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Cooper H, Simpson J, Dale M, Eccles FJR. Experiences of young people growing up in a family with Huntington's disease: A meta-ethnography of qualitative research. J Genet Couns 2024. [PMID: 38469914 DOI: 10.1002/jgc4.1886] [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: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Huntington's disease is a genetic neurodegenerative condition with wide physical and psychological impacts. Children of a parent with the condition have a 50% chance of carrying the gene expansion and developing the condition themselves. This systematic review and meta-ethnography presents a synthesis of the qualitative research on the experiences of young people growing up in a family with Huntington's disease. The MEDLINE, PsycINFO, and CINAHL databases were systematically searched, and 13 papers met the inclusion criteria. Through the process of meta-ethnography, four themes were identified highlighting aspects of childhood that were stolen and fought for: thief of relationships, thief of self, thief of transparency, and search for reclamation. Within the themes, the complex challenges young people faced when growing up in a HD family were explored such as the impact of adverse childhood experiences and the possible effects of HD on attachment and social relationships. Clinical implications are considered, and recommendations are made for future research.
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Affiliation(s)
- Hollie Cooper
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Leicestershire, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
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2
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 238] [Impact Index Per Article: 238.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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3
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Cirino AL, Harris SL, Murad AM, Hansen B, Malinowski J, Natoli JL, Kelly MA, Christian S. The uptake and utility of genetic testing and genetic counseling for hypertrophic cardiomyopathy-A systematic review and meta-analysis. J Genet Couns 2022; 31:1290-1305. [PMID: 35799446 DOI: 10.1002/jgc4.1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
Genetic testing and genetic counseling are routinely indicated for patients with hypertrophic cardiomyopathy (HCM); however, the uptake and utility of these services is not entirely understood. This systematic review and meta-analysis summarizes the uptake and utility of genetic counseling and genetic testing for patients with HCM and their at-risk family members, as well as the impact of genetic counseling/testing on patient-reported outcomes (PROs). A systematic search was performed through March 12, 2021. Meta-analyses were performed whenever possible; other findings were qualitatively summarized. Forty-eight studies met inclusion criteria (47 observational, 1 randomized). Uptake of genetic testing in probands was 57% (95% confidence interval [CI]: 40, 73). Uptake of cascade screening for at-risk relatives were as follows: 61% for cascade genetic testing (95% CI: 45, 75), 58% for cardiac screening (e.g. echocardiography) (95% CI: 40, 73), and 69% for either/both approaches (95% CI: 43, 87). In addition, relatives of probands with a positive genetic test result were significantly more likely to undergo cascade screening compared to relatives of probands with a negative result (odds ratio = 3.17, 95% CI: 2.12, 4.76). Overall, uptake of genetic counseling in both probands and relatives ranged from 37% to 84%. Multiple studies found little difference in PROs between individuals receiving positive versus negative genetic test results; however, other studies found that individuals with positive genetic test results experienced worse psychological outcomes. Genetic testing may also inform life choices, particularly decisions related to reproduction and insurance. Genetic counseling was associated with high satisfaction, increased perceived personal control and empowerment, and decreased anxiety. Approximately half to three-quarters of patients with HCM and their relatives undergo genetic testing or cascade screening. PROs after genetic testing varied and genetic counseling was associated with high satisfaction and improved PROs.
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Affiliation(s)
- Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Stephanie L Harris
- Cardiovascular Genetics Program, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea M Murad
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brittany Hansen
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jaime L Natoli
- Kaiser Permanente, Southern California Permanente Medical Group, Pasadena, California, USA
| | - Melissa A Kelly
- Geisinger, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | - Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
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4
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Jennings C, Wynn J, Miguel C, Levinson E, Florido ME, White M, Sands CB, Schwartz LA, Daly M, O'Toole K, Buys SS, Glendon G, Hanna D, Andrulis IL, Terry MB, Chung WK, Bradbury A. Mother and Daughter Perspectives on Genetic Counseling and Testing of Adolescents for Hereditary Breast Cancer Risk. J Pediatr 2022; 251:113-119.e7. [PMID: 35777474 DOI: 10.1016/j.jpeds.2022.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the risks, benefits, and utility of testing for adult-onset hereditary breast and ovarian cancer (HBOC) in adolescents and young adults. STUDY DESIGN We evaluated interest in genetic testing of adolescents for adult-onset HBOC genes through semistructured interviews with mothers and adolescents who had previously participated in breast cancer research or had pursued (mothers) clinical testing for HBOC. RESULTS The majority of mothers (73%) and daughters (75%) were interested in the daughter having genetic testing and were motivated by the future medical utility and current social utility of relieving anxiety and allowing them to prepare. Mothers and daughters both reported that approximately 3 years in the future was the best time to test the daughter regardless of the current age of the daughter. Overall, both mothers and daughters expressed the importance of the involvement of the mother to provide educational and emotional support but ultimately it was the daughter's decision to test. Balancing the independence and maturity of the daughter while reinforcing communication and support within the dyad was a prominent theme throughout the interviews. CONCLUSIONS There is interest among some high-risk adolescents and young adults to engage in genetic counseling and undergo testing. Providing pretest and posttest genetic counseling, assessing preferences for parent involvement, and offering psychosocial support may be important if genetic testing for HBOC is offered to adolescents and young adults before age 25 years.
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Affiliation(s)
- Catherine Jennings
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY; Genetic Counseling Graduate Program, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Cecilia Miguel
- Genetic Counseling Graduate Program, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Elana Levinson
- Genetic Counseling Graduate Program, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Michelle E Florido
- Genetic Counseling Graduate Program, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Melissa White
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY
| | - Colleen Burke Sands
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lisa A Schwartz
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mary Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Karen O'Toole
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Saundra S Buys
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Gordon Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Danielle Hanna
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY
| | - Wendy K Chung
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY; Department of Medicine, Columbia University Irving Medical Center, New York, NY.
| | - Angela Bradbury
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Wells I, Simons G, Davenport C, Mallen CD, Raza K, Falahee M. Acceptability of predictive testing for ischemic heart disease in those with a family history and the impact of results on behavioural intention and behaviour change: a systematic review. BMC Public Health 2022; 22:1751. [PMID: 36109776 PMCID: PMC9479351 DOI: 10.1186/s12889-022-14116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tests to predict the development of chronic diseases in those with a family history of the disease are becoming increasingly available and can identify those who may benefit most from preventive interventions. It is important to understand the acceptability of these predictive approaches to inform the development of tools to support decision making. Whilst data are lacking for many diseases, data are available for ischemic heart disease (IHD). Therefore, this study investigates the willingness of those with a family history of IHD to take a predictive test, and the effect of the test results on risk-related behaviours. METHOD Medline, EMBASE, PsycINFO, LILACS and grey literature were searched. Primary research, including adult participants with a family history of IHD, and assessing a predictive test were included. Qualitative and quantitative outcomes measuring willingness to take a predictive test and the effect of test results on risk-related behaviours were also included. Data concerning study aims, participants, design, predictive test, intervention and findings were extracted. Study quality was assessed using the Standard Quality Assessment Criteria for Evaluating Research Papers from a Variety of Fields and a narrative synthesis undertaken. RESULTS Five quantitative and two qualitative studies were included. These were conducted in the Netherlands (n = 1), Australia (n = 1), USA (n = 1) and the UK (n = 4). Methodological quality ranged from moderate to good. Three studies found that most relatives were willing to take a predictive test, reporting family history (n = 2) and general practitioner (GP) recommendation (n = 1) as determinants of interest. Studies assessing the effect of test results on behavioural intentions (n = 2) found increased intentions to engage in physical activity and smoking cessation, but not healthy eating in those at increased risk of developing IHD. In studies examining actual behaviour change (n = 2) most participants reported engaging in at least one preventive behaviour, particularly medication adherence. CONCLUSION The results suggests that predictive approaches are acceptable to those with a family history of IHD and have a positive impact on health behaviours. Further studies are needed to provide a comprehensive understanding of predictive approaches in IHD and other chronic conditions.
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Affiliation(s)
- Imogen Wells
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS trust, Birmingham, UK.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre, Versus Arthritis, University of Birmingham, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Goldman JS, Vallabh SM. Genetic counseling for prion disease: Updates and best practices. Genet Med 2022; 24:1993-2003. [PMID: 35819418 DOI: 10.1016/j.gim.2022.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022] Open
Abstract
Prion disease is a rare, fatal, and often rapidly progressive neurodegenerative disease. Ten to fifteen percent of cases are caused by autosomal dominant gain-of-function variants in the prion protein gene, PRNP. Rarity and phenotypic variability complicate diagnosis, often obscuring family history and leaving families unprepared for the genetic implications of an index case. Several recent developments inspire this update in best practices for prion disease genetic counseling. A new prion-detection assay has transformed symptomatic diagnosis. Meanwhile, penetrance, age of onset, and duration of illness have been systematically characterized across PRNP variants in a global cohort. Clinically, the traditional genotype-phenotype correlation has weakened over time, and the term genetic prion disease may now better serve providers than the historical subtypes Creutzfeldt-Jakob disease, fatal familial insomnia, and Gerstmann-Sträussler-Scheinker disease. Finally, in the age of genetically targeted therapies, clinical trials for prion disease are being envisaged, and healthy at-risk individuals may be best positioned to benefit. Such individuals need to be able to access clinical services for genetic counseling and testing. Thus, this update on the genetics of prion disease and best practices for genetic counseling for this disease aims to provide the information needed to expand genetic counseling services.
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Affiliation(s)
| | - Sonia M Vallabh
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA; Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Prion Alliance, Cambridge, MA.
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7
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Roos P, Johannsen P, Lindquist SG, Brown JM, Waldemar G, Duno M, Nielsen TT, Budtz‐Jørgensen E, Gydesen S, Holm IE, Collinge J, Isaacs AM, Nielsen JE, Gade A, Stokholm J, Thusgaard T, Fisher EM, Englund E. Six generations of CHMP2B-mediated Frontotemporal Dementia: Clinical features, predictive testing, progression, and survival. Acta Neurol Scand 2022; 145:529-540. [PMID: 34997757 DOI: 10.1111/ane.13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Chromosome 3-linked frontotemporal dementia (FTD-3) is caused by a c.532-1G > C mutation in the CHMP2B gene. It is extensively studied in a Danish family comprising one of the largest families with an autosomal dominantly inherited frontotemporal dementia (FTD). This retrospective cohort study utilizes demographics to identify risk factors for onset, progression, life expectancy, and death in CHMP2B-mediated FTD. The pedigree of 528 individuals in six generations is provided, and clinical descriptions are presented. Choices of genetic testing are evaluated. MATERIALS AND METHODS Demographic and lifestyle factors were assessed in survival analysis in all identified CHMP2B mutation carriers (44 clinically affected FTD-3 patients and 16 presymptomatic CHMP2B mutation carriers). Predictors of onset and progression included sex, parental disease course, education, and vascular risk factors. Life expectancy was established by matching CHMP2B mutation carriers with average life expectancies in Denmark. RESULTS Disease course was not correlated to parental disease course and seemed unmodified by lifestyle factors. Diagnosis was recognized at an earlier age in members with higher levels of education, probably reflecting an early dysexecutive syndrome, unmasked earlier in people with higher work-related requirements. Carriers of the CHMP2B mutation had a significant reduction in life expectancy of 13 years. Predictive genetic testing was chosen by 20% of at-risk family members. CONCLUSIONS CHMP2B-mediated FTD is substantiated as an autosomal dominantly inherited disease of complete penetrance. The clinical phenotype is a behavioral variant FTD. The disease course is unpredictable, and life expectancy is reduced. The findings may be applicable to other genetic FTD subtypes.
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Affiliation(s)
- Peter Roos
- Danish Dementia Research Centre Department of Neurology Rigshospitalet University of Copenhagen Denmark
| | - Peter Johannsen
- Danish Dementia Research Centre Department of Neurology Rigshospitalet University of Copenhagen Denmark
- Medical & Science Novo Nordisk A/S Søborg Denmark
| | - Suzanne G. Lindquist
- Danish Dementia Research Centre Department of Neurology Rigshospitalet University of Copenhagen Denmark
- Department of Clinical Genetics, Rigshospitalet University of Copenhagen Denmark
| | | | - Gunhild Waldemar
- Danish Dementia Research Centre Department of Neurology Rigshospitalet University of Copenhagen Denmark
| | - Morten Duno
- Department of Clinical Genetics, Rigshospitalet University of Copenhagen Denmark
| | - Troels T. Nielsen
- Danish Dementia Research Centre Department of Neurology Rigshospitalet University of Copenhagen Denmark
| | - Esben Budtz‐Jørgensen
- Section of Biostatistics Department of Public Health University of Copenhagen Denmark
| | | | - Ida E. Holm
- Department of Pathology Aalborg University Hospital Randers Denmark
| | - John Collinge
- MRC Prion Unit at UCL UCL Institute of Prion Diseases Courtauld Building London UK
| | - Adrian M. Isaacs
- Department of Neuromuscular Diseases UCL Institute of Neurology Queen Square London UK
- UK Dementia Research Institute at UCL UCL Institute of Neurology Queen Square London UK
| | - Jørgen E. Nielsen
- Danish Dementia Research Centre Department of Neurology Rigshospitalet University of Copenhagen Denmark
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Patient-Reported Outcomes following Genetic Testing for Familial Hypercholesterolemia, Breast and Ovarian Cancer Syndrome, and Lynch Syndrome: A Systematic Review. J Pers Med 2021; 11:jpm11090850. [PMID: 34575627 PMCID: PMC8467628 DOI: 10.3390/jpm11090850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Patient-reported outcomes (PROs) and PRO measures (PROMs) are real-world evidence that can help capture patient experiences and perspectives regarding a clinical intervention such as genetic testing. Objective: To identify and capture methods and qualitative PRO themes among studies reporting PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Methods: A systematic review was conducted via PubMed/MEDLINE, EMBASE, and Yale University’s TRIP Medical Databases on articles published by April 2021. Results: We identified 24 studies published between 1996 and 2021 representing 4279 participants that reported PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Studies collected and reported PROs from validated PROM instruments (n = 12; 50%), validated surveys (n = 7; 26%), and interviews (n = 10; 42%). PRO themes ranged across all collection methods (e.g., psychological, knowledge, coping and satisfaction, concern about stigma/discrimination, etc.). Conclusions: Important gaps identified include (1) most studies (n = 18; 75%) reported PROs following genetic testing for breast and ovarian cancer, and (2) populations reporting PROs overall were largely of White/Caucasian/Northern European/Anglo-Saxon descent. We offer recommendations and describe real-world implications for the field moving forward.
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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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10
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Ahimaz P, Sabatello M, Qian M, Wang A, Miller EM, Parrott A, Lal AK, Chatfield KC, Rossano JW, Ware SM, Parent JJ, Kantor P, Yue L, Wynn J, Lee TM, Addonizio LJ, Appelbaum PS, Chung WK. Impact of Genetic Testing for Cardiomyopathy on Emotional Well-Being and Family Dynamics: A Study of Parents and Adolescents. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003189. [PMID: 34255550 DOI: 10.1161/circgen.120.003189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genetic testing is indicated for children with a personal or family history of hereditary cardiomyopathy to determine appropriate management and inform risk stratification for family members. The implications of a positive genetic result for children can potentially impact emotional well-being. Given the nuances of cardiomyopathy genetic testing for minors, this study aimed to understand how parents involve their children in the testing process and investigate the impact of genetic results on family dynamics. METHODS A survey was distributed to participants recruited from the Children's Cardiomyopathy Foundation and 7 North American sites in the Pediatric Cardiomyopathy Registry. The survey explored adolescent and parent participants' emotions upon receiving their/their child's genetic results, parent-child result communication and its impact on family functionality, using the McMaster Family Assessment Device. RESULTS One hundred sixty-two parents of minors and 48 adolescents who were offered genetic testing for a personal or family history of cardiomyopathy completed the survey. Parents whose child had cardiomyopathy were more likely to disclose positive diagnostic genetic results to their child (P=0.014). Parents with unaffected children and positive predictive testing results were more likely to experience negative emotions about the result (P≤0.001) but also had better family functioning scores than those with negative predictive results (P=0.019). Most adolescents preferred results communicated directly to the child, but parents were divided about whether their child's result should first be released to them or their child. CONCLUSIONS These findings have important considerations for how providers structure genetic services for adolescents and facilitate discussion between parents and their children about results.
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Affiliation(s)
- Priyanka Ahimaz
- Division of Molecular Genetics, Department of Pediatrics (P.A., J.W., W.K.C.), Columbia University Irving Medical Center
| | - Maya Sabatello
- Center for Precision Medicine and Genomics, Division of Ethics, Departments of Medicine, Medical Humanities and Ethics (M.S.)
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health (M.Q., A.W.)
| | - Aijin Wang
- Department of Biostatistics, Mailman School of Public Health (M.Q., A.W.)
| | - Erin M Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Heart Institute Cincinnati, OH (E.M.M.)
| | - Ashley Parrott
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (A.P.)
| | - Ashwin K Lal
- Primary Children's Hospital, University of Utah, Salt Lake City (A.K.L.)
| | - Kathryn C Chatfield
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (K.C.C.)
| | | | - Stephanie M Ware
- Departments of Pediatrics and Medical and Molecular Genetics (S.M.W.), Indiana University School of Medicine, Indianapolis
| | - John J Parent
- Department of Pediatrics (J.J.P.), Indiana University School of Medicine, Indianapolis
| | - Paul Kantor
- Stollery Children's Hospital, Edmonton, Alberta, Canada (P.K.)
| | - Lisa Yue
- Children's Cardiomyopathy Foundation (L.Y.), Columbia University Irving Medical Center
| | - Julia Wynn
- Division of Molecular Genetics, Department of Pediatrics (P.A., J.W., W.K.C.), Columbia University Irving Medical Center
| | - Teresa M Lee
- Division of Cardiology, Department of Pediatrics (T.M.L., L.J.A.), Columbia University Irving Medical Center
| | - Linda J Addonizio
- Division of Cardiology, Department of Pediatrics (T.M.L., L.J.A.), Columbia University Irving Medical Center
| | - Paul S Appelbaum
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY (P.S.A.)
| | - Wendy K Chung
- Division of Molecular Genetics, Department of Pediatrics (P.A., J.W., W.K.C.), Columbia University Irving Medical Center.,Department of Medicine (W.K.C.), Columbia University Irving Medical Center
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11
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Martin AP, Downing J, Collins B, Godman B, Alfirevic A, Greenhalgh KL, Pirmohamed M. Examining the uptake of predictive BRCA testing in the UK; findings and implications. Eur J Hum Genet 2021; 29:699-708. [PMID: 33328582 PMCID: PMC8115171 DOI: 10.1038/s41431-020-00783-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/08/2022] Open
Abstract
Predictive BRCA testing is offered to asymptomatic individuals to predict future risk where a variant has been identified in a relative. It is uncertain whether all eligible relatives access testing, and whether this is related to health care inequalities. Our aim was to analyse trends and inequalities in uptake of testing, and identify predictors of testing and time-to-receipt of testing. A database from April 2010 to March 2017 was collated. Multivariate analysis explored individual associations with testing. Predictor variables included gender, BRCA test type, cancer history, Index of Multiple Deprivation (IMD) and education status. To evaluate factors associated with time-to-testing, a Cox proportional-hazards (CP) model was used. Of 779 tests undertaken, 336 (43.1%) were identified with a BRCA variant. A total of 537 (68.9%) were female and in 83.4% (387/464) of probands, predictive testing was received by relatives. Analysis identified inequalities since decreased testing was found when the proband was unaffected by cancer (OR 0.14, 95% CI 0.06-0.33). Median time-to-testing was 390 days (range, 0-7090 days) and the CP model also identified inequalities in the hazard ratio (HR) for testing for people aged >40 was higher than for aged <40 (HR 1.41, 95% CI 1.20-1.67) and BRCA2 testing was higher than for BRCA1 testing (HR 1.39, 95% CI 1.18-1.64). Reduced testing was found when probands were unaffected by cancer and time-to-testing was found to vary by age and BRCA1/2 test. Given limited study sample size, further research is recommended to examine inequalities in predictive BRCA testing.
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Affiliation(s)
- Antony P Martin
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK.
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK.
| | - Jennifer Downing
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Brian Godman
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Ana Alfirevic
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | | | - Munir Pirmohamed
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), North West Coast, UK
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
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12
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Holland L, Young MA, Lewin J, Pearce A, Thompson K. Education in youth-friendly genetic counseling. J Genet Couns 2021; 30:1133-1142. [PMID: 33786933 DOI: 10.1002/jgc4.1397] [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: 07/19/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/11/2022]
Abstract
Genetic counselors have long recognized the challenges of working with adolescents and young adults (AYA) and their families. In 2010, a framework of Youth-friendly Genetic Counseling was developed by an expert reference group with the aim to improve both care for AYAs and the experience of health professionals delivering that care. Subsequently, an education workshop was developed aimed to upskill genetic health professionals in youth-friendly genetic counseling. The workshop was piloted with genetic counselors in Australia and New Zealand. A purpose designed, pre- and post-workshop survey and post-workshop focus group was utilized for evaluation. Mean confidence scores increased pre- and post-workshop. Participants also demonstrated increases in knowledge regarding: adolescent development; developmental theory; social factors impacting on health; the needs of young people; practice challenges; youth-friendly engagement, communication, consent and confidentiality; practice approaches; principles of adolescent healthcare; ethical issues; and available services and resources. Focus group data revealed several themes relating to practice challenges, learning gains, barriers, and enablers to clinical translation and workshop feedback. Results demonstrate utility of the workshop in up-skilling genetic health professionals in the provision of youth-friendly genetic counseling. Consideration of adaptation and sustainability, by embedding this theoretical and skills-based workshop as a module within genetic counseling education, is required to ensure practice competence and the best health outcomes for young people and their families.
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Affiliation(s)
- Lucy Holland
- Queensland University of Technology, Brisbane, Queensland, Australia.,Children's Health Queensland, Brisbane, Queensland, Australia.,The University of Newcastle, Newcastle, New South Wales, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,Univeristy of New South Wales, Sydney, New South Wales, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Victoria, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Pearce
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
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13
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Pavarini G, Hamdi L, Lorimer J, Singh I. Young people's moral attitudes and motivations towards direct-to-consumer genetic testing for inherited risk of Alzheimer disease. Eur J Med Genet 2021; 64:104180. [PMID: 33781925 PMCID: PMC8192412 DOI: 10.1016/j.ejmg.2021.104180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 11/18/2022]
Abstract
Purpose Since the U.S. Food and Drug Administration approved sales of genetic tests for late-onset Alzheimer's disease (LOAD) risk, a heated debate has arisen over whether these tests should indeed be offered online and direct-to-consumer (DTC). As this debate progresses, it is important to understand the ethical perspectives and motivations of young people, who are a key target group for DTC services. Methods Thirty-one grandchildren of people with LOAD, aged 16–26, were interviewed about their moral attitudes and motivations with regards to DTC genetic testing for LOAD. Results Even though most participants claimed that people should have the right to access these services, they also expressed concerns about potential distress in response to learning about risk, particularly for minors. About a third were interested in testing, primarily to gain self-knowledge regarding one's health; however, face-to-face services were vastly preferred over the online option. Conclusion While DTC genetic companies often market their services as a “fun consumer product”, DTC testing for LOAD was largely understood as a serious health screening procedure and a vulnerable moment in the lives of young people in Alzheimer's families. This points to the importance of appropriate standards of information and support to young people pre- and post-testing.
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Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Ethics and Humanities, University of Oxford, UK
| | - Lamis Hamdi
- Department of Psychiatry, University of Oxford, UK.
| | - Jessica Lorimer
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Ethics and Humanities, University of Oxford, UK
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Ethics and Humanities, University of Oxford, UK
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14
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Nurmi SM, Halkoaho A, Moilanen J, Remes AM, Solje E. The ethical implications of genetic testing in neurodegenerative diseases: A systematic review. Scand J Caring Sci 2020; 35:1057-1074. [PMID: 33210792 DOI: 10.1111/scs.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Availability of genetic testing in neurodegenerative disorders has developed rapidly. This growing ability is providing specific genetic information to individuals and, in turn, their families, raising ethical concerns. However, family members' perspective is a seldom-studied phenomenon. AIM The aim of this systematic review was to describe the ethical aspect of genetic testing in neurodegenerative diseases from the perspective of at-risk family members. METHOD A systematic review of data was performed in accordance with the PRISMA statement. The data search was conducted using the CINAHL, PubMed and Scopus databases to identify original peer-reviewed studies published between January 2009 and April 2019. A total of 24 articles were selected. The data were analysed using inductive content analysis. FINDINGS On the basis of the analysis, four central ethical implications were identified: (i) decision-making in genetic testing as a dilemma: balance between autonomy and responsibility, (ii) the individual's right to make a voluntary and informed decision for genetic testing, (iii) conflicting emotions after knowing one's genetic status and (iv) privacy and confidentiality of genetic information: the fear of genetic discrimination and stigma. CONCLUSIONS The findings of this review increase understanding about the central ethical implications of genetic testing in neurodegenerative diseases from the perspective of family members, and identify and underline outstanding needs for further research.
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Affiliation(s)
| | - Arja Halkoaho
- Tampere University of Applied Sciences, Tampere, Finland
| | - Jukka Moilanen
- Department of Clinical Genetics, Oulu University Hospital, Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu and Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
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15
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Mosor E, Stoffer-Marx M, Steiner G, Raza K, Stack RJ, Simons G, Falahee M, Skingle D, Dobrin M, Schett G, Englbrecht M, Smolen JS, Kjeken I, Hueber AJ, Stamm TA. I Would Never Take Preventive Medication! Perspectives and Information Needs of People Who Underwent Predictive Tests for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:360-368. [PMID: 30710453 PMCID: PMC7064954 DOI: 10.1002/acr.23841] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Little is known about the experiences, values, and needs of people without arthritis who undergo predictive biomarker testing for the development of rheumatoid arthritis (RA). Our study aimed to explore the perspectives of these individuals and describe their information needs. METHODS A qualitative, multicenter interview study with a thematic analysis was conducted in Austria, Germany and the UK. Individuals were interviewed who underwent predictive biomarker testing for RA and had a positive test result but no diagnosis of any inflammatory joint disease. Participants included patients with arthralgia and asymptomatic individuals. Information and education needs were developed from the qualitative codes and themes using the Arthritis Educational Needs Assessment Tool as a frame of reference. RESULTS Thematic saturation was reached in 34 individuals (76% female, 24 [71%] with arthralgia, and 10 [29%] asymptomatic individuals). Thirty-seven codes were summarized into 4 themes: 1) decision-making around whether to undergo initial predictive testing, 2) willingness to consider further predictive tests, and/or 3) preventive interventions, including medication, and 4) varying reactions after receiving a positive test result. Individuals with arthralgia were more likely to be willing to take preventive action, undergo further testing, and experience psychological distress than asymptomatic individuals. All participants expressed the need for tailored, patient-understandable information. CONCLUSION Individuals at risk of RA are currently the subjects of research aimed at developing better predictive strategies and preventive approaches. Their perceptions and needs should be addressed to inform the future development of interventions combined with education.
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Affiliation(s)
- Erika Mosor
- Medical University of Vienna, Vienna, Austria
| | | | - Günter Steiner
- Medical University of Vienna and Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria
| | - Karim Raza
- University of Birmingham and Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | | | - Mircia Dobrin
- The Romanian League Against Rheumatism, Timisoara, Romania
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Ingvild Kjeken
- Oslo Metropolitan University and Diakonhjemmet Hospital, Oslo, Norway
| | - Axel J Hueber
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja A Stamm
- Medical University of Vienna and Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria
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16
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Platt J. A Person-Centered Approach to Cardiovascular Genetic Testing. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036624. [PMID: 31570390 DOI: 10.1101/cshperspect.a036624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular genetic counselors provide guidance to people facing the reality or prospect of inherited cardiovascular conditions. Key activities in this role include discussing clinical cardiac screening for at-risk family members and offering genetic testing. Psychological factors often influence whether patients choose to have genetic testing and how they understand and communicate the results to at-risk relatives, so psychological counseling increases the impact of genetic education and medical recommendations. This work reviews the literature on the factors that influence patient decisions about cardiovascular genetic testing and the psychological impact of results on people who opt to test. It also models use of a psychological framework to apply themes from the literature to routine cardiovascular genetic counseling practice. Modifications of the framework are provided to show how it can be adapted to serve the needs of both new and experienced genetic counselors.
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Affiliation(s)
- Julia Platt
- Stanford Center for Inherited Cardiovascular Disease, Falk Cardiovascular Research Center, Stanford, California 94305, USA
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17
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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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18
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Andersson NG, Rossing M, Fager Ferrari M, Gabrielaite M, Leinøe E, Ljung R, Mårtensson A, Norström E, Zetterberg E. Genetic screening of children with suspected inherited bleeding disorders. Haemophilia 2020; 26:314-324. [DOI: 10.1111/hae.13948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Nadine G. Andersson
- Department of Clinical Sciences Paediatrics Lund University Lund Sweden
- Centre for Thrombosis and Haemostasis Skåne University Hospital Malmö Sweden
- Department for Paediatric Haematology and Oncology Skåne University Hospital Malmö Sweden
| | - Maria Rossing
- Centre for Genomic Medicine Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Marcus Fager Ferrari
- Centre for Thrombosis and Haemostasis Skåne University Hospital Malmö Sweden
- Department of Translational Medicine Lund University Malmö Sweden
| | - Migle Gabrielaite
- Centre for Genomic Medicine Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Eva Leinøe
- Department of Haematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Rolf Ljung
- Department of Clinical Sciences Paediatrics Lund University Lund Sweden
| | - Annika Mårtensson
- Department of Clinical Sciences Paediatrics Lund University Lund Sweden
- Department for Paediatric Haematology and Oncology Skåne University Hospital Malmö Sweden
| | - Eva Norström
- Department for Clinical Chemistry Skåne University Hospital Malmö Sweden
| | - Eva Zetterberg
- Centre for Thrombosis and Haemostasis Skåne University Hospital Malmö Sweden
- Department of Translational Medicine Lund University Malmö Sweden
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19
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Lenk C, Duttge G, Flatau L, Frommeld D, Poser W, Reitt M, Schulze T, Weber A, Zoll B. A look into the future? Patients' and health care staff's perception and evaluation of genetic information and the right not to know. Am J Med Genet B Neuropsychiatr Genet 2019; 180:576-588. [PMID: 31287218 DOI: 10.1002/ajmg.b.32751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/12/2022]
Abstract
The progress of medical genetics leads to a significant increase in genetic knowledge and a vast expansion of genetic diagnostics. However, it is still unknown how these changes will be integrated into medical practice and how they will change patients' and healthy persons' perception and evaluation of genetic diagnoses and genetic knowledge. Therefore, we carried out a comprehensive questionnaire survey with more than 500 patients, clients seeking genetic counseling, health care staff, and healthy persons (N = 523). The questionnaire survey covered detailed questions on the value of genetic diagnoses for the different groups of study participants, the right to know or not to know genetic diagnoses, possible differences between genetic and other medical diagnoses, and the practical use and implications of genetic knowledge with a special focus on hereditary neuropsychiatric diseases. A huge majority of the participants (90.7%) stated to have a right to learn every aspect of her or his genetic make-up. Similarly, study participants showed high interest (81.8%) in incidental health care findings-independent of whether the diseases are treatable or not. One can derive from the data outcome that study participants did not follow the implications of a "genetic exceptionalism" and often considered genetic findings as equivalent in relation to other medical diagnoses.
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Affiliation(s)
- Christian Lenk
- Institute for the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Gunnar Duttge
- Center for Medical Law, Göttingen University, Göttingen, Germany
| | - Laura Flatau
- Institute of Psychiatric Phenomics and Genomics, Ludwigs-Maximilians-Universität München, München, Germany
| | - Debora Frommeld
- Institute for Social Research and Technology Assessment, Regensburg University of Applied Sciences, Regensburg, Germany
| | - Wolfgang Poser
- Department of Psychiatry and Psychotherapy, Göttingen University, Göttingen, Germany
| | - Markus Reitt
- Department of Psychiatry and Psychotherapy, Göttingen University, Göttingen, Germany
| | - Thomas Schulze
- Institute of Psychiatric Phenomics and Genomics, Ludwigs-Maximilians-Universität München, München, Germany
| | - Alexandra Weber
- Center for Medical Law, Göttingen University, Göttingen, Germany
| | - Barbara Zoll
- Institute of Human Genetics, Göttingen University, Göttingen, Germany
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20
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Young MA, Thompson K, Lewin J, Holland L. A framework for youth-friendly genetic counseling. J Community Genet 2019; 11:161-170. [PMID: 31691103 DOI: 10.1007/s12687-019-00439-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022] Open
Abstract
Young people represent a unique cohort in the context of both healthcare and genetic risk. Genetic counselors have long recognized and documented the challenges of working with young people and their families compared with working with older adults. Challenges for health professionals include engagement with the young person, communication, developmentally appropriate psychosocial assessment, and working with the young person and their family. Likewise, young people also report experiencing challenges within the genetic counseling process. In response to these challenges, and increasing numbers of young people presenting for genetic testing, genetic counselors at the Parkville Familial Cancer Centre (Peter MacCallum Cancer Centre, Australia) formed a collaboration with the ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service. Consisting of a multidisciplinary expert panel who provide care to young people with cancer and their families, the collaboration identified the need to develop an evidence-based framework to ensure the delivery of youth-friendly care and support for young people and their families facing genetic risk. To guide this work, a working party comprising of experts in genetic counseling, adolescent and young adult (AYA) oncology, adolescent health, clinical ethics, and clinical research was established. A literature review was undertaken and based on expert and consumer input and feedback, a consensus-based framework for youth-friendly genetic counseling was developed over several stages. This paper describes the evidence base supporting the development of this framework, the process of development, and the resulting framework of youth-friendly genetic counseling.
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Affiliation(s)
- Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, 370 Victoria St Darlinghurst, Sydney, NSW, 2010, Australia. .,Parkville Familial Cancer Centre, Melbourne, Victoria, Australia.
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Victoria, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Holland
- Queensland University of Technology, Brisbane, Queensland, Australia.,The University of Newcastle, Newcastle, New South Wales, Australia
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21
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Lewit-Mendes MF, Lowe GC, Lewis S, Corben LA, Delatycki MB. Young People Living at Risk of Huntington's Disease: The Lived Experience. J Huntingtons Dis 2019; 7:391-402. [PMID: 30372686 DOI: 10.3233/jhd-180308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For young people in families with Huntington's disease (HD) the challenge of having an affected family member (AFM) compounds challenges related to being at risk of HD themselves. OBJECTIVE This study aimed to quantitatively examine the experiences of young people in families with HD, adding to existing qualitative studies regarding teenagers and young adults in families with HD. METHODS The experiences of young people with living in a family with HD were captured by an online anonymous questionnaire, available worldwide through the Huntington's Disease Youth Organization. The questionnaire contained mostly forced choice questions. RESULTS Most participants (n = 84/101, 83.2%) provide assistance to an AFM and 46.4% (n = 39/84) wish they didn't have to look after their AFM. Many participants (n = 64/78, 82.1%) reported feeling anxious about being at risk; 64.9% (n = 50/77) agreed it is a barrier in their life. Over one third (n = 29/76, 38.2%) of participants disagreed that they have support in relation to being at risk, despite 85.5% (n = 65/76) agreeing it is important to have support and ongoing follow up. CONCLUSIONS Young people in families with HD endure considerable emotional, social and practical burden secondary to having an AFM and being at risk themselves. Without increased support and services, the effects of being a young caregiver and living at risk are likely to have long term impacts on the well-being of these young people.
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Affiliation(s)
- Miranda F Lewit-Mendes
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Georgia C Lowe
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Louise A Corben
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, VIC, Australia
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22
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Trans-counseling: A case series of transgender individuals at high risk for BRCA1
pathogenic variants. J Genet Couns 2019; 28:708-716. [DOI: 10.1002/jgc4.1046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
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23
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Clarke AJ, Wallgren-Pettersson C. Ethics in genetic counselling. J Community Genet 2019; 10:3-33. [PMID: 29949066 PMCID: PMC6325035 DOI: 10.1007/s12687-018-0371-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/15/2018] [Indexed: 12/22/2022] Open
Abstract
Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient's family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient's community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term.
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Affiliation(s)
- Angus J Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, CF14 4XN, UK.
| | - Carina Wallgren-Pettersson
- The Folkhaelsan Department of Medical Genetics, Topeliusgatan, 20 00250, Helsinki, Finland
- The Folkhaelsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
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24
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A Systematic Review of How Young People Live with Inherited Disease: What Can We Learn for Li-Fraumeni Syndrome? J Adolesc Young Adult Oncol 2018; 7:525-545. [DOI: 10.1089/jayao.2018.0028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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25
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Shen MD, Piven J. Brain and behavior development in autism from birth through infancy. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29398928 PMCID: PMC5789210 DOI: 10.31887/dcns.2017.19.4/mshen] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder (ASD) is a heterogeneous condition that affects 1 in 68 children. Diagnosis is based on the presence of characteristic behavioral impairments that emerge in the second year of life and thus is not typically made until 3 to 4 years of age. Recent studies of early brain and behavior development have provided important new insights into the nature of this condition. Autism-specific brain imaging features have been identified as early as 6 months of age, and age-specific brain and behavior changes have been demonstrated across the first 2 years of life, highlighting the developmental nature of ASD. New findings demonstrate that early brain imaging in the first year of life holds great promise for presymptomatic prediction of ASD. There is a general understanding in medicine that earlier treatment has better outcomes than later treatment, and in autism, there is an emerging consensus that earlier intervention results in more successful outcomes for the child. Examining early brain and behavior trajectories also has the potential to parse the etiologic heterogeneity in ASD, a well-recognized impediment to developing targeted, mechanistic treatments. This review highlights the current state of the science in the pursuit of early brain and behavioral markers of autism during infancy and examines the potential implications of these findings for treatment of this condition.
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Affiliation(s)
- Mark D Shen
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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26
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Mandich P, Lamp M, Gotta F, Gulli R, Iacometti A, Marchese R, Bellone E, Abbruzzese G, Ferrandes G. 1993-2014: two decades of predictive testing for Huntington's disease at the Medical Genetics Unit of the University of Genoa. Mol Genet Genomic Med 2017; 5:473-480. [PMID: 28944231 PMCID: PMC5606876 DOI: 10.1002/mgg3.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Predictive testing for Huntington's disease has been available at the Medical Genetics Unit of the University of Genoa from 1987. In 1989, an integrated counseling protocol (geneticist, psychologist, and neurologist) was developed following International Guidelines. Methods This is a retrospective analysis of the clinical charts and motivation questionnaires of persons seeking predictive testing through direct DNA analysis from 1993 until 2014, with the aim to evaluate their individual characteristics, motivations, and the outcomes of the counseling protocol. Results A total of 299 persons (164 women, 135 men) applied for predictive testing. Most applicants’ features and motivations were similar to those previously described, but surprisingly the percentage of completed protocols was higher among men, 68.5% versus 53.5% (P = 0.011). Likewise, persons over 25 years of age were more likely to take the test than younger applicants (18–25 years): 63.4% versus 48.1% (P = 0.043). In addition, relationship status, having children, and the gender of the affected parent showed different effects on the decision about testing in males and females. No catastrophic reactions were reported during the study period. Conclusions We observed that factors influencing the decision‐making process might differ between males and females, and that predictive testing appears a safe procedure if framed within an integrated counseling protocol.
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Affiliation(s)
- Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Merit Lamp
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Fabio Gotta
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Rossella Gulli
- Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Ariela Iacometti
- Unit of Clinical Psychology and PsychotherapyIRCCS AOU San Martino-ISTGenoaItaly
| | | | - Emilia Bellone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Medical Genetics UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child SciencesUniversity of GenoaGenoaItaly.,Clinical Neurology UnitIRCCS AOU San Martino-ISTGenoaItaly
| | - Giovanna Ferrandes
- Unit of Clinical Psychology and PsychotherapyIRCCS AOU San Martino-ISTGenoaItaly
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27
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Ibisler A, Ocklenburg S, Stemmler S, Arning L, Epplen JT, Saft C, Hoffjan S. Prospective Evaluation of Predictive DNA Testing for Huntington's Disease in a Large German Center. J Genet Couns 2017; 26:1029-1040. [PMID: 28361381 DOI: 10.1007/s10897-017-0085-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/14/2017] [Indexed: 10/19/2022]
Abstract
We present a prospective study of counselees seeking predictive testing for Huntington's disease at the Huntington Center North Rhine-Westphalia (Bochum, Germany) between 2010 and 2012. The aim was to observe the decision-making process of at-risk individuals and explore their experiences following the decision as well as the impacts of positive and negative mutation results. Data were collected using two standardized questionnaires as well as via a semi-standardized telephone interview one year after the initial counseling session. Seventy-two individuals participated in at least one of the three phases of the survey, including 31 individuals in the telephone interview. Sociodemographic data were in accordance with previous reports. The process of predictive testing was generally perceived in a positive manner, with almost all interviewees reporting a balanced emotional state one year after initial counseling, regardless of the decision for or against the test. The most important reasons named in favor of or against testing were assembled as well as different aspects regarding the satisfaction with the reached decision. In line with and expanding previous observations on gender-related differences in decision-making, our results suggest that gender-related aspects should be more strongly taken into account in genetic counseling during the predictive testing and counseling processes.
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Affiliation(s)
- Aysegül Ibisler
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany. .,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany.
| | - Sebastian Ocklenburg
- Department of Biopsychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Susanne Stemmler
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Larissa Arning
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Jörg T Epplen
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany.,Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Carsten Saft
- Center for Rare Diseases Ruhr (CeSER), Bochum, Germany.,Department of Neurology, St. Josef Hospital, Huntington Center NRW, Ruhr-University Bochum, Bochum, Germany
| | - Sabine Hoffjan
- Department of Human Genetics, Huntington Center NRW, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
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28
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Impact of Huntington Disease Gene-Positive Status on Pre-Symptomatic Young Adults and Recommendations for Genetic Counselors. J Genet Couns 2016; 25:1188-1197. [PMID: 27103420 DOI: 10.1007/s10897-016-9951-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 01/09/2023]
Abstract
Huntington disease (HD) is an autosomal dominant, progressive neurodegenerative disorder for which there is no cure. Predictive testing for HD is available to asymptomatic at-risk individuals. Approximately half of the population undergoing predictive testing for HD consists of young adults (≤35 years old). Finishing one's education, starting a career, engaging in romantic relationships and becoming a parent are key milestones of young adulthood. We conducted a qualitative study to explore how testing gene-positive for HD influences young adults' attainment of these milestones, and to identify major challenges that pre-symptomatic young adults face to aid the development of targeted genetic counseling. Results of our study demonstrate that 1) knowing one's gene-positive status results in an urgency to reach milestones and positively changes young adults' approach to life; 2) testing positive influences young adults' education and career choices, romantic relationships, and family planning; 3) young adults desire flexible and tailored genetic counseling to address needs and concerns unique to this population. Findings of this study contribute to the understanding of the impact of predictive testing for HD on young adults, and highlight issues unique to this population that call for further research, intervention and advocacy.
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29
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Godino L, Turchetti D, Jackson L, Hennessy C, Skirton H. Impact of presymptomatic genetic testing on young adults: a systematic review. Eur J Hum Genet 2015; 24:496-503. [PMID: 26173961 DOI: 10.1038/ejhg.2015.153] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 11/09/2022] Open
Abstract
Presymptomatic and predictive genetic testing should involve a considered choice, which is particularly true when testing is undertaken in early adulthood. Young adults are at a key life stage as they may be developing a career, forming partnerships and potentially becoming parents: presymptomatic testing may affect many facets of their future lives. The aim of this integrative systematic review was to assess factors that influence young adults' or adolescents' choices to have a presymptomatic genetic test and the emotional impact of those choices. Peer-reviewed papers published between January 1993 and December 2014 were searched using eight databases. Of 3373 studies identified, 29 were reviewed in full text: 11 met the inclusion criteria. Thematic analysis was used to identify five major themes: period before testing, experience of genetic counselling, parental involvement in decision-making, impact of test result communication, and living with genetic risk. Many participants grew up with little or no information concerning their genetic risk. The experience of genetic counselling was either reported as an opportunity for discussing problems or associated with feelings of disempowerment. Emotional outcomes of disclosure did not directly correlate with test results: some mutation carriers were relieved to know their status, however, the knowledge they may have passed on the mutation to their children was a common concern. Parents appeared to have exerted pressure on their children during the decision-making process about testing and risk reduction surgery. Health professionals should take into account all these issues to effectively assist young adults in making decisions about presymptomatic genetic testing.
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Affiliation(s)
- Lea Godino
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Daniela Turchetti
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Catherine Hennessy
- 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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30
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Martin MM, Rothwell EW, Venne VL, Foster NL. Perceptions of Tissue Storage in a Dementia Population Among Spouses and Offspring. J Genet Couns 2015; 24:503-11. [DOI: 10.1007/s10897-015-9818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 01/02/2015] [Indexed: 11/24/2022]
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31
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Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ, Tabrizi SJ. Huntington disease. Nat Rev Dis Primers 2015; 1:15005. [PMID: 27188817 DOI: 10.1038/nrdp.2015.5] [Citation(s) in RCA: 879] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Huntington disease is devastating to patients and their families - with autosomal dominant inheritance, onset typically in the prime of adult life, progressive course, and a combination of motor, cognitive and behavioural features. The disease is caused by an expanded CAG trinucleotide repeat (of variable length) in HTT, the gene that encodes the protein huntingtin. In mutation carriers, huntingtin is produced with abnormally long polyglutamine sequences that confer toxic gains of function and predispose the protein to fragmentation, resulting in neuronal dysfunction and death. In this Primer, we review the epidemiology of Huntington disease, noting that prevalence is higher than previously thought, geographically variable and increasing. We describe the relationship between CAG repeat length and clinical phenotype, as well as the concept of genetic modifiers of the disease. We discuss normal huntingtin protein function, evidence for differential toxicity of mutant huntingtin variants, theories of huntingtin aggregation and the many different mechanisms of Huntington disease pathogenesis. We describe the genetic and clinical diagnosis of the condition, its clinical assessment and the multidisciplinary management of symptoms, given the absence of effective disease-modifying therapies. We review past and present clinical trials and therapeutic strategies under investigation, including impending trials of targeted huntingtin-lowering drugs and the progress in development of biomarkers that will support the next generation of trials. For an illustrated summary of this Primer, visit: http://go.nature.com/hPMENh.
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Affiliation(s)
- Gillian P Bates
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - James F Gusella
- Molecular Neurogenetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, and Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael R Hayden
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Kay
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minneapolis, Minnesota, USA; and Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry and Departments of Neurology, Pharmacology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachael I Scahill
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Ronald Wetzel
- Department of Structural Biology and Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Edward J Wild
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
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32
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Forrest Keenan K, McKee L, Miedzybrodzka Z. Help or hindrance: young people's experiences of predictive testing for Huntington's disease. Clin Genet 2014; 87:563-9. [DOI: 10.1111/cge.12439] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- K. Forrest Keenan
- Health Services Research Unit University of Aberdeen Aberdeen AB25 2ZD UK
| | - L. McKee
- Health Services Research Unit University of Aberdeen Aberdeen AB25 2ZD UK
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33
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Liu Y, Cao C. The relationship between family history of cancer, coping style and psychological distress. Pak J Med Sci 2014; 30:507-10. [PMID: 24948968 PMCID: PMC4048495 DOI: 10.12669/pjms.303.4634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/20/2014] [Accepted: 02/05/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the relationship between family history of cancer, coping style and psychological distress. METHODS Total 80 patients with family history of cancer and 72 normal controls were analyzed using self-reporting inventory (SCL-90), coping style scale and impact of event scale-revised (IES-R). RESULTS 1. Between the two groups of patients, there were significant differences in anxiety, depression, cancer-specific distress and coping style. 2. Psychological distress (anxiety, depression and cancer-specific distress) had positive correlation with negative coping style and family history. 3. Negative coping style played an intermediary role in the family history and psychological distress. CONCLUSION The negative coping style will predispose to a more stronger psychological distress among the individuals with family history of cancer.
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Affiliation(s)
- Yu Liu
- Yu Liu, Department of Psychology, Tsinghua University, Beijing 10084, China
| | - Chunmei Cao
- Chunmei Cao, Department of Physical Education, Tsinghua University, Beijing 10084, China
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