy. ACTA ACUST UNITED AC 2016; 38:113-20. [PMID: 26870910 PMCID: PMC7111364 DOI: 10.1590/1516-4446-2014-1617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/13/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study anxiety as a variable of the mid- and long-term psychological impact of pre-symptomatic testing for three autosomal dominant late-onset disorders - Huntington's disease (HD), Machado-Joseph disease (MJD) and familial amyloid polyneuropathy (FAP) TTR V30M - in a Portuguese sample. METHODS This cross-sectional study included 203 participants: 170 (83.7%) underwent pre-symptomatic testing for FAP, 29 (14.3%) for HD, and 4 (2%) for MJD. Of the 203 participants, 73 (36.0%) were asymptomatic carriers, 29 (14.5%) were symptomatic carriers, 9 (4.5%) were diagnosed with FAP and had a liver transplant, and 89 (44.5%) were non-carriers. Most were women (58.1%) and married (66.5%). The anxiety variable was assessed using the Zung Self-Rating Anxiety Scale (SAS). RESULTS The anxiety scores were higher for symptomatic carriers and for those who underwent psychological support consultations over the years. For symptomatic carriers, the mean scores were superior to 40 points, which reflects clinical anxiety. CONCLUSION Although it was not possible to differentiate between the mid- and long-term psychological impacts, this study supports the conclusion that the proximity to the age of symptoms onset might be a trigger for anxiety.
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Affiliation(s)
- Susana Lêdo
- Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto , Portugal, Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto , Portugal, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ângela Leite
- Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto , Portugal, Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Universidade Lusófona do Porto (ULP), Universidade Lusófona do Porto, Porto , Portugal, Universidade Lusófona do Porto (ULP), Porto, Portugal
| | - Teresa Souto
- Universidade Lusófona do Porto (ULP), Universidade Lusófona do Porto, Porto , Portugal, Universidade Lusófona do Porto (ULP), Porto, Portugal
| | - Maria A Dinis
- Universidade Fernando Pessoa (UFP), Unidade de Investigação em Energia, Ambiente e Saúde (FP-ENAS), Laboratório de Investigação em Energia, Ambiente e Saúde Ambiental e Pública (3ERL), Universidade Fernando Pessoa, Porto , Portugal, Unidade de Investigação em Energia, Ambiente e Saúde (FP-ENAS), Laboratório de Investigação em Energia, Ambiente e Saúde Ambiental e Pública (3ERL), Universidade Fernando Pessoa (UFP), Porto, Portugal
| | - Jorge Sequeiros
- Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto , Portugal, Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto , Portugal, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
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Recommendations for presymptomatic genetic testing and management of individuals at risk for hereditary transthyretin amyloidosis. Curr Opin Neurol 2016; 29 Suppl 1:S27-35. [PMID: 26734953 PMCID: PMC4739313 DOI: 10.1097/wco.0000000000000290] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW These recommendations highlight recent experience in genetic counselling for the severe autosomal-dominant, late-onset transthyretin familial amyloid polyneuropathy (TTR-FAP) disease, and present a structured approach towards identification and monitoring of asymptomatic carriers of the mutated gene. RECENT FINDINGS The effectiveness of current treatment options is still limited in patients with TTR-FAP beyond stage I. Diagnosis in the early stages of TTR-FAP is essential to prevent or delay the progression of disease. Existing legal and cultural issues differ among countries within Europe. Experts of the European Network for TTR-FAP (ATTReuNET) concluded that genetic counselling for diagnosed individuals and at-risk family members is mostly beneficial and should be carried out with care by trained professionals. Systematic and regular monitoring of an asymptomatic carrier is necessary to detect early signs of TTR-FAP and maximize the effectiveness of treatment. This includes five areas of assessment: history/clinical examination, sensorimotor function, autonomic dysfunction, cardiac function, and renal function. At least two related symptoms and positive biopsy findings are required to confirm diagnosis of TTR-FAP. SUMMARY Early detection of TTR-FAP is essential to improve the prognosis of TTR-FAP. ATTReuNET recommends genetic counselling and routine monitoring for asymptomatic carriers of TTR-FAP.
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Tambasco N, Nigro P, Romoli M, Prontera P, Simoni S, Calabresi P. A53T in a parkinsonian family: a clinical update of the SNCA phenotypes. J Neural Transm (Vienna) 2016; 123:1301-1307. [PMID: 27250986 DOI: 10.1007/s00702-016-1578-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/21/2016] [Indexed: 01/04/2023]
Abstract
Approximately 15 % of PD patients with Parkinson Disease (PD) have the familial type and 5-10 % of these are known to have monogenic forms with either an autosomal dominant or a recessive inheritance pattern. Here, we report on a family carrying the A53T SNCA mutation and we review SNCA mutation phenotypes by comparing point mutations within each other as well as with duplication and triplication.
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Affiliation(s)
- Nicola Tambasco
- Clinica Neurologica, Azienda Ospedaliera e Universitaria di Perugia, S.Andrea delle Fratte, 06156, Perugia, Italy.
| | - Pasquale Nigro
- Clinica Neurologica, Azienda Ospedaliera e Universitaria di Perugia, S.Andrea delle Fratte, 06156, Perugia, Italy
| | - Michele Romoli
- Clinica Neurologica, Azienda Ospedaliera e Universitaria di Perugia, S.Andrea delle Fratte, 06156, Perugia, Italy
| | - Paolo Prontera
- Servizio di Genetica Medica, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Simone Simoni
- Clinica Neurologica, Azienda Ospedaliera e Universitaria di Perugia, S.Andrea delle Fratte, 06156, Perugia, Italy
| | - Paolo Calabresi
- Clinica Neurologica, Azienda Ospedaliera e Universitaria di Perugia, S.Andrea delle Fratte, 06156, Perugia, Italy.,I.R.C.C.S. Fondazione S.Lucia, Rome, Italy
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25
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Benatar M, Stanislaw C, Reyes E, Hussain S, Cooley A, Fernandez MC, Dauphin DD, Michon SC, Andersen PM, Wuu J. Presymptomatic ALS genetic counseling and testing: Experience and recommendations. Neurology 2016; 86:2295-302. [PMID: 27194384 DOI: 10.1212/wnl.0000000000002773] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/15/2016] [Indexed: 12/11/2022] Open
Abstract
Remarkable advances in our understanding of the genetic contributions to amyotrophic lateral sclerosis (ALS) have sparked discussion and debate about whether clinical genetic testing should routinely be offered to patients with ALS. A related, but distinct, question is whether presymptomatic genetic testing should be offered to family members who may be at risk for developing ALS. Existing guidelines for presymptomatic counseling and testing are mostly based on small number of individuals, clinical judgment, and experience from other neurodegenerative disorders. Over the course of the last 8 years, we have provided testing and 317 genetic counseling sessions (including predecision, pretest, posttest, and ad hoc counseling) to 161 first-degree family members participating in the Pre-Symptomatic Familial ALS Study (Pre-fALS), as well as testing and 75 posttest counseling sessions to 63 individuals with familial ALS. Based on this experience, and the real-world challenges we have had to overcome in the process, we recommend an updated set of guidelines for providing presymptomatic genetic counseling and testing to people at high genetic risk for developing ALS. These recommendations are especially timely and relevant given the growing interest in studying presymptomatic ALS.
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Affiliation(s)
- Michael Benatar
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden.
| | - Christine Stanislaw
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Eliana Reyes
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Sumaira Hussain
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Anne Cooley
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Maria Catalina Fernandez
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Danielle D Dauphin
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Sara-Claude Michon
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Peter M Andersen
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
| | - Joanne Wuu
- From the Department of Neurology (M.B., E.R., S.H., A.C., M.C.F., D.D.D., S.-C.M., J.W.), University of Miami, FL; Winship Cancer Institute and Department of Human Genetics (C.S.), Emory University, Atlanta, GA; and Department of Pharmacology and Clinical Neuroscience (P.M.A.), Umeå University, Sweden
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Online genetic counseling from the providers' perspective: counselors' evaluations and a time and cost analysis. Eur J Hum Genet 2016; 24:1255-61. [PMID: 26785833 DOI: 10.1038/ejhg.2015.283] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/29/2015] [Accepted: 12/08/2015] [Indexed: 11/09/2022] Open
Abstract
Telemedicine applications are increasingly being introduced in patient care in various disciplines, including clinical genetics, mainly to increase access to care and to reduce time and costs for patients and professionals. Most telegenetics reports describe applications in large geographical areas, showing positive patients' and professionals' satisfaction. One economic analysis published thus far reported lower costs than in-person care. We hypothesized that telegenetics can also be beneficial from the professional's view in relatively small geographical areas. We performed a pilot study in the Northern Netherlands of 51 home-based online counseling sessions for cardiogenetic and oncogenetic cascade screening, and urgent prenatal counseling. Previously, we showed patient satisfaction, anxiety, and perceived control of online counseling to be comparable to in-person counseling. This study focuses on expectations, satisfaction, and practical evaluations of the involved counselors, and the impact in terms of time and costs. Most counselors expected disadvantages of online counseling for themselves and their patients, mainly concerning insufficient non-verbal communication; few expected advantages for themselves. Afterwards, counselors additionally raised the disadvantage of insufficient verbal communication, and reported frequent technical problems. Their overall mean telemedicine satisfaction itemscore was 3.38 before, and 2.95 afterwards, being afterwards slightly below the minimum level we set for a satisfactory result. We estimated reduced time and costs by online counseling with about 8% and 10-12%, respectively. We showed online genetic counseling to be effective, feasible and cost-efficient, but technical improvements are needed to increase counselors' satisfaction.
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27
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Higuchi EC, Sheldon JP, Zikmund-Fisher BJ, Yashar BM. Non-invasive prenatal screening for trisomy 21: Consumers' perspectives. Am J Med Genet A 2015; 170A:375-385. [PMID: 26553705 DOI: 10.1002/ajmg.a.37460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
Non-invasive prenatal screening (NIPS) has the potential to dramatically increase the prenatal detection rate of Down syndrome because of improvements in safety and accuracy over existing tests. There is concern that NIPS could lead to more negative attitudes towards Down syndrome and less support for individuals with Down syndrome. To assess the impact of NIPS on support for prenatal testing, decision-making about testing, and beliefs or attitudes about Down syndrome, we performed an Internet-based experiment using adults (N = 1,789) recruited through Amazon Mechanical Turk. Participants were randomly assigned to read a mock news article about NIPS, a mock news article about amniocentesis, or no article. The content in the two articles varied only in their descriptions of the test characteristics. Participants then answered questions about their support for testing, hypothetical testing decision, and beliefs and attitudes about Down syndrome. Reading the mock NIPS news article predicted increased hypothetical test uptake. In addition, the NIPS article group also agreed more strongly that pregnant women, in general, should utilize prenatal testing. We also found that the more strongly participants supported prenatal testing for pregnant women, the less favorable their attitudes towards individuals with Down syndrome; providing some evidence that NIPS may indirectly result in more negative perceptions of individuals with this diagnosis.
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Affiliation(s)
- Emily C Higuchi
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Jane P Sheldon
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
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Non-invasive Prenatal Diagnosis for BRCA Mutations – a Qualitative Pilot Study of Health Professionals’ Views. J Genet Couns 2015; 25:198-207. [DOI: 10.1007/s10897-015-9858-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
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Cruz-Mariño T, Vázquez-Mojena Y, Velázquez-Pérez L, González-Zaldívar Y, Aguilera-Rodríguez R, Velázquez-Santos M, Estupiñán-Rodríguez A, Laffita-Mesa JM, Almaguer-Mederos LE, Paneque M. SCA2 predictive testing in Cuba: challenging concepts and protocol evolution. J Community Genet 2015; 6:265-73. [PMID: 25893506 DOI: 10.1007/s12687-015-0226-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/08/2015] [Indexed: 12/14/2022] Open
Abstract
Spinocerebellar ataxia type 2 (SCA2) is a neurodegenerative disease caused by a CAG repeat expansion in the ATXN2 gene. Cuba has the highest prevalence (6.57 cases/10(5) inhabitants) of SCA2 in the world. The existence of 753 affected individuals and 7173 relatives at risk prompted the development in 2001 of the first predictive testing program in the country. The medical records of over 1193 individuals, who requested the test within a 13-year period, were analyzed retrospectively. The presymptomatic and the prenatal tests had uptake rates of 43.4 and 23.9 %, respectively. Several ethical challenges resulted from this program. These include the following: (1) withdrawal due to the initial protocol's length; (2) the request to participate by 16 at-risk adolescents; (3) the decision made by ten out of 33 couples with a test-positive fetus to carry the pregnancy to term, leading to de facto predictive testing of minors; (4) the elevated frequency of the ATXN2 gene large normal alleles (≥23 to 31 repeats) in the reference population. These issues have led to major changes in the guidelines of the predictive testing protocol: (1) the protocol length was shortened; (2) the inclusion criteria were expanded to reach at-risk adolescents with an interest in prenatal diagnosis; (3) interdisciplinary follow-up was offered to families in which test-positive fetuses were not aborted; (4) prenatal testing was made available to carriers of large normal alleles with ≥27 CAG repeats. The profiles of the participants were similar to those reported for other predictive testing programs for conditions like Huntington disease and familial adenomatous polyposis. The genetic counseling practices at the community level, the ample health education provided to the at-risk population, together with multidisciplinary and specialized attention to the affected families, are lessons from the Cuban experience that can be relevant for other international teams conducting predictive testing for other late-onset neurodegenerative disorders.
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Affiliation(s)
- Tania Cruz-Mariño
- Predictive Genetics Department, Center for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba,
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30
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Quality issues concerning genetic counselling for presymptomatic testing: a European Delphi study. Eur J Hum Genet 2015; 23:1468-72. [PMID: 25689925 DOI: 10.1038/ejhg.2015.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/09/2015] [Accepted: 01/20/2015] [Indexed: 12/16/2022] Open
Abstract
Genetic counselling for presymptomatic testing is complex, bringing both ethical and practical questions. There are protocols for counselling but a scarcity of literature regarding quality assessment of such counselling practice. Generic quality assessment tools for genetic services are not specific to presymptomatic testing (PST). Therefore, the aim of this study was to identify aspects of effective counselling practice in PST for late-onset neurological disorders. We used the Delphi method to ascertain the views of relevant European experts in genetic counselling practice, ascertained via published literature and nomination by practitioners. Ethical approval was obtained. Questionnaires were sent electronically to a list of 45 experts, (Medical Doctors, Geneticists, Genetic Counsellors and Genetic Nurses), who each contributed to one to three rounds. In the first round, we provided a list of relevant indicators of quality of practice from a literature review. Experts were requested to evaluate topics in four domains: (a) professional standards; (b) service standards; (c) the consultant's perspective; and (d) protocol standards. We then removed items receiving less than 65% approval and added new issues suggested by experts. The second round was performed for the refinement of issues and the last round was aimed at achieving final consensus on high-standard indicators of quality, for inclusion in the assessment tool. The most relevant indicators were related to (1) consultant-centred practice and (2) advanced counselling and interpersonal skills of professionals. Defined high-standard indicators can be used for the development of a new tool for quality assessment of PST counselling practice.
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31
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Padró-Miquel A, Candás-Estébanez B. Meeting report: present state of molecular genetics in clinical laboratories. Report on the VII European Symposium on Clinical Laboratory and In Vitro Diagnostic Industry in Barcelona. Clin Chem Lab Med 2015; 53:199-204. [DOI: 10.1515/cclm-2014-0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/09/2014] [Indexed: 11/15/2022]
Abstract
AbstractThe VII European Symposium of the Clinical Laboratory and In Vitro Diagnostic Industry, co-organized between the Catalan Association for Clinical Laboratory Sciences (ACCLC) and the Catalan Society of Biology, was held on May 28th–29th, 2013 in Barcelona (Catalonia, Spain) under the IFCC auspices and the IUPAC sponsorship. The subject of the present Symposium was “Molecular Genetics in the Clinical Laboratory” and began with an opening conference that was a stroll through the history of molecular genetics in the context of the clinical laboratory. The scientific program was structured in several 2-h length roundtables that dealt with the following topics: recent advances in molecular genetics for clinical microbiology, latest evidences and real applicability of pharmacogenetics in the clinical practice, quality assurance of a molecular genetics laboratory, and latest trends in prenatal genetic diagnosis. The aim of the Symposium was the discussion of the transformation that molecular genetics has generated on clinical laboratories in terms of organization, specialization, interpretation of results and fast technical and knowledge evolution. High-qualified professionals from several countries together with in-country experts formed the roundtables. Attendants participated actively in the debates, increasing the overall interest.
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32
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Zanko A, Abrams L. Case report: concurrent Wilson disease and Huntington disease: lightning can strike twice. J Genet Couns 2014; 24:40-5. [PMID: 25378206 DOI: 10.1007/s10897-014-9789-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Andrea Zanko
- Division of Medical Genetics, Department of Pediatrics, University of California Medical Center, San Francisco, 94143, CA, USA,
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Paneque M, Mendes Á, Guimarães L, Sequeiros J, Skirton H. Genetics Health Professionals' Views on Quality of Genetic Counseling Service Provision for Presymptomatic Testing in Late-Onset Neurological Diseases in Portugal: Core Components, Specific Challenges and the Need for Assessment Tools. J Genet Couns 2014; 24:616-25. [PMID: 25363284 DOI: 10.1007/s10897-014-9784-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/03/2014] [Indexed: 11/30/2022]
Abstract
Quality assessment of genetic counseling practice for improving healthcare is a challenge for genetic services worldwide; however, there is scarce literature regarding quality issues in genetic counseling in the context of presymptomatic testing for late-onset neurological diseases (Paneque et al. 2012) The aims of this qualitative study were to: (1) explore the views of professionals' who provide genetic counseling services for presymptomatic testing for late-onset neurological diseases regarding relevant quality indicators for counseling practice; and (2) examine current assessment of such counseling practice for Portuguese genetic services. Quality indicators are a means of measuring either the process or outcomes of patient services, with the aim of evaluating and improving quality of care (Mainz 2003). In this study, we defined quality indicators as measurable outcomes of the counseling process that may reflect good professional practice and desirable end-term effects. We undertook interviews with 18 genetic health professionals (85 % of all genetic counseling professionals involved) from the major genetic services in Portugal. Results indicate that professionals valued some core components of genetic counseling, including providing information and decision-making support, informing the consultand about the genetic counseling protocol, as well as exploring motivations, expectations for test results, consequent anticipated life changes, psychosocial adjustment, and personal and familial experience with the disease. Professionals were not, however, able to clearly elucidate quality indicators for effective practice and some reported they had not reflected on that topic before. Professionals also reported specific challenges in their practice, such as ambiguity of the health/illness status and affirming consultands' autonomy. Results of the study have revealed a lack of knowledge about quality indicators and tools to assess counseling practice. A credible set of quality indicators for presymptomatic testing is required as a foundation for the development of specific tools.
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Affiliation(s)
- M Paneque
- UnIGENe and Centre for Predictive and Preventive Genetics (CGPP), IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal,
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Naing BT, Watanabe A, Tanigaki S, Ono M, Iwashita M, Shimada T. Presymptomatic genetic analysis during pregnancy for vascular type Ehlers-Danlos syndrome. Int Med Case Rep J 2014; 7:99-102. [PMID: 24971038 PMCID: PMC4069127 DOI: 10.2147/imcrj.s59879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The vascular type of Ehlers–Danlos syndrome (EDS), EDS type IV (Online Mendelian Inheritance in Man [MIM] #130050) is characterized by thin, translucent skin, easy bruising, and arterial, intestinal, and/or uterine fragility during pregnancy, which may lead to sudden death. It is an autosomal dominant inherited disorder caused by type III procollagen gene (COL3A1: MIM #120180) mutations. Approximately 50% of the COL3A1 mutations are inherited from an affected parent, and 50% are de novo mutations. Each child of an affected individual has a 50% chance of inheriting the mutation and developing the disorder. Pregnant women with vascular EDS are at an increased risk of uterine and arterial rupture during the peripartum period, with high maternal morbidity and mortality rates. We report the first case of an asymptomatic 35-year-old woman at a risk of complications of vascular EDS who underwent presymptomatic evaluation during pregnancy. The sequencing results of both her brother and mother had a one-base-pair deletion, resulting in Glutamate at position 730 changing to Lysine and causing a frame shift and premature termination codon at 61 amino acids from the mutation position (p. Glu730Lysfs*61) on exon 32 of COL3A1. This deletion caused frameshift, leading to a premature termination codon (TAG) at 181 nucleotides downstream in exon 35, which could not be detected by previous total RNA (ribonucleic acid) method. Thus, she was at risk of complications of vascular EDS, and diagnostic testing was employed at 8 weeks of pregnancy to minimize the risk of developing vascular EDS-related complications. The negative presymptomatic diagnostic result allowed the patient to choose normal delivery at term. Vascular EDS is a serious disorder, with high mortality, especially in high-risk women with vascular EDS during pregnancy. The presymptomatic genetic testing of vascular EDS during pregnancy for a high-risk family can help with the early establishment of preventive measures.
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Affiliation(s)
- Banyar Than Naing
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan
| | - Atsushi Watanabe
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan ; Division of Clinical Genetics, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinji Tanigaki
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masae Ono
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Mitsutoshi Iwashita
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Shimada
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan ; Division of Clinical Genetics, Nippon Medical School Hospital, Tokyo, Japan
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Jackson L, Goldsmith L, Skirton H. Guidance for patients considering direct-to-consumer genetic testing and health professionals involved in their care: development of a practical decision tool. Fam Pract 2014; 31:341-8. [PMID: 24473677 DOI: 10.1093/fampra/cmt087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Direct-to-consumer (DTC) genetic tests are available online, but there is little practical guidance for health professionals and consumers concerning their use. Work to produce such guidance was initially informed by three systematic reviews assessing the evidence on views and experiences of users and health professionals and policies of professional and bioethics organizations. The evidence suggested that consumers' motivations include general curiosity, improving their general health, ascertaining the risk of a particular condition or planning for future children. However, health professionals and bioethics organizations expressed concerns about potential harms resulting from these tests. Using this evidence, we constructed a list of topics to be included in proposed guidelines. METHODS Using an expert group technique, we aimed to develop guidance for (i) potential consumers and (ii) health professionals approached by patients considering or having undertaken such tests. We considered it important to involve a wide range of participants with relevant experience. Accordingly, researchers and clinicians based in four countries were invited to a 2-day workshop in August 2012. Following an iterative process, we decided to produce clinically relevant and pragmatic guidance in the form of a decision support tool for use in primary care. RESULTS By utilizing both the relevant literature and the experience of the expert group, we identified seven key underlying reasons that might prompt individuals to consider DTC testing. We considered primary care physicians as the most likely health professionals from whom individuals would seek advice. CONCLUSIONS Based on the outcomes of the workshop, we developed a decision support tool encompassing varied clinical scenarios. Health professionals and patients are guided through a pathway that includes relevant actions and information on the appropriateness of the test. This tool will be freely accessible to health professionals and patients online.
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Affiliation(s)
- Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Lesley Goldsmith
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Heather Skirton
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.
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Smith AL, Teener JW, Callaghan BC, Harrington J, Uhlmann WR. Amyotrophic lateral sclerosis in a patient with a family history of huntington disease: genetic counseling challenges. J Genet Couns 2014; 23:725-33. [PMID: 24763861 DOI: 10.1007/s10897-014-9715-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/12/2014] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) and Huntington disease (HD) are generally considered to be distinct and easily differentiated neurologic conditions. However, there are case reports of the co-occurrence of ALS with HD. We present a 57-year-old male with a clinical diagnosis of sporadic ALS in the context of a family history of HD. This case adds to the limited literature regarding individuals with a family history of HD who present with features of ALS. There were several genetic counseling challenges in counseling this patient including the diagnostic consideration of two fatal conditions, complex risk information, the personal and familial implications, and the patient's inability to communicate verbally or through writing due to disease progression. DNA banking effectively preserved the right of our patient and his wife not to learn his HD genetic status during a stressful time of disease progression while providing the option for family members to learn this information in the future if desired. We present lessons learned and considerations for other clinical genetics professionals who are presented with similar challenging issues.
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Affiliation(s)
- Andrea L Smith
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA,
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Ormond KE, Cho MK. Translating personalized medicine using new genetic technologies in clinical practice: the ethical issues. Per Med 2014; 11:211-222. [PMID: 25221608 PMCID: PMC4160120 DOI: 10.2217/pme.13.104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The integration of new genetic technologies into clinical practice holds great promise for the personalization of medical care, particularly the use of large-scale DNA sequencing for genome-wide genetic testing. However, these technologies also yield unprecedented amounts of information whose clinical implications are not fully understood, and we are still developing technical standards for measuring sequence accuracy. These technical and clinical challenges raise ethical issues that are similar to but qualitatively different from those that we are accustomed to dealing with for traditional medical genetics. The sheer amount of information afforded by genome sequencing requires rethinking of how to implement core ethical principles including, but not limited to: informed consent, privacy and data ownership and sharing, technology regulation, issues of access, particularly as new technology is integrated into clinical practice, and issues of potential stigma and impact on perceptions of disability. In this article, we will review the issues of informed consent, privacy, data ownership and technology regulation as they relate to the emerging field of personalized medicine and genomics.
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Affiliation(s)
- Kelly E Ormond
- Department of Genetics, Mail Stop-5208, Stanford University, Stanford, CA 94305-5208, USA
- Stanford Center for Biomedical Ethics, 1215 Welch Road, Modular A, Stanford, CA 94305-5417, USA
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, 1215 Welch Road, Modular A, Stanford, CA 94305-5417, USA
- Department of Pediatrics, 300 Pasteur Drive, Stanford, CA 94305-5208, USA
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Cruz-Mariño T, Velázquez-Pérez L, González-Zaldivar Y, Aguilera-Rodríguez R, Velázquez-Santos M, Vázquez-Mojena Y, Estupiñán-Rodríguez A, Laffita-Mesa JM, Reynaldo-Armiñán R, Almaguer-Mederos LE, Paneque M. The Cuban program for predictive testing of SCA2: 11 years and 768 individuals to learn from. Clin Genet 2013; 83:518-24. [PMID: 23495852 DOI: 10.1111/cge.12142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 11/29/2022]
Abstract
Having reported the world's highest prevalence of spinocerebellar ataxia type 2 (SCA2), health professionals in Cuba developed a program for the predictive testing of this condition. Between February 2001 and December 2011, a total of 1050 individuals requested their inclusion in the presymptomatic testing (PST) program. Their medical records were retrospectively analyzed in the present descriptive study. A total of 768 participants completed the protocol, 204 withdrew and 78 were excluded. The PST uptake was 24.91%. Females predominated and 70.96% had negative test results. Their main motivations were risk assessment in their descendants, physical and psychological preparation to cope with the disease and planning for the future. The profile of Cuban participants in the predictive testing program is similar to the one reported for other programs all over the world, nevertheless the genetic counseling practice at the community level is a distinctive aspect, which is valuable in providing at-risk individuals with wide and proper knowledge before their testing inclusion request. The SCA2 predictive testing program has high uptake rates and is renowned in our population. Future research is needed to assess the long-term psychological impact in the participants, their partners and relatives.
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Affiliation(s)
- T Cruz-Mariño
- Predictive Genetics Department, Center for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.
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Nippert I, Julian-Reynier C, Harris H, Evans G, van Asperen CJ, Tibben A, Schmidtke J. Cancer risk communication, predictive testing and management in France, Germany, the Netherlands and the UK: general practitioners' and breast surgeons' current practice and preferred practice responsibilities. J Community Genet 2013; 5:69-79. [PMID: 24297247 DOI: 10.1007/s12687-013-0173-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022] Open
Abstract
Genetic testing has its greatest public health value when it identifies individuals who will benefit from specific interventions based upon their risk. This paradigm is the basis for the use of predictive tests, such as BRCA1/BRCA2 testing which has become part of clinical practice for more than a decade. Currently predictive BRCA1/BRCA2 testing is offered to women using low, moderate and high risk based upon family history as cut-off levels. Non-genetic health professionals such as general practitioners (GPs) and breast surgeons (BS) are seen as gatekeepers to manage demand and/or facilitate access to appropriate services for high-risk patients. Data about current practices are lacking. The paper presents data on the current practice of GPs' and BS' cancer risk assessment, referral practices and preferred practice responsibilities for women at risk for familial breast cancer in France, Germany, the Netherlands and the UK derived by a self-administered questionnaire send to a representative sample of GPs and BS in the four countries. One thousand one hundred ninety-seven GPs and 1,223 BS completed the questionnaire. Both GPs and BS reported that they are consulted by a considerable number of patients presenting with concerns about a family history of cancer. Both commonalities and striking differences could be observed between GPs and BS from the four participating countries. GPs from France and Germany reported significantly higher proportions taking a family history of cancer including the extended family than GPs from the Netherlands and the UK. Most GPs from France, Germany and the Netherlands stated their willingness for providing risk assessment for an unaffected (high-risk) woman with a family history of breast cancer and the vast majority of BS from all four countries reported that they themselves would provide risk assessment for an unaffected (high-risk) woman with a family history of breast cancer. However, a substantial number of both GPs and BS would not have taken an appropriate family history for their patient failing to take into account the paternal side of the family. GPs from Germany reported a significantly lower readiness to refer a patient with a family history of a BRCA1 mutation for specialist genetic counselling when compared to the GPs from the other countries. GPs and BS from France, Germany and the Netherlands significantly less often assigned practice responsibilities to a genetic specialist as compared to the participating GPs and BS from the UK. The outcome of the study confirms the need for capability building in genetics for non-genetic health professionals. Using genetic risk assessment tools without a full understanding could result in missed opportunities for cancer prevention and harm patients. In order to provide best possible services for high-risk patients presenting with cancer concerns, close collaboration with clinical geneticists should become routine part of mainstream medical practice.
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Affiliation(s)
- Irmgard Nippert
- Women's Health Research Unit/Department of Human Genetics, Medical School, Westfaelische Wilhelms-University, Münster, Germany,
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Skirton H, Jackson L, Goldsmith L, O'Connor A. Are health professionals ready for direct-to-consumer genetic and genomic testing? Per Med 2013; 10:673-682. [PMID: 29768754 DOI: 10.2217/pme.13.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Direct-to-consumer genetic and genomic tests have been offered for over a decade. With the reduction in the cost of sequencing, the options for consumers will increase, with subsequent pressure on health services to interpret data and integrate the results into healthcare management. However, indications are that health professionals are grossly unprepared to deal with requests for support from those who have undertaken direct-to-consumer genetic or genomic tests. While benefits may be derived from patient-driven investigations, distinction needs to be made between the mostly uncertain clinical utility of susceptibility testing and the potential benefits of a reliably interpreted sequencing result. It is essential that we develop strategies, including enhanced professional education, to cope with the potential impact on the health services, rather than ignoring these developments. There may also be implications for the future of genetic counseling, with potential changes in the current paradigm.
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Affiliation(s)
- Heather Skirton
- Applied Health Genetics Research Group, Faculty of Health, Education & Society, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK.
| | - Leigh Jackson
- Applied Health Genetics Research Group, Faculty of Health, Education & Society, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK
| | - Lesley Goldsmith
- Applied Health Genetics Research Group, Faculty of Health, Education & Society, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK
| | - Anita O'Connor
- Applied Health Genetics Research Group, Faculty of Health, Education & Society, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK
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Dimond R. Patient and family trajectories of mitochondrial disease: diversity, uncertainty and genetic risk. LIFE SCIENCES, SOCIETY AND POLICY 2013; 9:2. [PMCID: PMC4513040 DOI: 10.1186/2195-7819-9-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 10/25/2023]
Abstract
Mitochondrial disease can be a devastating, degenerative illness, with limited treatment and no cure. Novel reproductive techniques involving mitochondria donation present an opportunity for women with mitochondrial disease to prevent the transmission of disease to her offspring. Current IVF techniques, such as pre-implantation genetic diagnosis, reduce but do not eliminate the risk for the child. However, knowledge of the contexts within which this disease is experienced and reproductive decisions are made is limited. This article draws on qualitative interviews with adult patients to explore the practical realities of living with mitochondrial disease. Three key themes were identified; the personal and familial experiences of illness, age and generation as factors in shaping patient experience and the importance of experiential knowledge in making sense of reproductive choice. Overall, this article identifies potential barriers to patients accessing reproductive technologies highlighting how the complex nature and uncertain trajectory of mitochondrial disease poses considerable challenges for patients, practitioners and policy makers.
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Affiliation(s)
- Rebecca Dimond
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT UK
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Guimarães L, Sequeiros J, Skirton H, Paneque M. What counts as effective genetic counselling for presymptomatic testing in late-onset disorders? A study of the consultand's perspective. J Genet Couns 2013; 22:437-47. [PMID: 23292684 DOI: 10.1007/s10897-012-9561-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/06/2012] [Indexed: 11/24/2022]
Abstract
Genetic counselling must be offered in the context of presymptomatic testing (PST) for severe late-onset diseases; however, effective genetic counselling is not well defined, and measurement tools that allow a systematic evaluation of genetic practice are still not available. The aims of this qualitative study were to (1) recognize relevant aspects across the whole process of genetic counselling in PST for late-onset neurodegenerative disorders that might indicate effective practice from the consultand's perspective; and (2) analyse aspects of current protocols of counselling that might be relevant for successful practice. We interviewed 22 consultands undergoing PST for late-onset neurological disorders (Huntington disease, spinocerebellar ataxias and familial amyloid polyneuropathy ATTRV30M) in the three major counselling services for these diseases in Portugal. The main themes emerging from the content analysis were (1) the consultand's general assessment of the PST process in genetic services; (2) appropriateness and adaptation of the protocol to the consultand's personal expectations and needs; and (3) consultand's experience of the decision-making process and the role of engagement and counselling skills of the counsellor. Participants also provided a set of recommendations and constructive criticisms relating to the length of the protocol, the time gap between consultations and the way results were delivered. These issues and the construction of the relationship between counsellor and counselee should be further investigated and used for the improvement of current protocols of counselling.
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