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Paneque M, Carvalho M, Rodrigues F, Saraiva J, Leonardo A, Sousa AB, Machado V, Gonçalves-Rocha M, Sequeiros J, Costa PS, Serra de Lemos M. A new scale informed by the Reciprocal-Engagement Model for quality evaluation of genetic counselling by patients: Development and initial validation. Eur J Med Genet 2021; 64:104375. [PMID: 34740860 DOI: 10.1016/j.ejmg.2021.104375] [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: 03/13/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
Monitoring the quality of genetic counselling is essential to ensure appropriate provision. This study describes the development and initial psychometric validation of a novel scale for genetic counselling quality evaluation by patients. A deductive approach was taken to formulate scale items. Exploratory factor analysis with the principal axis factoring method was used to assess the scale's factor structure (n = 118). Internal consistency (Cronbach's Alpha) was also examined. Exploratory factor analysis resulted in a single overarching construct consisting of seven factors, which account for 59% of the variance explained. Items showed, in general, strong factor loadings (>0.5). Some items focused on patient satisfaction with services provision did not load onto the factors. Thus, another factor analysis was performed with these items, which resulted in one-factor. The identified factor accounted for 57% of variance explained, and communalities were strong (≥0.5) for most items. Cronbach's alpha score for the scale was 0.85, indicating high internal consistency. Factors were significantly and moderately interrelated (from r = 0.31 to r = 0.71). Further studies are needed to establish the psychometric validity of the scale.
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Affiliation(s)
- Milena Paneque
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Portugal; Centre for Predictive and Preventive Genetics (CGPP), Universidade do Porto, Portugal.
| | - Márcia Carvalho
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Portugal; Centre for Predictive and Preventive Genetics (CGPP), Universidade do Porto, Portugal; Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Fidjy Rodrigues
- CHUC - Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Jorge Saraiva
- CHUC - Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Alexandra Leonardo
- CHULN-HSM - Serviço de Genética Médica, Centro Hospitalar Universitário de Lisboa Norte - Hospital de Santa Maria, Portugal
| | - Ana B Sousa
- CHULN-HSM - Serviço de Genética Médica, Centro Hospitalar Universitário de Lisboa Norte - Hospital de Santa Maria, Portugal
| | - Vânia Machado
- EPER - Hospital de Santo Espírito da Ilha Terceira, Portugal
| | | | - Jorge Sequeiros
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Portugal; Centre for Predictive and Preventive Genetics (CGPP), Universidade do Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
| | - Patrício Soares Costa
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Marina Serra de Lemos
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal; Centro de Psicologia, Universidade do Porto, Porto, Portugal
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Genetic counseling and testing practices for late-onset neurodegenerative disease: a systematic review. J Neurol 2021; 269:676-692. [PMID: 33649871 PMCID: PMC7920548 DOI: 10.1007/s00415-021-10461-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Objective To understand contemporary genetic counseling and testing practices for late-onset neurodegenerative diseases (LONDs), and identify whether practices address the internationally accepted goals of genetic counseling: interpretation, counseling, education, and support. Methods Four databases were systematically searched for articles published from 2009 to 2020. Peer-reviewed research articles in English that reported research and clinical genetic counseling and testing practices for LONDs were included. A narrative synthesis was conducted to describe different practices and map genetic counseling activities to the goals. Risk of bias was assessed using the Qualsyst tool. The protocol was registered with PROSPERO (CRD42019121421). Results Sixty-one studies from 68 papers were included. Most papers focused on predictive testing (58/68) and Huntington’s disease (41/68). There was variation between papers in study design, study population, outcomes, interventions, and settings. Although there were commonalities, novel and inconsistent genetic counseling practices were identified. Eighteen papers addressed all four goals of genetic counseling. Conclusion Contemporary genetic counseling and testing practices for LONDs are varied and informed by regional differences and the presence of different health providers. A flexible, multidisciplinary, client- and family-centered care continues to emerge. As genetic testing becomes a routine part of care for patients (and their relatives), health providers must balance their limited time and resources with ensuring clients are safely and effectively counseled, and all four genetic counseling goals are addressed. Areas of further research include diagnostic and reproductive genetic counseling/testing practices, evaluations of novel approaches to care, and the role and use of different health providers in practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10461-5.
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Redlinger-Grosse K, MacFarlane IM, Cragun D, Zierhut H. A Delphi study to prioritize genetic counseling outcomes: What matters most. J Genet Couns 2020; 30:676-692. [PMID: 33179357 DOI: 10.1002/jgc4.1352] [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: 03/04/2019] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
Research on genetic counseling outcomes has examined a range of metrics many that differ in quality and extent of psychometric assessment and in some cases fail to encompass potential benefits of genetic counseling for patients. Although a variety of possible outcomes have been explored, selecting the most important or relevant outcomes and identifying well-validated measures remain challenging. An online, modified Delphi method was used to prioritize genetic counseling outcomes from the viewpoint of individuals from four stakeholder groups - clinical genetic counselors, outcome researchers, genetic counseling training directors, and genetic counseling consumers/advocates. A survey of 181 genetic counseling outcomes were rated based on perceived importance and then sorted and categorized using the Framework for Outcomes of Clinical Communication Services in Genetic Counseling (FOCUS-GC) framework. Three of the FOCUS-GC domains (Process, Patient Care Experience, and Patient Changes) were assessed as most important, while none of the most highly rated outcomes fell into the domains of Patient Health or Family Changes. The majority of outcomes deemed most important by stakeholder groups were within the process domain. When looking at the proportion of outcomes that overlapped with the consumer group, clinical genetic counselors had the highest degree of similarity with consumers when looking at the high relative importance band outcomes (61.1% overlap), followed by training directors (58.3%), and outcome researchers (41.7%). Variability in importance according to stakeholder groups was an important consideration and prioritizing outcomes was challenging given that the majority of outcomes were rated as important. Working to bridge the realities of clinical care and fundamental differences in the viewpoints and priorities of genetic counseling research directions is an area for future exploration.
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Affiliation(s)
| | | | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA
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Harding B, Webber C, Ruhland L, Dalgarno N, Armour CM, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips S, MacKenzie JJ. Primary care providers' lived experiences of genetics in practice. J Community Genet 2018; 10:85-93. [PMID: 29700759 PMCID: PMC6325046 DOI: 10.1007/s12687-018-0364-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/12/2018] [Indexed: 12/28/2022] Open
Abstract
To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners’ additional concerns included cost, distance, and poor patient engagement. PCPs’ perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.
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Affiliation(s)
- Brittany Harding
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, Kingston, Ontario, K7L 2N6, Canada
| | - Colleen Webber
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Lucia Ruhland
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Nancy Dalgarno
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Richard Birtwhistle
- Centre for Studies in Primary Care, Queen's University, 220 Bagot Street, P.O.#8888, Kingston, Ontario, K7L 5E9, Canada
| | - Glenn Brown
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - June C Carroll
- Department of Family & Community Medicine, Mount Sinai Hospital, Granovsky Gluskin Family Medicine Centre, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario, M5T 3L9, Canada
| | - Michael Flavin
- Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
| | - Susan Phillips
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - Jennifer J MacKenzie
- Department of Pediatrics, McMaster Children's Hospital, 1280 Main St. West, 3N11-G, Hamilton, ON, L8S 4K1, Canada.
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Paalosalo-Harris K, Skirton H. Mixed method systematic review: the relationship between breast cancer risk perception and health-protective behaviour in women with family history of breast cancer. J Adv Nurs 2016; 73:760-774. [DOI: 10.1111/jan.13158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | - Heather Skirton
- School of Nursing and Midwifery; Faculty of Health and Human Sciences; Plymouth University; Plymouth UK
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Pisnoli L, O’Connor A, Goldsmith L, Jackson L, Skirton H. Impact of fetal or child loss on parents’ perceptions of non-invasive prenatal diagnosis for autosomal recessive conditions. Midwifery 2016; 34:105-110. [DOI: 10.1016/j.midw.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/26/2015] [Indexed: 11/26/2022]
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Chiang PJ, Li TC, Chang CH, Chen LL, Lin JD, Su YC. SEED: the six excesses (Liu Yin) evaluation and diagnosis scale. Chin Med 2015; 10:30. [PMID: 26516343 PMCID: PMC4624590 DOI: 10.1186/s13020-015-0059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Infections such as common colds, influenza, acute upper respiratory infections, bacterial gastroenteritis, and urinary tract infections are usually diagnosed according to patients’ signs and symptoms. This study aims to develop a scale for the diagnosis of infectious diseases based on the six excesses (Liu Yin) etiological theory of Chinese medicine (CM) by the Delphi method. Methods A total of 200 CM-guided diagnostic items measuring signs and symptoms for infectious diseases were compiled from CM literature archives from the Han to Ming dynasties, CM textbooks in both China and Taiwan, and journal articles from the China Knowledge Resource Integrated Database. The items were based on infections and the six excesses (Liu Yin) etiological theory, i.e., Feng Xie (wind excess), Han Xie (coldness excess), Shu Xie (summer heat excess), Shi Xie (dampness excess), Zao Xie (dryness excess), and Huo Xie (fire excess). The items were further classified into the six excess syndromes and reviewed via a Delphi process to reach consensus among CM experts. Results In total, 178 items with a mean or median rating of 7 or above on a scale of 1–9 from a panel of 32 experts were retained. The numbers of diagnostic items in the categories of Feng (wind), Han (coldness), Shu (summer heat), Shi (dampness), Zao (dryness), and Huo (fire) syndromes were 15, 22, 25, 37, 17, and 62, respectively. Conclusions A CM-based six excesses (Liu Yin) evaluation and diagnosis (SEED) scale was developed for the evaluation and diagnosis of infectious diseases based only on signs and symptoms.
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Affiliation(s)
- Pei-Jung Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan ; Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Chih-Hung Chang
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Li-Li Chen
- School of Nursing, China Medical University, Taichung, Taiwan ; Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Jun-Dai Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yi-Chang Su
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan
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