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Phung L, Wood E, Egleston B, Hoffman-Andrews L, Ofidis D, Howe S, Mim R, Griffin H, Fetzer D, Owens A, Domchek S, Pyeritz R, Katona B, Kallish S, Sirugo G, Weaver J, Nathanson KL, Rader DJ, Bradbury AR. Facilitating return of actionable genetic research results from a biobank repository: Participant uptake and utilization of digital interventions. HGG ADVANCES 2024; 5:100346. [PMID: 39183478 DOI: 10.1016/j.xhgg.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024] Open
Abstract
Research participants report interest in receiving genetic research results. How best to return results remains unclear. In this randomized pilot study, we sought to assess the feasibility of returning actionable research results through a two-step process including a patient-centered digital intervention as compared with a genetic counselor (GC) in the Penn Medicine biobank. In Step 1, participants with an actionable result and procedural controls (no actionable result) were invited to digital pre-disclosure education and provided options for opting out of results. In Step 2, those with actionable results who had not opted out were randomized to receive results via a digital disclosure intervention or with a GC. Five participants (2%) opted out of results after Step 1. After both steps, 52 of 113 (46.0%) eligible cases received results, 5 (4.4%) actively declined results, 34 (30.1%) passively declined, and 22 (19.5%) could not be reached. Receiving results was associated with younger age (p < 0.001), completing pre-disclosure education (p < 0.001), and being in the GC arm (p = 0.06). Being older, female, and of Black race were associated with being unable to reach. Older age and Black race were associated with passively declining. Forty-seven percent of those who received results did not have personal or family history to suggest the mutation, and 55.1% completed clinical confirmation testing. The use of digital tools may be acceptable to participants and could reduce costs of returning results. Low uptake, disparities in uptake, and barriers to confirmation testing will be important to address to realize the benefit of returning actionable research results.
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Affiliation(s)
- Lillian Phung
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Elisabeth Wood
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Brian Egleston
- Fox Chase Cancer Center, Temple University, Philadelphia, PA, USA
| | - Lily Hoffman-Andrews
- The University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA
| | - Demetrios Ofidis
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Sarah Howe
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Rajia Mim
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Hannah Griffin
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Dominique Fetzer
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Anjali Owens
- The University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA
| | - Susan Domchek
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA
| | - Reed Pyeritz
- The University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Bryson Katona
- The University of Pennsylvania, Division of Gastroenterology, Philadelphia, PA, USA
| | - Staci Kallish
- The University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Giorgio Sirugo
- The University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - JoEllen Weaver
- The University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Katherine L Nathanson
- The University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Daniel J Rader
- The University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Angela R Bradbury
- The University of Pennsylvania, Abramson Cancer Center and Division of Hematology-Oncology, Philadelphia, PA, USA; The University of Pennsylvania, Department of Medical Ethics and Health Policy, Philadelphia, PA, USA.
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2
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Capasso A, Nehoray B, Gorman N, Quinn EA, Bucio D, Blazer KR. Genetic counselors' and community clinicians' implementation and perceived barriers to informed consent during pre-test counseling for hereditary cancer risk. J Genet Couns 2024. [PMID: 38480478 PMCID: PMC11393174 DOI: 10.1002/jgc4.1887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 04/21/2024]
Abstract
As demand for genetic cancer risk assessment (GCRA) continues to increase, so does the sense of urgency to scale up efforts to triage patients, facilitate informed consent, and order genetic testing for cancer risk. The National Society of Genetic Counselors outlines the elements of informed consent that should be addressed in a GCRA session. While this practice resource aims to improve health equity, research on how well the elements of informed consent are implemented in practice is lacking. This retrospective and prospective mixed-methods study assessed how adequately the elements of informed consent are addressed during pre-test GCRA among 307 community clinicians (CC) and 129 cancer genetic counselors (GC), and barriers they face to addressing these elements. Results revealed that more than 90% of both cohorts consistently addressed components of at least 5 of the 10 elements of informed consent during a pre-test consultation. Technical aspects and accuracy of the test and utilization of test results were the most similarly addressed elements. Notably, GCs more often review the purpose of the test and who to test, general information about the gene(s), and economic considerations whereas CCs more often review alternatives to testing. Both cohorts reported psychosocial aspects of the informed consent process as the least adequately addressed element. Time constraints and patient-related concerns were most often cited by both cohorts as barriers to optimal facilitation of informed consent. Additional barriers reported by CCs included provider lack of awareness, experience, or education, and availability of resources and institutional support. Findings from this study may contribute to the development of alternative delivery models that incorporate supplementary educational tools to enhance patient understanding about the utility of genetic testing, while helping to mitigate the barrier of time constraints. Equally important is the use of this information to develop continuing education tools for providers.
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Affiliation(s)
- Alexandra Capasso
- School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, California, USA
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, California, USA
| | - Bita Nehoray
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, California, USA
| | - Nicholas Gorman
- School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, California, USA
| | - Emily A Quinn
- School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, California, USA
| | - Daiana Bucio
- Clinical Consultation Services, Invitae Corporation, San Francisco, California, USA
| | - Kathleen R Blazer
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, California, USA
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Pichler T, Mumm F, Dehar N, Dickman E, Díez de Los Ríos de la Serna C, Dinkel A, Heinrich K, Hennink M, Parviainen AD, Raske V, Wicki N, Moore AC. Understanding communication between patients and healthcare professionals regarding comprehensive biomarker testing in precision oncology: A scoping review. Cancer Med 2024; 13:e6913. [PMID: 38298115 PMCID: PMC10905543 DOI: 10.1002/cam4.6913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT-related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology. METHODS A scoping review was conducted using records published in PubMed during January 2017-August 2022, focusing on the breadth of topics on patient-HCP communication and knowledge resources used by HCPs as guidance in cBT-related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics. RESULTS The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT-related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information-seeking behavior and factors influencing cBT-related knowledge and confidence, often self-reported as insufficient. CONCLUSIONS Patient education by knowledgeable and confident HCPs, information management and a caring patient-HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision-making in precision oncology. More data on the process and structure of cBT-related communication, distinction between and characterization of different timepoints of patient-HCP interactions are needed.
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Affiliation(s)
- Theresia Pichler
- Department of Internal Medicine III, University HospitalLMU MunichMunichGermany
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | - Friederike Mumm
- Department of Internal Medicine III, University HospitalLMU MunichMunichGermany
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | - Navdeep Dehar
- Department of Medical OncologyQueen's UniversityKingstonOntarioCanada
| | - Erin Dickman
- Oncology Nursing SocietyPittsburghPennsylvaniaUSA
| | - Celia Díez de Los Ríos de la Serna
- European Oncology Nursing SocietyBrusselsBelgium
- Faculty of Medicine and Health Sciences, School of NursingBarcelona UniversityBarcelonaCataloniaSpain
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine and HealthTechnical University of MunichMunichGermany
- Comprehensive Cancer Center Munich TUM (CCC Munich)MunichGermany
| | - Kathrin Heinrich
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | | | - Anndra D. Parviainen
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
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Binion S, Sorgen LJ, Peshkin BN, Valdimarsdottir H, Isaacs C, Nusbaum R, Graves KD, DeMarco T, Wood M, McKinnon W, Garber J, McCormick S, Ladd MK, Schwartz MD. Telephone versus in-person genetic counseling for hereditary cancer risk: Patient predictors of differential outcomes. J Telemed Telecare 2024; 30:334-343. [PMID: 34779303 PMCID: PMC9902210 DOI: 10.1177/1357633x211052220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Telegenetics has become the predominant mode of cancer genetic counseling during the COVID-19 pandemic. We sought to identify potential patient-level contraindicators for telegenetic genetic counseling. METHODS We analyzed post-counseling (pre-result disclosure) follow-up data from a randomized noninferiority trial of a telephone genetic counseling versus usual care genetic counseling. Among 669 randomized participants, 600 completed pre-test counseling and 568 completed a 2-week follow-up assessment before receiving test results. In this analysis, we focused on genetic counseling outcomes (knowledge, decisional conflict, and distress). In multivariate models controlling for bivariate predictors of these outcomes, we tested our a priori hypotheses that pre-counseling numeracy, perceived stress, and race/ethnicity would moderate the outcomes of telephone genetic counseling versus usual care. RESULTS Only numeracy significantly moderated associations between mode of genetic counseling and outcomes. Higher numeracy was associated with higher post-counseling knowledge following telephone genetic counseling (p < 0.001), but not usual care (p = 0.450). Higher numeracy was also associated with lower distress following telephone genetic counseling (p = 0.009) but not usual care (p = 0.16). Neither perceived stress nor race/ethnicity exhibited differential impacts on telephone genetic counseling versus usual care (ps > 0.20). CONCLUSION Although high numeracy was associated with higher levels of knowledge following telegenetic counseling, we did not identify any clinically significant patient-level contraindicators for telegenetic counseling. These results lend further confidence to the broad use of telegenetics.
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Affiliation(s)
- Savannah Binion
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Lia J. Sorgen
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Beth N. Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Heiddis Valdimarsdottir
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Rachel Nusbaum
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Current Affiliation: University of Maryland, School of Medicine, Baltimore, MD
| | - Kristi D. Graves
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Tiffani DeMarco
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Current Affiliation: Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA
| | - Marie Wood
- Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT
| | - Wendy McKinnon
- Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT
| | - Judy Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA
| | - Shelley McCormick
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mary K. Ladd
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
| | - Marc D. Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC
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5
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McGill BC, Wakefield CE, Tucker KM, Daly RA, Donoghoe MW, Vetsch J, Warby M, Fuentes‐Bolanos NA, Barlow‐Stewart K, Kirk J, Courtney E, O’Brien TA, Marshall GM, Pinese M, Cowley MJ, Tyrrell V, Deyell RJ, Ziegler DS, Hetherington K. Parents' expectations, preferences, and recall of germline findings in a childhood cancer precision medicine trial. Cancer 2023; 129:3620-3632. [PMID: 37382186 PMCID: PMC10952780 DOI: 10.1002/cncr.34917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Germline genome sequencing in childhood cancer precision medicine trials may reveal pathogenic or likely pathogenic variants in cancer predisposition genes in more than 10% of children. These findings can have implications for diagnosis, treatment, and the child's and family's future cancer risk. Understanding parents' perspectives of germline genome sequencing is critical to successful clinical implementation. METHODS A total of 182 parents of 144 children (<18 years of age) with poor-prognosis cancers enrolled in the Precision Medicine for Children with Cancer trial completed a questionnaire at enrollment and after the return of their child's results, including clinically relevant germline findings (received by 13% of parents). Parents' expectations of germline genome sequencing, return of results preferences, and recall of results received were assessed. Forty-five parents (of 43 children) were interviewed in depth. RESULTS At trial enrollment, most parents (63%) believed it was at least "somewhat likely" that their child would receive a clinically relevant germline finding. Almost all expressed a preference to receive a broad range of germline genomic findings, including variants of uncertain significance (88%). Some (29%) inaccurately recalled receiving a clinically relevant germline finding. Qualitatively, parents expressed confusion and uncertainty after the return of their child's genome sequencing results by their child's clinician. CONCLUSIONS Many parents of children with poor-prognosis childhood cancer enrolled in a precision medicine trial expect their child may have an underlying cancer predisposition syndrome. They wish to receive a wide scope of information from germline genome sequencing but may feel confused by the reporting of trial results.
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6
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Kilbride M, Egleston BL, Chung WK, Olopade O, Maxwell KN, Shah P, Churpek JE, Fleisher L, Terry MB, Fetzer D, Gaieski JB, Bulafka J, Espinal A, Karpink K, Walser S, Singleton D, Palese M, Siljander I, Brandt A, Clark D, Koval C, Wynn J, Long JM, McKenna D, Powers J, Nielsen S, Domchek SM, Nathanson KL, Bradbury AR. Uptake of Genetic Research Results and Patient-Reported Outcomes With Return of Results Incorporating Web-Based Predisclosure Education. J Clin Oncol 2023; 41:4905-4915. [PMID: 37611220 PMCID: PMC10617912 DOI: 10.1200/jco.22.00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/04/2023] [Accepted: 06/21/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE We developed a web-based education intervention as an alternative to predisclosure education with a genetic counselor (GC) to reduce participant burden and provider costs with return of genetic research results. METHODS Women at three sites who participated in 11 gene discovery research studies were contacted to consider receiving cancer genetic research results. Participants could complete predisclosure education through web education or with a GC. Outcomes included uptake of research results, factors associated with uptake, and patient-reported outcomes. RESULTS Of 819 participants, 178 actively (21.7%) and 167 passively (20.4%) declined return of results; 474 (57.9%) were enrolled. Most (60.3%) received results although this was lower than the 70% uptake we hypothesized. Passive and active decliners were more likely to be Black, to have less education, and to have not received phone follow-up after the invitation letter. Most participants selected web education (88.5%) as an alternative to speaking with a GC, but some did not complete or receive results. Knowledge increased significantly from baseline to other time points with no significant differences between those who received web versus GC education. There were no significant increases in distress between web and GC education. CONCLUSION Interest in web-based predisclosure education for return of genetic research results was high although it did not increase uptake of results. We found no negative patient-reported outcomes with web education, suggesting that it is a viable alternative delivery model for reducing burdens and costs of returning genetic research results. Attention to attrition and lower uptake of results among Black participants and those with less formal education are important areas for future research.
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Affiliation(s)
- Madison Kilbride
- Department of Philosophy, University of Utah, Salt Lake City, UT
| | | | - Wendy K. Chung
- Department of Pediatrics and Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York City, NY
| | | | - Kara N. Maxwell
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Payal Shah
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | | | - Linda Fleisher
- Fox Chase Cancer Center, Temple University, Philadelphia, PA
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center and the Mailman School of Public Health, Columbia University Irving Medical Center, New York City, NY
| | - Dominique Fetzer
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Jill Bennett Gaieski
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Jessica Bulafka
- Herbert Irving Comprehensive Cancer Center and the Mailman School of Public Health, Columbia University Irving Medical Center, New York City, NY
| | - Aileen Espinal
- Herbert Irving Comprehensive Cancer Center and the Mailman School of Public Health, Columbia University Irving Medical Center, New York City, NY
| | - Kelsey Karpink
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Sarah Walser
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Davone Singleton
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | | | | | - Amanda Brandt
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Dana Clark
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Carrie Koval
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, NY
| | - Julia Wynn
- Department of Pediatrics, Columbia University, New York City, NY
| | - Jessica M. Long
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Danielle McKenna
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Jacquelyn Powers
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | | | - Susan M. Domchek
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Katherine L. Nathanson
- Division of Translational Medicine and Human Genetics, The University of Pennsylvania, Philadelphia, PA
| | - Angela R. Bradbury
- Division of Hematology-Oncology, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Department of Medical Ethics and Health Policy, The University of Pennsylvania, Philadelphia, PA
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7
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Hagiwara N, Harika N, Carmany EP, Shin Y, Eggly S, Jones SCT, Quillin J. Racial disparities in cancer genetic counseling encounters: study protocol for investigating patient-genetic counselor communication in the naturalistic clinical setting using a convergent mixed methods design. BMC Cancer 2023; 23:983. [PMID: 37845629 PMCID: PMC10578042 DOI: 10.1186/s12885-023-11486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Despite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers' implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers' explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients. METHODS Using a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses. DISCUSSION Findings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.
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Affiliation(s)
- Nao Hagiwara
- Department of Public Health Sciences, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Nadia Harika
- Department of Pediatrics, Virginia Commonwealth University, 1008 East Clay Street, B-011 Box 980270, Richmond, VA, 23219, USA
| | - Erin P Carmany
- Center for Molecular Medicine and Genetics, Wayne State University, 3127 Scott Hall, 540 E. Canfield Ave, Detroit, MI, 48201, USA
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, One Capitol Square 718, Richmond, VA, 23298, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University, Karmanos Cancer Institute, 4100 John R, Detroit, MI, 48201, USA
| | - Shawn C T Jones
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, 23284, Richmond, VA, USA
| | - John Quillin
- Department of Pediatrics, Virginia Commonwealth University, 1008 East Clay Street, B-011 Box 980270, Richmond, VA, 23219, USA
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8
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McKenna DB, Sanchez P, Powers J, Brower J, Wang L, Mueller R, Symecko H, Hamilton JG, Wildman T, Domchek SM, Couch FJ, Garber JE, Offit K, Robson ME, Katona BW. Summary of the experiences, knowledge, medical management, and family communication of monoallelic MUTYH carriers. J Genet Couns 2023; 32:342-350. [PMID: 36245263 PMCID: PMC10436665 DOI: 10.1002/jgc4.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022]
Abstract
Germline genetic testing for inherited cancer risk is increasingly being performed with multigene panel testing with MUTYH often included on colorectal cancer- and polyposis-focused panels, as well as on broader pan-cancer panels. With up to 1%-2% of the general population being monoallelic MUTYH carriers, pathogenic/likely pathogenic (P/LP) variants in MUTYH are one of the most common findings on multigene cancer panels. However, little is known about patient experience and understanding of monoallelic MUTYH P/LP variants, nor whether such findings influence medical management recommendations and familial communication, which this study aims to better understand. Monoallelic P/LP MUTYH carriers were recruited from the Prospective Registry of Multiplex Testing (PROMPT) and completed a cross-sectional self-report survey on sociodemographic characteristics, medical and family history, experiences with MUTYH genetic testing, genetics and MUTYH knowledge, perceived cancer risk, and familial communication. Of 115 eligible PROMPT participants, 49 (43%) completed the survey who were primarily female (94%), white (96%), had a history of cancer (61%), and a median age of 51.4 years. Most participants (61%) reported satisfaction with how their healthcare provider managed their genetic test result and care, and 65% of survey participants reported their provider recommended colonoscopy based on their genetic test results. Participants' responses also reflected variable levels of knowledge regarding cancer risks and screening recommendations for MUTYH carriers. The majority (98%) of participants shared their genetic test results with at least some of their relatives; however, only 13% of eligible relatives reportedly underwent cascade testing. Taken together, this study provides needed insight into the overall experiences of monoallelic MUTYH carriers and highlights numerous areas for improvement in clinician education, communication, and management of these individuals.
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Affiliation(s)
- Danielle B. McKenna
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pauleen Sanchez
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacquelyn Powers
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jamie Brower
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louise Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rebecca Mueller
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heather Symecko
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jada G. Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Temima Wildman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan M. Domchek
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Judy E. Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Mark E. Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Bryson W. Katona
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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9
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López-Fernández A, Villacampa G, Salinas M, Grau E, Darder E, Carrasco E, Solanes A, Velasco A, Torres M, Munté E, Iglesias S, Torres-Esquius S, Tuset N, Diez O, Lázaro C, Brunet J, Corbella S, Balmaña J. Role of psychological background in cancer susceptibility genetic testing distress: It is not only about a positive result. J Genet Couns 2023. [PMID: 36748747 DOI: 10.1002/jgc4.1687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 02/08/2023]
Abstract
Clinical and familial factors predict psychological distress after genetic testing for cancer susceptibility. However, the contribution of an individual's psychological background to such distress is unclear. This study aims to analyze the psychological impact of genetic testing and to identify the profile of individuals at higher risk. This is a longitudinal multicenter study of individuals undergoing genetic testing for cancer susceptibility. Demographic, clinical, genetic, familial, and psychological (personality types, cancer worry) characteristics were assessed by validated questionnaires the day of genetic testing. Distress, uncertainty, and positive experience perception (MICRA scale) were evaluated at the results disclosure visit, and 3 and 12 months afterwards. Multivariate analysis was performed. A total of 714 individuals were included. A high neuroticism score, high baseline cancer worry, and a positive genetic test result were independently associated with higher psychological impact (p-value < 0.05). The highest risk profile (10% of the cohort) included women with high level of neuroticism and a positive result. Uncertainty was mainly associated with a high level of neuroticism, regardless of the genetic test result. A holistic approach to personalized germline genetic counseling should include the assessment of personality dimensions.
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Affiliation(s)
- Adrià López-Fernández
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Genetic and Microbiology Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mònica Salinas
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Elia Grau
- Genetic and Microbiology Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Esther Darder
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, IDIBGI, Girona, Spain
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ares Solanes
- Hereditary Cancer Program, Germans Trias i Pujol Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Angela Velasco
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, IDIBGI, Girona, Spain
| | - Maite Torres
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Elisabet Munté
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Silvia Iglesias
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Sara Torres-Esquius
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Noemí Tuset
- Genetic Counseling Unit, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Orland Diez
- Hereditary Cancer Genetics Group, Area of Clinical and Molecular Genetics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Conxi Lázaro
- Hereditary Cancer Program, Molecular Diagnosis Laboratory, Catalan Institute of Oncology, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain.,Medical Sciences Dpt. School of Medicine, University of Girona, Girona, Spain
| | - Sergi Corbella
- School of Psychology, Education and Sports Sciences, Ramon Llull University - Blanquerna, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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10
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Savage SA. Who Should Have Multigene Germline Testing for Hereditary Cancer? J Clin Oncol 2022; 40:4040-4043. [PMID: 36166722 PMCID: PMC9746744 DOI: 10.1200/jco.22.01691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sharon A. Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD,Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892; e-mail:
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11
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Koplin JJ, Gyngell C, Savulescu J, Vears DF. Moving from 'fully' to 'appropriately' informed consent in genomics: The PROMICE framework. BIOETHICS 2022; 36:655-665. [PMID: 35390218 PMCID: PMC9321597 DOI: 10.1111/bioe.13027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 06/01/2023]
Abstract
Genomic sequencing technologies (GS) pose novel challenges not seen in older genetic technologies, making traditional standards for fully informed consent difficult or impossible to meet. This is due to factors including the complexity of the test and the broad range of results it may identify. Meaningful informed consent is even more challenging to secure in contexts involving significant time constraints and emotional distress, such as when rapid genomic testing (RGS) is performed in neonatal intensive care units. In this article, we propose that informed consent matters not for its own sake, but because obtaining it furthers a range of morally important goals, such as promoting autonomy, well-being, and trust in medicine. These goals form the basis of a new framework [PROmoting Morally Important Consent Ends (PROMICE)] for assessing the ethical appropriateness of various informed consent models. We illustrate this framework with two examples: (a) a tiered and layered consent model for obtaining consent for GS, and (b) consent for RGS in critically ill newborns. We conclude that appropriately-rather than fully-informed consent provides the correct standard for genomic medicine and research.
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Affiliation(s)
- Julian J. Koplin
- Biomedical Ethics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - Christopher Gyngell
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Julian Savulescu
- Biomedical Ethics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Faculty of Philosophy, Oxford Uehiro Centre for Practical EthicsOxford UniversityOxfordUK
| | - Danya F. Vears
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
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12
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Carlsson L, Thain E, Gillies B, Metcalfe K. Psychological and health behaviour outcomes following multi-gene panel testing for hereditary breast and ovarian cancer risk: a mini-review of the literature. Hered Cancer Clin Pract 2022; 20:25. [PMID: 35733200 PMCID: PMC9215075 DOI: 10.1186/s13053-022-00229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Knowledge of the genetic mechanisms driving hereditary breast and ovarian cancer (HBOC) has recently expanded due to advances in gene sequencing technologies. Genetic testing for HBOC risk now involves multi-gene panel testing, which includes well characterized high-penetrance genes (e.g. BRCA1 and BRCA2), as well as moderate- and low-penetrance genes. Certain moderate and low penetrance genes are associated with limited data to inform cancer risk estimates and clinical management recommendations, which create new sources of genetic and clinical uncertainty for patients. PURPOSE The aim of this review is to evaluate the psychological and health behaviour outcomes associated with multi-gene panel testing for HBOC risk. The search was developed in collaboration with an Information Specialist (Princess Margaret Cancer Centre) and conducted in the following databases: MEDLINE, EMBASE, EMCare, PsycINFO, Epub Ahead of Publication. RESULTS Similar to the BRCA1/2 literature, individuals with a pathogenic variant (PV) reported higher levels of testing-related concerns and cancer-specific distress, as well as higher uptake of prophylactic surgery in both affected and unaffected individuals compared to those with variant of uncertain significance (VUS) or negative result. A single study demonstrated that individuals with a PV in a moderate penetrance gene reported higher rates of cancer worry, genetic testing concerns and cancer-related distress when compared to women with high penetrance PV. Analysis of cancer screening and prevention outcomes based upon gene penetrance were limited to two studies, with conflicting findings. CONCLUSION The findings in this review emphasize the need for studies examining psychological and health behavior outcomes associated with panel testing to include between group differences based upon both variant pathogenicity and gene penetrance. Future studies evaluating the impact of gene penetrance on patient-reported and clinical outcomes will require large samples to be powered for these analyses given that a limited number of tested individuals are found to have a PV.
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Affiliation(s)
- Lindsay Carlsson
- Drug Development Program, Princess Margaret Cancer Centre, 620 University Avenue, 8-132, Toronto, ON, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Emily Thain
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Brittany Gillies
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute , Toronto, ON, Canada
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13
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Lacey HP, Lacey SC, Forest C, Blasi D, Dayal P. The role of emotional sensitivity to probability in the decision to choose genetic testing. J Genet Couns 2022; 31:677-688. [PMID: 34873773 DOI: 10.1002/jgc4.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/08/2022]
Abstract
While the availability of genetic testing is rapidly increasing, many opt out of testing. The decision to test or not is emotionally charged, and both clinical research and theoretical work in psychology show that in emotional decisions, people often struggle to interpret and utilize risk information. Clinical research on genetic testing uptake also shows that feeling overwhelmed by numeric information may be a deterrent to testing. However, recent psychological research indicates that some portion of the population has greater emotional sensitivity to probability, (i.e., the extent to which emotional reactions to risk depend on probabilities) than others. We hypothesize that participants high in emotional sensitivity to probability will be more interested in genetic testing as an opportunity to seek greater precision in risk estimates and that this relationship is moderated by the testing context itself. In an online survey of a nationally representative sample (not recruited as patients), participants were presented with a hypothetical scenario describing a suspected diagnosis with an option for genetic testing. The scenario experimentally varied the pre-test probability estimate of the diagnosis (low or high) and whether the test results would result in certainty (ruling in or ruling out the diagnosis), or reduced uncertainty (providing a more precise individual risk estimate). Results indicated that emotional sensitivity to probability was a strong predictor of intention to test, particularly when the test allowed participants to rule out a diagnosis, reducing an already low probability to zero. These results highlight the way patients' individual characteristics interact with the testing context to guide decision-making and provide important insight into the way patients integrate risk probability information into intensely emotional decisions.
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Affiliation(s)
- Heather P Lacey
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
| | - Steven C Lacey
- Carroll School of Management, Boston College, Massachusetts, USA
| | - Caroline Forest
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
| | - Dana Blasi
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
| | - Prerna Dayal
- Department of Psychology, Bryant University, Smithfield, Rhode Island, USA
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14
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Best MC, Butow P, Savard J, Jacobs C, Bartley N, Davies G, Napier CE, Ballinger ML, Thomas DM, Biesecker B, Tucker KM, Juraskova I, Meiser B, Schlub T, Newson AJ. Preferences for return of germline genome sequencing results for cancer patients and their genetic relatives in a research setting. Eur J Hum Genet 2022; 30:930-937. [PMID: 35277654 PMCID: PMC9349221 DOI: 10.1038/s41431-022-01069-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
Germline genome sequencing (GS) holds great promise for cancer prevention by identifying cancer risk and guiding prevention strategies, however research evidence is mixed regarding patient preferences for receiving GS results. The aim of this study was to discern preferences for return of results by cancer patients who have actually undergone GS. We conducted a mixed methods study with a cohort of cancer probands (n = 335) and their genetic relatives (n = 199) undergoing GS in a research setting. Both groups completed surveys when giving consent. A subset of participants (n = 40) completed semi-structured interviews. A significantly higher percentage of probands thought people would like to be informed about genetic conditions for which there is prevention or treatment that can change cancer risk compared to conditions for which there is no prevention or treatment (93% [311] versus 65% [216]; p < 0.001). Similar results were obtained for relatives (91% [180] versus 61% [121]; p < 0.001). Themes identified in the analysis of interviews were: (1) Recognised benefits of GS, (2) Balancing benefits with risks, (3) Uncertain results are perceived as unhelpful and (4) Competing obligations. While utility was an important discriminator in what was seen as valuable for this cohort, there was a variety of responses. In view of varied participant preferences regarding return of results, it is important to ensure patient understanding of test validity and identify individual choices at the time of consent to GS. The nature and value of the information, and a contextual understanding of researcher obligations should guide result return.
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Affiliation(s)
- Megan C Best
- Faculty of Science, University of Sydney, Sydney, NSW, Australia. .,Institute for Ethics and Society, University of Notre Dame Australia, Sydney, WA, Australia.
| | - Phyllis Butow
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | | | - Chris Jacobs
- Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Nicole Bartley
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Grace Davies
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ilona Juraskova
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, University of NSW, Sydney, NSW, Australia
| | - Timothy Schlub
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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15
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Bradbury AR, Lee JW, Gaieski JB, Li S, Gareen IF, Flaherty KT, Herman BA, Domchek SM, DeMichele AM, Maxwell KN, Onitilo AA, Virani S, Park S, Faller BA, Grant SC, Ramaekers RC, Behrens RJ, Nambudiri GS, Carlos RC, Wagner LI. A randomized study of genetic education versus usual care in tumor profiling for advanced cancer in the ECOG-ACRIN Cancer Research Group (EAQ152). Cancer 2021; 128:1381-1391. [PMID: 34890045 PMCID: PMC8917095 DOI: 10.1002/cncr.34063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
Background Enthusiasm for precision oncology may obscure the psychosocial and ethical considerations associated with the implementation of tumor genetic sequencing. Methods Patients with advanced cancer undergoing tumor‐only genetic sequencing in the National Cancer Institute Molecular Analysis for Therapy Choice (MATCH) trial were randomized to a web‐based genetic education intervention or usual care. The primary outcomes were knowledge, anxiety, depression, and cancer‐specific distress collected at baseline (T0), posteducation (T1) and after results (T2). Two‐sided, 2‐sample t tests and univariate and multivariable generalized linear models were used. Results Five hundred ninety‐four patients (80% from NCI Community Oncology Research Program sites) were randomized to the web intervention (n = 293) or usual care (n = 301) before the receipt of results. Patients in the intervention arm had greater increases in knowledge (P for T1‐T0 < .0001; P for T2‐T0 = .003), but there were no significant differences in distress outcomes. In unadjusted moderator analyses, there was a decrease in cancer‐specific distress among women (T0‐T1) in the intervention arm but not among men. Patients with lower health literacy in the intervention arm had greater increases in cancer‐specific distress and less decline in general anxiety (T0‐T1) and greater increases in depression (T0‐T2) in comparison with those receiving usual care. Conclusions Web‐based genetic education before tumor‐only sequencing results increases patient understanding and reduces distress in women. Refinements to the intervention could benefit low‐literacy groups and men. In the Communication and Education in Tumor Profiling (COMET) study, patients with advanced cancer undergoing tumor genetic sequencing in the National Cancer Institute Molecular Analysis for Therapy Choice (MATCH) trial have been randomized to a web‐based genetic education intervention or usual care. Web‐based genetic education has resulted in increased patient understanding and reduced distress in female patients with cancer.
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Affiliation(s)
- Angela R Bradbury
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Ju-Whei Lee
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Shuli Li
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ilana F Gareen
- ECOG-ACRIN Biostatistics Center, Brown University, Providence, Rhode Island
| | - Keith T Flaherty
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Benjamin A Herman
- ECOG-ACRIN Biostatistics Center, Brown University, Providence, Rhode Island
| | - Susan M Domchek
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Angela M DeMichele
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Kara N Maxwell
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania
| | | | | | - SuJung Park
- Medical Oncology Hematology Consultants PA, Newark, Delaware
| | | | - Stefan C Grant
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | | | | | | | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
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16
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Defining the Critical Components of Informed Consent for Genetic Testing. J Pers Med 2021; 11:jpm11121304. [PMID: 34945775 PMCID: PMC8706495 DOI: 10.3390/jpm11121304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: Informed consent for genetic testing has historically been acquired during pretest genetic counseling, without specific guidance defining which core concepts are required. Methods: The Clinical Genome Resource (ClinGen) Consent and Disclosure Recommendations Workgroup (CADRe) used an expert consensus process to identify the core concepts essential to consent for clinical genetic testing. A literature review identified 77 concepts that are included in informed consent for genetic tests. Twenty-five experts (9 medical geneticists, 8 genetic counselors, and 9 bioethicists) completed two rounds of surveys ranking concepts’ importance to informed consent. Results: The most highly ranked concepts included: (1) genetic testing is voluntary; (2) why is the test recommended and what does it test for?; (3) what results will be returned and to whom?; (4) are there other types of potential results, and what choices exist?; (5) how will the prognosis and management be impacted by results?; (6) what is the potential family impact?; (7) what are the test limitations and next steps?; and (8) potential risk of genetic discrimination and legal protections. Conclusion: Defining the core concepts necessary for informed consent for genetic testing provides a foundation for quality patient care across a variety of healthcare providers and clinical indications.
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17
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Butow P, Davies G, Napier CE, Bartley N, Ballinger ML, Biesecker B, Juraskova I, Meiser B, Schlub T, Thomas DM, Goldstein D, Best MC. Value of whole-genome sequencing to Australian cancer patients and their first-degree relatives participating in a genomic sequencing study. J Genet Couns 2021; 31:96-108. [PMID: 34218500 DOI: 10.1002/jgc4.1455] [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: 03/19/2021] [Revised: 05/10/2021] [Accepted: 05/22/2021] [Indexed: 12/19/2022]
Abstract
Genomic Sequencing (GS) to identify high cancer risk will soon enter clinical practice at significant cost to the health system. This study aimed to quantify perceived value of GS to Australian cancer patients and their first-degree relatives participating in a genomic sequencing study, and factors associated with value. Participants were recruited upon consent to the genomics study. Eligible participants (with cancer of likely genetic etiology, or a first-degree relative) completed a questionnaire prior to GS. Willingness to pay was assessed via hypothetical trade-off scenarios of actionable result return rates of 1%, 10%, 20%, 30%, 40% or 50%. Of 348 probands and 213 relatives (92% and 93% response rate), 81% would consistently have GS for as little as a 1% actionable return rate. Participants would pay a median of $1,000 for return rates of at least 20% (probands) or 30% (relatives), and $300 for lower return rates. Probands with common cancers and negative attitudes to uncertainty were more likely to have GS; those with higher education were more willing to pay $1,000 and $3,000 for lower return rates. This study found high interest in, but lower willingness to pay for GS in cancer patients and their first-degree relatives, possibly due to inability to pay. Further research is needed to improve our understanding of how individuals in different risk circumstances, trade-off the risks, harms, and benefits of GS.
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Affiliation(s)
- Phyllis Butow
- School of Psychology, Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Grace Davies
- School of Psychology, Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Nicci Bartley
- School of Psychology, Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Sydney, NSW, Australia
| | | | - Ilona Juraskova
- School of Psychology, Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Kensington, NSW, Australia
| | - Timothy Schlub
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Sydney, NSW, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Megan C Best
- School of Psychology, Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia
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18
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Cacioppo CN, Egleston BL, Fetzer D, Burke Sands C, Raza SA, Reddy Malleda N, McCarty Wood E, Rittenburg I, Childs J, Cho D, Hosford M, Khair T, Khatri J, Komarnicky L, Poretta T, Rahman F, Shah S, Patrick-Miller LJ, Domchek SM, Bradbury AR. Randomized study of remote telehealth genetic services versus usual care in oncology practices without genetic counselors. Cancer Med 2021; 10:4532-4541. [PMID: 34102012 PMCID: PMC8267134 DOI: 10.1002/cam4.3968] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To examine the benefit of telehealth over current delivery options in oncology practices without genetic counselors. Methods Participants meeting cancer genetic testing guidelines were recruited to this multi‐center, randomized trial comparing uptake of genetic services with remote services (telephone or videoconference) to usual care in six predominantly community practices without genetic counselors. The primary outcome was the composite uptake of genetic counseling or testing. Secondary outcomes compare telephone versus videoconference services. Results 147 participants enrolled and 119 were randomized. Eighty percent of participants in the telehealth arm had genetic services as compared to 16% in the usual care arm (OR 30.52, p < 0.001). Five genetic mutation carriers (6.7%) were identified in the telehealth arm, compared to none in the usual care arm. In secondary analyses, factors associated with uptake were lower anxiety (6.77 vs. 8.07, p = 0.04) and lower depression (3.38 vs. 5.06, p = 0.04) among those who had genetic services. There were no significant differences in change in cognitive or affective outcomes immediately post‐counseling and at 6 and 12 months between telephone and videoconference arms. Conclusion Telehealth increases uptake of genetic counseling and testing at oncology practices without genetic counselors and could significantly improve identification of genetic carriers and cancer prevention outcomes.
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Affiliation(s)
- Cara N Cacioppo
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian L Egleston
- Fox Chase Cancer Center, Biostatistics and Bioinformatics Facility, Temple University Health System, Philadelphia, PA, USA
| | - Dominique Fetzer
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen Burke Sands
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Syeda A Raza
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - India Rittenburg
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David Cho
- Cape Regional Medical Center, Cape May Court House, NJ, USA
| | | | - Tina Khair
- Gettysburg Cancer Center, Gettysburg, PA, USA
| | | | | | | | | | - Satish Shah
- Gettysburg Cancer Center, Gettysburg, PA, USA
| | - Linda J Patrick-Miller
- Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL, USA
| | - Susan M Domchek
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela R Bradbury
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
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19
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Heald B, Hampel H, Church J, Dudley B, Hall MJ, Mork ME, Singh A, Stoffel E, Stoll J, You YN, Yurgelun MB, Kupfer SS. Collaborative Group of the Americas on Inherited Gastrointestinal Cancer Position statement on multigene panel testing for patients with colorectal cancer and/or polyposis. Fam Cancer 2021; 19:223-239. [PMID: 32172433 DOI: 10.1007/s10689-020-00170-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multigene panel tests for hereditary cancer syndromes are increasingly utilized in the care of colorectal cancer (CRC) and polyposis patients. However, widespread availability of panels raises a number of questions including which patients should undergo testing, which genes should be included on panels, and the settings in which panels should be ordered and interpreted. To address this knowledge gap, key questions regarding the major issues encountered in clinical evaluation of hereditary CRC and polyposis were designed by the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer Position Statement Committee and leadership. A literature search was conducted to address these questions. Recommendations were based on the best available evidence and expert opinion. This position statement addresses which genes should be included on a multigene panel for a patient with a suspected hereditary CRC or polyposis syndrome, proposes updated genetic testing criteria, discusses testing approaches for patients with mismatch repair proficient or deficient CRC, and outlines the essential elements for ordering and disclosing multigene panel test results. We acknowledge that critical gaps in access, insurance coverage, resources, and education remain barriers to high-quality, equitable care for individuals and their families at increased risk of hereditary CRC.
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Affiliation(s)
- Brandie Heald
- Sanford R Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA.
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - James Church
- Sanford R Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - Beth Dudley
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Maureen E Mork
- Department of Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aparajita Singh
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Elena Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Stoll
- Gastrointestinal Cancer Risk and Prevention Clinic, University of Chicago, Chicago, IL, USA
| | - Y Nancy You
- Department of Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew B Yurgelun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sonia S Kupfer
- Gastrointestinal Cancer Risk and Prevention Clinic, University of Chicago, Chicago, IL, USA
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20
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Medendorp NM, Hillen MA, Visser LNC, Aalfs CM, Duijkers FAM, van Engelen K, Ausems MGEM, Verhoef S, Stiggelbout AM, Smets EMA. A randomized experimental study to test the effects of discussing uncertainty during cancer genetic counseling: different strategies, different outcomes? Eur J Hum Genet 2021; 29:789-799. [PMID: 33437034 PMCID: PMC8110589 DOI: 10.1038/s41431-020-00799-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 01/29/2023] Open
Abstract
Uncertainty is increasingly discussed during genetic counseling due to innovative techniques, e.g., multigene panel testing. Discussions about uncertainty may impact counselees variably, depending on counselors' communication styles. Ideally, the discussion of uncertainty enables counselees to cope with uncertainty and make well-informed decisions about testing. We examined the impact of how counselors convey uncertainty and address counselees' uncertainty, and explored the role of individual characteristics. Therefore, a randomized controlled experiment using videos was conducted. Former counselees (N = 224) viewed one video depicting a genetic consultation about multigene panel testing. The extent of counselors' communication of uncertainty (comprehensive vs. the essence) and their response to counselees' uncertainty expressions (providing information vs. providing space for emotions vs. normalizing and counterbalancing uncertainty) were systematically manipulated. Individual characteristics, e.g., uncertainty tolerance, were assessed, as well as outcome variables (primary outcomes: feelings of uncertainty and information recall). No effects were found on primary outcomes. Participants were most satisfied when the essence was communicated, combined with providing information or providing space responses (p = 0.002). Comprehensive information resulted in less perceived steering toward testing (p = 0.005). Participants with lower uncertainty tolerance or higher trait anxiety were less confident about their understanding when receiving comprehensive information (p = 0.025). Participants seeking information experienced less uncertainty (p = 0.003), and trusted their counselor more (p = 0.028), when the counselor used information providing responses. In sum, the impact of discussing uncertainty primarily depends on individual characteristics. Practical guidelines should address how to tailor the discussion of uncertainty.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor A M Duijkers
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaartje van Engelen
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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21
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Bartley N, Napier CE, Butt Z, Schlub TE, Best MC, Biesecker BB, Ballinger ML, Butow P. Cancer Patient Experience of Uncertainty While Waiting for Genome Sequencing Results. Front Psychol 2021; 12:647502. [PMID: 33967906 PMCID: PMC8100530 DOI: 10.3389/fpsyg.2021.647502] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited knowledge about cancer patients' experiences of uncertainty while waiting for genome sequencing results, and whether prolonged uncertainty contributes to psychological factors in this context. To investigate uncertainty in patients with a cancer of likely hereditary origin while waiting for genome sequencing results, we collected questionnaire and interview data at baseline, and at three and 12 months follow up (prior to receiving results). Participants (N = 353) had negative attitudes towards uncertainty (M = 4.03, SD 0.68) at baseline, and low levels of uncertainty at three (M = 8.23, SD 7.37) and 12 months (M = 7.95, SD 7.64). Uncertainty about genome sequencing did not change significantly over time [t(210) = 0.660, p = 0.510]. Greater perceived susceptibility for cancer [r(348) = 0.14, p < 0.01], fear of cancer recurrence [r(348) = 0.19, p < 0.01], perceived importance of genome sequencing [r(350) = 0.24, p < 0.01], intention to change behavior if a gene variant indicating risk is found [r(349) = 0.29, p < 0.01], perceived ability to cope with results [r(349) = 0.36, p < 0.01], and satisfaction with decision to have genome sequencing [r(350) = 0.52, p < 0.01] were significantly correlated with negative attitudes towards uncertainty at baseline. Multiple primary cancer diagnoses [B = -2.364 [-4.238, -0.491], p = 0.014], lower perceived ability to cope with results [B = -0.1.881 [-3.403, -0.359], p = 0.016] at baseline, greater anxiety about genome sequencing (avoidance) [B = 0.347 [0.148, 0.546], p = 0.0012] at 3 months, and greater perceived uncertainty about genome sequencing [B = 0.494 [0.267, 0.721] p = 0.000] at 3 months significantly predicted greater perceived uncertainty about genome sequencing at 12 months. Greater perceived uncertainty about genome sequencing at 3 months significantly predicted greater anxiety (avoidance) about genome sequencing at 12 months [B = 0.291 [0.072, 0.509], p = 0.009]. Semi-structured interviews revealed that while participants were motivated to pursue genome sequencing as a strategy to reduce their illness and risk uncertainty, genome sequencing generated additional practical, scientific and personal uncertainties. Some uncertainties were consistently discussed over the 12 months, while others emerged over time. Similarly, some uncertainty coping strategies were consistent over time, while others emerged while patients waited for their genome sequencing results. This study demonstrates the complexity of uncertainty generated by genome sequencing for cancer patients and provides further support for the inter-relationship between uncertainty and anxiety. Helping patients manage their uncertainty may ameliorate psychological morbidity.
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Affiliation(s)
- Nicci Bartley
- Psycho-Oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Zoe Butt
- Psycho-Oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Timothy E Schlub
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Megan C Best
- Psycho-Oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Institute for Ethics & Society, The University of Notre Dame Australia, Sydney, NSW, Australia
| | | | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia.,St Vincent's Clinical School, University of NSW, Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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22
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Reyes KG, Clark C, Gerhart M, Newson AJ, Ormond KE. "I wish that there was more info": characterizing the uncertainty experienced by carriers of pathogenic ATM and/or CHEK2 variants. Fam Cancer 2021; 21:143-155. [PMID: 33855648 DOI: 10.1007/s10689-021-00251-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/04/2021] [Indexed: 12/29/2022]
Abstract
Little is known about what uncertainties patients experience after being identified to carry a pathogenic variant in a moderate-risk cancer gene as a result of undergoing multigene panel testing for cancer susceptibility. Data regarding cancer risk estimates and effectiveness of risk management strategies for these variants continues to evolve, which has the potential to evoke uncertainty. Acknowledging uncertainty during pre- and post-test discussions is imperative to helping individuals to adapt to their results. A better understanding of this population's experience of uncertainty is needed to facilitate such discussions and is the aim of the current study. Semi-structured interviews (30-60 min in length), informed by Han and colleagues' taxonomy of uncertainty in clinical genomic sequencing, were conducted to assess motivations to pursue genetic testing, areas of perceived uncertainty, and strategies for managing uncertainty among 20 carriers of pathogenic variants in two moderate-risk genes, ATM and CHEK2. We found that participants pursue genetic testing with the expectation that results will clarify cancer risks and approaches to management. Participants experience uncertainties aligning with Han's taxonomy relating to the ambiguity of specific cancer risk estimates and effectiveness of certain risk management strategies. These uncertainties influenced decisions around the uptake of risk management strategies, which were additionally impacted by clinicians' uncertainty towards such strategies. Participants employ a variety of uncertainty management approaches to cope with their anxieties. Clinicians may wish to use these findings to facilitate patient adaptation to the implications of multigene panel testing for cancer susceptibility during both pre- and post-test counseling sessions.
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Affiliation(s)
- Kathryn G Reyes
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheyla Clark
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Gerhart
- Cancer Genetics and Genomics, Stanford Health Care, Stanford, CA, USA
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA. .,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
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23
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López-Fernández A, Villacampa G, Grau E, Salinas M, Darder E, Carrasco E, Torres-Esquius S, Iglesias S, Solanes A, Gadea N, Velasco A, Urgell G, Torres M, Tuset N, Brunet J, Corbella S, Balmaña J. Patients' and professionals' perspective of non-in-person visits in hereditary cancer: predictors and impact of the COVID-19 pandemic. Genet Med 2021; 23:1450-1457. [PMID: 33824504 PMCID: PMC8023774 DOI: 10.1038/s41436-021-01157-2] [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: 11/30/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To identify predictors of patient acceptance of non-in-person cancer genetic visits before and after the COVID-19 pandemic and assess the preferences of health-care professionals. METHODS Prospective multicenter cohort study (N = 578, 1 February 2018-20 April 2019) and recontacted during the COVID-19 lockdown in April 2020. Health-care professionals participated in May 2020. Association of personality traits and clinical factors with acceptance was assessed with multivariate analysis. RESULTS Before COVID-19, videoconference was more accepted than telephone-based visits (28% vs. 16% pretest, 30% vs. 19% post-test). Predictors for telephone visits were age (pretest, odds ratio [OR] 10-year increment = 0.79; post-test OR 10Y = 0.78); disclosure of panel testing (OR = 0.60), positive results (OR = 0.52), low conscientiousness group (OR = 2.87), and post-test level of uncertainty (OR = 0.93). Predictors for videoconference were age (pretest, OR 10Y = 0.73; post-test, OR 10Y = 0.75), educational level (pretest: OR = 1.61), low neuroticism (pretest, OR = 1.72), and post-test level of uncertainty (OR = 0.96). Patients' reported acceptance for non-in-person visits after COVID-19 increased to 92% for the pretest and 85% for the post-test. Health-care professionals only preferred non-in-person visits for disclosure of negative results (83%). CONCLUSION These new delivery models need to recognize challenges associated with age and the psychological characteristics of the population and embrace health-care professionals' preferences.
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Affiliation(s)
- Adrià López-Fernández
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Elia Grau
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Mónica Salinas
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Esther Darder
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Torres-Esquius
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Silvia Iglesias
- Hereditary Cancer Program, Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Ares Solanes
- Hereditary Cancer Program, Germans Trias i Pujol Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Neus Gadea
- Medical Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Angela Velasco
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Gisela Urgell
- Genetic Counseling Unit, Arnau de Vilanova University Hospital, Barcelona, Spain
| | - Maite Torres
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Noemí Tuset
- Genetic Counseling Unit, Arnau de Vilanova University Hospital, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Josep Trueta University Hospital, Catalan Institute of Oncology, Barcelona, Spain
| | - Sergi Corbella
- School of Psychology, Education and Sports Sciences. Ramon Llull University-Blanquerna, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. .,Medical Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
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24
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Berliner JL, Cummings SA, Boldt Burnett B, Ricker CN. Risk assessment and genetic counseling for hereditary breast and ovarian cancer syndromes-Practice resource of the National Society of Genetic Counselors. J Genet Couns 2021; 30:342-360. [PMID: 33410258 DOI: 10.1002/jgc4.1374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
Cancer risk assessment and genetic counseling for hereditary breast and ovarian cancer (HBOC) are a communication process to inform and prepare patients for genetic test results and the related medical management. An increasing number of healthcare providers are active in the delivery of cancer risk assessment and testing, which can have enormous benefits for enhanced patient care. However, genetics professionals remain key in the multidisciplinary care of at-risk patients and their families, given their training in facilitating patients' understanding of the role of genetics in cancer development, the potential psychological, social, and medical implications associated with cancer risk assessment and genetic testing. A collaborative partnership of non-genetics and genetics experts is the ideal approach to address the growing number of patients at risk for hereditary breast and ovarian cancer. The goal of this practice resource is to provide allied health professionals an understanding of the key components of risk assessment for HBOC as well as the use of risk models and published guidelines for medical management. We also highlight what patient types are appropriate for genetic testing, what are the most appropriate test(s) to consider, and when to refer individuals to a genetics professional. This practice resource is intended to serve as a resource for allied health professionals in determining their approach to delivering comprehensive care for families and individuals facing HBOC. The cancer risk and prevalence figures in this document are based on cisgender women and men; the risks for transgender or non-binary individuals have not been studied and therefore remain poorly understood.
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Affiliation(s)
- Janice L Berliner
- Genetic Counseling Department, Bay Path University, East Longmeadow, MA, USA
| | | | | | - Charité N Ricker
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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25
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Medendorp NM, van Maarschalkerweerd PEA, Murugesu L, Daams JG, Smets EMA, Hillen MA. The impact of communicating uncertain test results in cancer genetic counseling: A systematic mixed studies review. PATIENT EDUCATION AND COUNSELING 2020; 103:1692-1708. [PMID: 32278626 DOI: 10.1016/j.pec.2020.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Cancer genetic counseling increasingly involves discussing uncertain test results, for example because multiple genes are sequenced simultaneously. This review was performed to provide insight into how counselors' communication of uncertain test results during genetic counseling for cancer affects counselors and counselees. METHODS A systematic mixed studies review was undertaken to review research on the effects of communicating uncertain test results. Four databases were searched using a PICO search strategy. Study findings of articles meeting the inclusion criteria were synthesized narratively. RESULTS Twenty-four articles were included. Uncertain test results encompassed either an inconclusive test result or a variant of unknown significance (VUS). Counselees involved almost exclusively women at risk of hereditary breast and/or ovarian cancer. None of the articles reported effects on counselor outcomes. Counselee outcomes were categorized as cognitive, affective or behavioral. Interpretation of a VUS was overall reported as difficult, and counselees' distress and worry were repeatedly found to decrease over time after the discussion of any uncertain test result. For most other outcomes, findings were sparse and/or inconsistent. CONCLUSION Evidence on effects on counselee outcomes is scant and inconsistent. Future studies are warranted to provide insight into how counselees and counselors are affected. PRACTICE IMPLICATIONS Clinical practice could benefit from guidelines on how to address uncertain test results during pre- and posttest genetic consultations.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | | | - Laxsini Murugesu
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
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26
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Underhill-Blazey M, Blonquist T, Chittenden A, Pozzar R, Nayak M, Lansang K, Hong F, Garber J, Stopfer JE. Informing models of cancer genetics care in the era of multigene panel testing with patient-led recommendations. J Genet Couns 2020; 30:268-282. [PMID: 32851753 DOI: 10.1002/jgc4.1317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
The study describes patient-reported experiences and recommendations to improve the genetic counseling and multigene panel testing (MGPT) process. A descriptive mixed-method study with concurrently collected and integrated qualitative and quantitative data was conducted. Eligible participants were English-speaking adults with a breast or gynecologic cancer diagnosis who had received genetic counseling and testing with a MGPT from one Comprehensive Cancer Center. Satisfaction with the genetic counseling, genetic knowledge using a recently validated scale (KnowGene), the multidimensional impact of cancer risk assessment (MICRA), family communication, and the association with demographic factors were evaluated. To supplement the large quantitative data set, qualitative focus group responses and open-ended text items were collected. Univariate and multivariable associations between each outcome of interest and personal characteristics were assessed. Qualitative data were content-analyzed. 603 participants completed the survey (48% response rate) and 10 individuals participated in the focus groups. Participants were mostly Caucasian, educated with a college degree or more, and female with median age 58 (24-91), and 78% of participants had a breast cancer diagnosis. Of all individuals undergoing genetic testing using a MGPT, 13% had a pathogenic variant identified, and 30% had a variant of uncertain significance (VUS). Overall, participants reported satisfaction with the genetic counseling and testing process (mean 36.9 [SD 4.7]). On average, participants had 7 incorrect answers out of 19 on the genetic knowledge scale (mean 12.3 [SD 3.4]). MICRA scores showed overall low levels of distress and uncertainty, as well as positive experiences, with wide variability (median 17 [0-84]). Age, marital status, education level, type of cancer diagnosis, and genetic testing results were significantly associated with outcomes. Most participants communicated genetic testing results to mainly female first-degree relatives. A wide range of individual preferences affecting overall satisfaction, or suggestions for improvement were shared. As new models of streamlined cancer genetic services are being clinically implemented, approaches should continue to assess and tailor the process based on patients' informational and emotional needs.
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Affiliation(s)
- Meghan Underhill-Blazey
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA.,School of Nursing, University of Rochester, Rochester, NY, USA
| | - Traci Blonquist
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anu Chittenden
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Manan Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristina Lansang
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judy Garber
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jill E Stopfer
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
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27
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Best M, Butow P, Jacobs C, Juraskova I, Savard J, Meiser B, Goldstein D, Ballinger M, Bartley N, Napier C, Davies G, Thomas D, Tucker K, Schlub T, Newson AJ. Advanced cancer patient preferences for receiving molecular profiling results. Psychooncology 2020; 29:1533-1539. [PMID: 32544291 DOI: 10.1002/pon.5446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to discern preferences for receiving somatic molecular profiling (MP) results in cancer patients who have given consent to undergo testing. METHODS We conducted a mixed-methods study to explore patients' views on which MP results they would like to receive and why. Advanced cancer patients (n = 1299) completed questionnaires after giving consent to participate in a parent genomics study and undergoing MP. A subset of patients (n = 20) participated in qualitative interviews. RESULTS Almost all (96%) participants were interested in receiving results which would direct cancer treatment (ie, were actionable). A smaller majority wanted to access results which were not actionable (64%) or were variants of unknown significance (60%). Most (86%) were interested in finding out about germline findings, though not as a priority. Themes identified in interview data were: (a) Cancer is the focus; (b) Trust in clinicians; and (c) Respect for a right not to know. CONCLUSIONS The majority of advanced cancer patients undergoing MP prioritised results which would lead to treatment options. They trusted their oncologists to help them navigate the results return process. While there was interest in knowing about other results, this was a lesser priority. Nevertheless, given high levels of interest in receiving all results, ethical aspects of not providing uninformative results requires further research, including a consideration of patient rationales for desiring this information and what health professionals can and should do to support patients in the absence of meaningful information being available.
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Affiliation(s)
- Megan Best
- The University of Notre Dame, Sydney, NSW, 2007, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital Cancer Services, Randwick, New South Wales, Australia
| | - Mandy Ballinger
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Nicci Bartley
- The University of Notre Dame, Sydney, NSW, 2007, Australia
| | - Christine Napier
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Grace Davies
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Thomas
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
| | - Timothy Schlub
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ainsley J Newson
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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28
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Schienda J, Stopfer J. Cancer Genetic Counseling-Current Practice and Future Challenges. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036541. [PMID: 31548230 DOI: 10.1101/cshperspect.a036541] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cancer genetic counseling practice is rapidly evolving, with services being provided in increasingly novel ways. Pretest counseling for cancer patients may be abbreviated from traditional models to cover the elements of informed consent in the broadest of strokes. Genetic testing may be ordered by a cancer genetics professional, oncology provider, or primary care provider. Increasingly, direct-to-consumer testing options are available and utilized by consumers anxious to take control of their genetic health. Finally, genetic information is being used to inform oncology care, from surgical decision-making to selection of chemotherapeutic agent. This review provides an overview of the current and evolving practice of cancer genetic counseling as well as opportunities and challenges for a wide variety of indications in both the adult and pediatric setting.
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Affiliation(s)
- Jaclyn Schienda
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Jill Stopfer
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
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29
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Bradbury AR, Egleston BL, Patrick-Miller LJ, Rustgi N, Brandt A, Brower J, DiGiovanni L, Fetzer D, Berkelbach C, Long JM, Powers J, Stopfer JE, Domchek SM. Longitudinal outcomes with cancer multigene panel testing in previously tested BRCA1/2 negative patients. Clin Genet 2020; 97:601-609. [PMID: 32022897 PMCID: PMC9984207 DOI: 10.1111/cge.13716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 01/04/2023]
Abstract
Although multigene panel testing (MGPT) is increasingly utilized in clinical practice, there remain limited data on patient-reported outcomes. BRCA 1/2 negative patients were contacted and offered MGPT. Patients completed pre- and posttest counseling, and surveys assessing cognitive, affective and behavioral outcomes at baseline, postdisclosure and 6 and 12 months. Of 317 eligible BRCA1/2 negative patients who discussed the study with research staff, 249 (79%) enrolled. Decliners were more likely to be older, non-White, and recruited by mail or email. Ninety-five percent of enrolled patients proceeded with MGPT. There were no significant changes in anxiety, depression, cancer specific distress or uncertainty postdisclosure. There were significant but small increases in knowledge, cancer-specific distress and depression at 6-12 months. Uncertainty declined over time. Those with a VUS had significant decreases in uncertainty but also small increases in cancer specific distress at 6 and 12 months. Among those with a positive result, medical management recommendations changed in 26% of cases and 2.6% of all tested. Most BRCA1/2 negative patients have favorable psychosocial outcomes after receipt of MGPT results, although small increases in depression and cancer-specific worry may exist and may vary by result. Medical management changed in few patients.
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Affiliation(s)
- Angela R. Bradbury
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian L. Egleston
- Fox Chase Cancer Center, Temple University Health System, Biostatistics and Bioinformatics Facility, Philadelphia, Pennsylvania, USA
| | - Linda J. Patrick-Miller
- Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Neil Rustgi
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amanda Brandt
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jamie Brower
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura DiGiovanni
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominique Fetzer
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Berkelbach
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica M. Long
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacquelyn Powers
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jill E. Stopfer
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susan M. Domchek
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Underhill ML, Pozzar R, Chung D, Sawhney M, Yurgelun M. Health Care Provider Perceptions of Caring for Individuals with Inherited Pancreatic Cancer Risk. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:194-203. [PMID: 31701425 PMCID: PMC7057412 DOI: 10.1007/s13187-019-01623-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recent national guidelines recommend genetic risk assessment for all patients diagnosed with pancreatic cancer, yet individuals with pancreatic cancer obtain genetic testing at suboptimal rates. Both patient and provider factors play a role in adherence to genetic testing recommendations. The purpose of this study was to understand health care provider perspectives of caring for patients with inherited pancreatic cancer risk. The study was a cross-sectional mixed method study utilizing a qualitative interview and a survey. The study sample included health care providers who provide care for patients with pancreatic cancer or inherited risk. Qualitative data were analyzed using content analysis, while quantitative data were summarized using descriptive statistics. Thirty participants had complete interview data and 29 completed a survey. The sample was comprised of physicians (n = 17), genetic counselors (n = 6), nurses (n = 3), and social workers (n = 3). Respondents were less confident in their ability to identify patients with inherited pancreatic cancer risk compared with other hereditary cancer syndromes. Several challenges were identified including the pancreatic cancer illness trajectory; lack of evidence-based practice guidelines; difficulty interpreting genetic test results; and difficulty following up on referrals. Participants perceived a lack of educational resources for patients with inherited pancreatic cancer risk. Health care providers who care for individuals with inherited pancreatic cancer risk face challenges that are distinct from those encountered during the care of individuals for other hereditary cancers. There is a need for additional resources at the patient-, provider-, and system-level.
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Affiliation(s)
- Meghan L Underhill
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW522, Boston, MA, 02215, USA.
| | - Rachel Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW522, Boston, MA, 02215, USA
| | | | | | - Mathew Yurgelun
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW522, Boston, MA, 02215, USA
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31
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Medendorp NM, Hillen MA, van Maarschalkerweerd PEA, Aalfs CM, Ausems MGEM, Verhoef S, van der Kolk LE, Berger LPV, Wevers MR, Wagner A, Caanen BAH, Stiggelbout AM, Smets EMA. 'We don't know for sure': discussion of uncertainty concerning multigene panel testing during initial cancer genetic consultations. Fam Cancer 2019; 19:65-76. [PMID: 31773425 PMCID: PMC7026220 DOI: 10.1007/s10689-019-00154-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
Pre-test counseling about multigene panel testing involves many uncertainties. Ideally, counselees are informed about uncertainties in a way that enables them to make an informed decision about panel testing. It is presently unknown whether and how uncertainty is discussed during initial cancer genetic counseling. We therefore investigated whether and how counselors discuss and address uncertainty, and the extent of shared decision-making (SDM), and explored associations between counselors’ communication and their characteristics in consultations on panel testing for cancer. For this purpose, consultations of counselors discussing a multigene panel with a simulated patient were videotaped. Simulated patients represented a counselee who had had multiple cancer types, according to a script. Before and afterwards, counselors completed a survey. Counselors’ uncertainty expressions, initiating and the framing of expressions, and their verbal responses to scripted uncertainties of the simulated patient were coded by two researchers independently. Coding was done according to a pre-developed coding scheme using The Observer XT software for observational analysis. Additionally, the degree of SDM was assessed by two observers. Correlation and regression analyses were performed to assess associations of communicated uncertainties, responses and the extent of SDM, with counselors’ background characteristics. In total, twenty-nine counselors, including clinical geneticists, genetic counselors, physician assistants-in-training, residents and interns, participated of whom working experience varied between 0 and 25 years. Counselors expressed uncertainties mainly regarding scientific topics (94%) and on their own initiative (95%). Most expressions were framed directly (77%), e.g. We don’t know, and were emotionally neutral (59%; without a positive/negative value). Counselors mainly responded to uncertainties of the simulated patient by explicitly referring to the uncertainty (69%), without providing space for further disclosure (66%). More experienced counselors provided less space to further disclose uncertainty (p < 0.02), and clinical geneticists scored lower on SDM compared with other types of counselors (p < 0.03). Our findings that counselors mainly communicate scientific uncertainties and use space-reducing responses imply that the way counselors address counselees’ personal uncertainties and concerns during initial cancer genetic counseling is suboptimal.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pomme E A van Maarschalkerweerd
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lieke P V Berger
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke R Wevers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara A H Caanen
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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32
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Grady MC, Kolla KA, Peshkin BN. Multigene Cancer Panels: Implications for Pre- and Post-test Genetic Counseling. CURRENT GENETIC MEDICINE REPORTS 2019. [DOI: 10.1007/s40142-019-00173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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Bradbury AR, Patrick-Miller LJ, Egleston BL, Hall MJ, Domchek SM, Daly MB, Ganschow P, Grana G, Olopade OI, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber R, Gulden C, Horte J, Long JM, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer JE, Yao XS. Randomized Noninferiority Trial of Telephone vs In-Person Disclosure of Germline Cancer Genetic Test Results. J Natl Cancer Inst 2019; 110:985-993. [PMID: 29490071 DOI: 10.1093/jnci/djy015] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Germline genetic testing is standard practice in oncology. Outcomes of telephone disclosure of a wide range of cancer genetic test results, including multigene panel testing (MGPT) are unknown. Methods Patients undergoing cancer genetic testing were recruited to a multicenter, randomized, noninferiority trial (NCT01736345) comparing telephone disclosure (TD) of genetic test results with usual care, in-person disclosure (IPD) after tiered-binned in-person pretest counseling. Primary noninferiority outcomes included change in knowledge, state anxiety, and general anxiety. Secondary outcomes included cancer-specific distress, depression, uncertainty, satisfaction, and screening and risk-reducing surgery intentions. To declare noninferiority, we calculated the 98.3% one-sided confidence interval of the standardized effect; t tests were used for secondary subgroup analyses. Only noninferiority tests were one-sided, others were two-sided. Results A total of 1178 patients enrolled in the study. Two hundred eight (17.7%) participants declined random assignment due to a preference for in-person disclosure; 473 participants were randomly assigned to TD and 497 to IPD; 291 (30.0%) had MGPT. TD was noninferior to IPD for general and state anxiety and all secondary outcomes immediately postdisclosure. TD did not meet the noninferiority threshold for knowledge in the primary analysis, but it did meet the threshold in the multiple imputation analysis. In secondary analyses, there were no statistically significant differences between arms in screening and risk-reducing surgery intentions, and no statistically significant differences in outcomes by arm among those who had MGPT. In subgroup analyses, patients with a positive result had statistically significantly greater decreases in general anxiety with telephone disclosure (TD -0.37 vs IPD +0.87, P = .02). Conclusions Even in the era of multigene panel testing, these data suggest that telephone disclosure of cancer genetic test results is as an alternative to in-person disclosure for interested patients after in-person pretest counseling with a genetic counselor.
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Affiliation(s)
- Angela R Bradbury
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Linda J Patrick-Miller
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Michael J Hall
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Susan M Domchek
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Mary B Daly
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Pamela Ganschow
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Generosa Grana
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Olufunmilayo I Olopade
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Dominique Fetzer
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Amanda Brandt
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rachelle Chambers
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Dana F Clark
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Andrea Forman
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Rikki Gaber
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Cassandra Gulden
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Janice Horte
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jessica M Long
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Terra Lucas
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Shreshtha Madaan
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Kristin Mattie
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Danielle McKenna
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Susan Montgomery
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Sarah Nielsen
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Jacquelyn Powers
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Kim Rainey
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Christina Rybak
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Michelle Savage
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Christina Seelaus
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Jessica Stoll
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Jill E Stopfer
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Xinxin Shirley Yao
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
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34
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Gaieski JB, Patrick‐Miller L, Egleston BL, Maxwell KN, Walser S, DiGiovanni L, Brower J, Fetzer D, Ganzak A, McKenna D, Long JM, Powers J, Stopfer JE, Nathanson KL, Domchek SM, Bradbury AR. Research participants' experiences with return of genetic research results and preferences for web-based alternatives. Mol Genet Genomic Med 2019; 7:e898. [PMID: 31376244 PMCID: PMC6732272 DOI: 10.1002/mgg3.898] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While there is increasing interest in sharing genetic research results with participants, how best to communicate the risks, benefits and limitations of research results remains unclear. METHODS Participants who received genetic research results answered open and closed-ended questions about their experiences receiving results and interest in and advantages and disadvantages of a web-based alternative to genetic counseling. RESULTS 107 BRCA1/2 negative women with a personal or family history of breast cancer consented to receive genetic research results and 82% completed survey items about their experience. Most participants reported there was nothing they disliked (74%) or would change (85%) about their predisclosure or disclosure session (78% and 89%). They most frequently reported liking the genetic counselor and learning new information. Only 24% and 26% would not be willing to complete predisclosure counseling or disclosure of results by a web-based alternative, respectively. The most frequently reported advantages included convenience and reduced time. Disadvantages included not being able to ask questions, the risk of misunderstanding and the impersonal nature of the encounter. CONCLUSION Most participants receiving genetic research results report high satisfaction with telephone genetic counseling, but some may be willing to consider self-directed web alternatives for both predisclosure genetic education and return of results.
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Affiliation(s)
- Jill B. Gaieski
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Linda Patrick‐Miller
- Department of Medicine, Division of Hematology‐OncologyThe University of ChicagoChicagoUSA
- Center for Clinical Cancer Genetics and Global HealthThe University of ChicagoChicagoUSA
| | - Brian L. Egleston
- Fox Chase Cancer CenterTemple University Health SystemPhiladelphiaUSA
| | - Kara N. Maxwell
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Sarah Walser
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Laura DiGiovanni
- Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Jamie Brower
- Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Dominique Fetzer
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Amanda Ganzak
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Danielle McKenna
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Jessica M. Long
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Jacquelyn Powers
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Jill E. Stopfer
- Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
| | - Katherine L. Nathanson
- Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
- Department of Medicine, Division of Translational Medicine and Human GeneticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
- Basser Center for BRCA, Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
| | - Susan M. Domchek
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
- Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
- Basser Center for BRCA, Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
| | - Angela R. Bradbury
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
- Abramson Cancer CenterPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
- Department of Medical Ethics and Health PolicyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
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35
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Musunuru K, Arora P, Cooke JP, Ferguson JF, Hershberger RE, Hickey KT, Lee JM, Lima JAC, Loscalzo J, Pereira NL, Russell MW, Shah SH, Sheikh F, Wang TJ, MacRae CA. Interdisciplinary Models for Research and Clinical Endeavors in Genomic Medicine: A Scientific Statement From the American Heart Association. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e000046. [PMID: 29844141 DOI: 10.1161/hcg.0000000000000046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The completion of the Human Genome Project has unleashed a wealth of human genomics information, but it remains unclear how best to implement this information for the benefit of patients. The standard approach of biomedical research, with researchers pursuing advances in knowledge in the laboratory and, separately, clinicians translating research findings into the clinic as much as decades later, will need to give way to new interdisciplinary models for research in genomic medicine. These models should include scientists and clinicians actively working as teams to study patients and populations recruited in clinical settings and communities to make genomics discoveries-through the combined efforts of data scientists, clinical researchers, epidemiologists, and basic scientists-and to rapidly apply these discoveries in the clinic for the prediction, prevention, diagnosis, prognosis, and treatment of cardiovascular diseases and stroke. The highly publicized US Precision Medicine Initiative, also known as All of Us, is a large-scale program funded by the US National Institutes of Health that will energize these efforts, but several ongoing studies such as the UK Biobank Initiative; the Million Veteran Program; the Electronic Medical Records and Genomics Network; the Kaiser Permanente Research Program on Genes, Environment and Health; and the DiscovEHR collaboration are already providing exemplary models of this kind of interdisciplinary work. In this statement, we outline the opportunities and challenges in broadly implementing new interdisciplinary models in academic medical centers and community settings and bringing the promise of genomics to fruition.
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Battistuzzi L, Franiuk M, Kasparian N, Rania N, Migliorini L, Varesco L. A qualitative study on decision‐making about
BRCA1/2
testing in Italian women. Eur J Cancer Care (Engl) 2019; 28:e13083. [DOI: 10.1111/ecc.13083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/12/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Linda Battistuzzi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering University of Genoa Genoa Italy
- Department of Internal Medicine and Medical Specialties University of Genoa Genoa Italy
| | - Marzena Franiuk
- Unit of Hereditary Cancer San Martino Polyclinic Hospital Genoa Italy
| | - Nadine Kasparian
- Harvard Medical School Harvard University Boston Massachusetts
- Department of Cardiology Boston Children’s Hospital Boston Massachusetts
- Discipline of Paediatrics, School of Women’s and Children’s Health UNSW Medicine, UNSW Sydney Sydney New South Wales Australia
| | - Nadia Rania
- Department of Education Sciences University of Genoa Genoa Italy
| | - Laura Migliorini
- Department of Education Sciences University of Genoa Genoa Italy
| | - Liliana Varesco
- Unit of Hereditary Cancer San Martino Polyclinic Hospital Genoa Italy
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Hamilton JG, Robson ME. Psychosocial Effects of Multigene Panel Testing in the Context of Cancer Genomics. Hastings Cent Rep 2019; 49 Suppl 1:S44-S52. [PMID: 31268573 PMCID: PMC7430497 DOI: 10.1002/hast.1016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In recent years, with both the development of next-generation sequencing approaches and the Supreme Court decision invalidating gene patents, declining costs have contributed to the emergence of a new model of hereditary cancer genetic testing. Multigene panel testing (or multiplex testing) involves using next-generation sequencing technology to determine the sequence of multiple cancer-susceptibility genes. In addition to high-penetrance cancer-susceptibility genes, multigene panels frequently include genes that are less robustly associated with cancer predisposition. Scientific understanding about associations between many specific moderate-penetrance gene variants and cancer risks is incomplete. The emergence of multigene panel tests has created unique challenges that may have meaningful psychosocial implications. Contrasted with the serial testing process, wherein patients consider the personal and clinical implications of each evaluated gene, with multigene panel testing, patients provide broad consent to whichever genes are included in a particular panel and then, after the test, receive in-depth genetic counseling to clarify the distinct implications of their specific results. Consequently, patients undergoing multigene panel testing may have a less nuanced understanding of the test and its implications, and they may have fewer opportunities to self-select against the receipt of particular types of genetic-risk information. Evidence is conflicting regarding the emotional effects of this testing.
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Affiliation(s)
- Jada G. Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Mark E. Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
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McCuaig JM, Tone AA, Maganti M, Romagnuolo T, Ricker N, Shuldiner J, Rodin G, Stockley T, Kim RH, Bernardini MQ. Modified panel-based genetic counseling for ovarian cancer susceptibility: A randomized non-inferiority study. Gynecol Oncol 2019; 153:108-115. [DOI: 10.1016/j.ygyno.2018.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022]
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Beri N, Patrick-Miller LJ, Egleston BL, Hall MJ, Domchek SM, Daly MB, Ganschow P, Grana G, Olopade OI, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber R, Gulden C, Horte J, Long J, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer JE, Yao X(S, Bradbury AR. Preferences for in-person disclosure: Patients declining telephone disclosure characteristics and outcomes in the multicenter Communication Of GENetic Test Results by Telephone study. Clin Genet 2019; 95:293-301. [PMID: 30417332 PMCID: PMC6453119 DOI: 10.1111/cge.13474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/04/2023]
Abstract
Telephone disclosure of cancer genetic test results is noninferior to in-person disclosure. However, how patients who prefer in-person communication of results differ from those who agree to telephone disclosure is unclear but important when considering delivery models for genetic medicine. Patients undergoing cancer genetic testing were recruited to a multicenter, randomized, noninferiority trial (NCT01736345) comparing telephone to in-person disclosure of genetic test results. We evaluated preferences for in-person disclosure, factors associated with this preference and outcomes compared to those who agreed to randomization. Among 1178 enrolled patients, 208 (18%) declined randomization, largely given a preference for in-person disclosure. These patients were more likely to be older (P = 0.007) and to have had multigene panel testing (P < 0.001). General anxiety (P = 0.007), state anxiety (P = 0.008), depression (P = 0.011), cancer-specific distress (P = 0.021) and uncertainty (P = 0.03) were higher after pretest counseling. After disclosure of results, they also had higher general anxiety (P = 0.003), depression (P = 0.002) and cancer-specific distress (P = 0.043). While telephone disclosure is a reasonable alternative to in-person disclosure in most patients, some patients have a strong preference for in-person communication. Patient age, distress and complexity of testing are important factors to consider and requests for in-person disclosure should be honored when possible.
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Affiliation(s)
- Nina Beri
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Linda J. Patrick-Miller
- Center for Clinical Cancer Genetics and Global Health, The
University of Chicago, Chicago, Illinois
| | - Brian L. Egleston
- Fox Chase Cancer Center, Temple University Health System,
Biostatistics and Bioinformatics Facility, Philadelphia, Pennsylvania
| | - Michael J. Hall
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Susan M. Domchek
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Mary B. Daly
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Pamela Ganschow
- Department of Internal Medicine, The John H. Stroger Jr.
Hospital of Cook County, Chicago, Illinois
| | - Generosa Grana
- Division of Hematology-Oncology, MD Anderson Cancer Center
at Cooper, Camden, New Jersey
| | - Olufunmilayo I. Olopade
- Center for Clinical Cancer Genetics and Global Health, The
University of Chicago, Chicago, Illinois
| | - Dominique Fetzer
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Amanda Brandt
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Rachelle Chambers
- Division of Hematology-Oncology, Department of Medicine,
The University of Chicago, Chicago, Illinois
| | - Dana F. Clark
- Division of Hematology-Oncology, MD Anderson Cancer Center
at Cooper, Camden, New Jersey
| | - Andrea Forman
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Rikki Gaber
- Department of Internal Medicine, The John H. Stroger Jr.
Hospital of Cook County, Chicago, Illinois
| | - Cassandra Gulden
- Division of Hematology-Oncology, Department of Medicine,
The University of Chicago, Chicago, Illinois
| | - Janice Horte
- Division of Hematology-Oncology, MD Anderson Cancer Center
at Cooper, Camden, New Jersey
| | - Jessica Long
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Terra Lucas
- Department of Internal Medicine, The John H. Stroger Jr.
Hospital of Cook County, Chicago, Illinois
| | - Shreshtha Madaan
- Division of Hematology-Oncology, Department of Medicine,
The University of Chicago, Chicago, Illinois
| | - Kristin Mattie
- Division of Hematology-Oncology, MD Anderson Cancer Center
at Cooper, Camden, New Jersey
| | - Danielle McKenna
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Susan Montgomery
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Sarah Nielsen
- Division of Hematology-Oncology, Department of Medicine,
The University of Chicago, Chicago, Illinois
| | - Jacquelyn Powers
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Kim Rainey
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Christina Rybak
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Michelle Savage
- Fox Chase Cancer Center, Temple University Health System,
Department of Medical Genetics, Philadelphia, Pennsylvania
| | - Christina Seelaus
- Department of Internal Medicine, The John H. Stroger Jr.
Hospital of Cook County, Chicago, Illinois
| | - Jessica Stoll
- Division of Hematology-Oncology, Department of Medicine,
The University of Chicago, Chicago, Illinois
| | - Jill E Stopfer
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Xinxin (Shirley) Yao
- Division of Hematology-Oncology, MD Anderson Cancer Center
at Cooper, Camden, New Jersey
| | - Angela R. Bradbury
- Department of Medicine, Division of Hematology-Oncology,
University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania,
Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, University
of Pennsylvania, Philadelphia, Pennsylvania
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Hall MJ, Patrick-Miller LJ, Egleston BL, Domchek SM, Daly MB, Ganschow P, Grana G, Olopade OI, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber R, Gulden C, Horte J, Long JM, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer JE, Yao X(S, Bradbury AR. Use and Patient-Reported Outcomes of Clinical Multigene Panel Testing for Cancer Susceptibility in the Multicenter Communication of Genetic Test Results by Telephone Study. JCO Precis Oncol 2018; 2:PO.18.00199. [PMID: 31819920 PMCID: PMC6901130 DOI: 10.1200/po.18.00199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multigene panels (MGPs) are increasingly being used despite questions regarding their clinical utility and no standard approach to genetic counseling. How frequently genetic providers use MGP testing and how patient-reported outcomes (PROs) differ from targeted testing (eg, BRCA1/2 only) are unknown. METHODS We evaluated use of MGP testing and PROs in participants undergoing cancer genetic testing in the multicenter Communication of Genetic Test Results by Telephone study (ClinicalTrials.gov identifier: ), a randomized study of telephone versus in-person disclosure of genetic test results. PROs included genetic knowledge, general and state anxiety, depression, cancer-specific distress, uncertainty, and satisfaction. Genetic providers offered targeted or MGP testing based on clinical assessment. RESULTS Since the inclusion of MGP testing in 2014, 395 patients (66%) were offered MGP testing. MGP testing increased over time from 57% in 2014 to 66% in 2015 (P = .02) and varied by site (46% to 78%; P < .01). Being offered MGP testing was significantly associated with not having Ashkenazi Jewish ancestry, having a history of cancer, not having a mutation in the family, not having made a treatment decision, and study site. After demographic adjustment, patients offered MGP testing had lower general anxiety (P = .04), state anxiety (P = .03), depression (P = .04), and uncertainty (P = .05) pre-disclosure compared with patients offered targeted testing. State anxiety (P = .05) and cancer-specific distress (P = .05) were lower at disclosure in the MGP group. There was a greater increase in change in uncertainty (P = .04) among patients who underwent MGP testing. CONCLUSION MGP testing was more frequently offered to patients with lower anxiety, depression, and uncertainty and was associated with favorable outcomes, with the exception of a greater increase in uncertainty compared with patients who had targeted testing. Addressing uncertainty may be important as MGP testing is increasingly adopted.
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Affiliation(s)
- Michael J. Hall
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Linda J. Patrick-Miller
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Brian L. Egleston
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Susan M. Domchek
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Mary B. Daly
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Pamela Ganschow
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Generosa Grana
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Olufunmilayo I. Olopade
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Dominique Fetzer
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Amanda Brandt
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Rachelle Chambers
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Dana F. Clark
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Andrea Forman
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Rikki Gaber
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Cassandra Gulden
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Janice Horte
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jessica M. Long
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Terra Lucas
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Shreshtha Madaan
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Kristin Mattie
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Danielle McKenna
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Susan Montgomery
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Sarah Nielsen
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jacquelyn Powers
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Kim Rainey
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Christina Rybak
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Michelle Savage
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Christina Seelaus
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jessica Stoll
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jill E. Stopfer
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Xinxin (Shirley) Yao
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Angela R. Bradbury
- Michael J. Hall, Brian L. Egleston, Mary B. Daly, Andrea Forman, Susan Montgomery, Kim Rainey, Christina Rybak, and Michelle Savage, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, Dominique Fetzer, Amanda Brandt, Jessica M. Long, Danielle McKenna, Jacquelyn Powers, Jill E. Stopfer, and Angela R. Bradbury, University of Pennsylvania; Susan M. Domchek and Angela R. Bradbury, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Linda J. Patrick-Miller and Olufunmilayo I. Olopade, Center for Clinical Cancer Genetics and Global Health, The University of Chicago; Pamela Ganschow, Rikki Gaber, Terra Lucas, and Christina Seelaus, The John H. Stroger Jr. Hospital of Cook County; Rachelle Chambers, Cassandra Gulden, Shreshtha Madaan, Sarah Nielsen, and Jessica Stoll, The University of Chicago, Chicago, IL; and Generosa Grana, Dana F. Clark, Janice Horte, Kristin Mattie, and Xinxin (Shirley) Yao, MD Anderson Cancer Center at Cooper, Camden, NJ
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Dwarte T, Barlow-Stewart K, O’Shea R, Dinger ME, Terrill B. Role and practice evolution for genetic counseling in the genomic era: The experience of Australian and UK genetics practitioners. J Genet Couns 2018; 28:378-387. [DOI: 10.1002/jgc4.1053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/26/2018] [Accepted: 10/20/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Tanya Dwarte
- Discipline of Genetic Medicine, Faculty of Medicine and Health, Northern Clinical School; University of Sydney, St Leonards; NSW Australia
| | - Kristine Barlow-Stewart
- Discipline of Genetic Medicine, Faculty of Medicine and Health, Northern Clinical School; University of Sydney, St Leonards; NSW Australia
| | - Rosie O’Shea
- Discipline of Genetic Medicine, Faculty of Medicine and Health, Northern Clinical School; University of Sydney, St Leonards; NSW Australia
| | - Marcel E. Dinger
- Kinghorn Centre for Clinical Genomics; Garvan Institute of Medical Research; Darlinghurst NSW Australia
- St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney; Kensington NSW Australia
| | - Bronwyn Terrill
- Kinghorn Centre for Clinical Genomics; Garvan Institute of Medical Research; Darlinghurst NSW Australia
- St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney; Kensington NSW Australia
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Joseph G, Lee R, Pasick RJ, Guerra C, Schillinger D, Rubin S. Effective communication in the era of precision medicine: A pilot intervention with low health literacy patients to improve genetic counseling communication. Eur J Med Genet 2018; 62:357-367. [PMID: 30553023 DOI: 10.1016/j.ejmg.2018.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 01/19/2023]
Abstract
Effective communication, where all parties share a common understanding, is necessary to realize the promise of Genomic Medicine. It is especially salient given the imperative to increase the participation of diverse populations in genomics research and to expand the reach of clinical genomics. We have previously shown that cancer genetic counseling is suboptimal for patients with limited health literacy. To address this finding, we implemented a pilot study to improve verbal communication between genetic counselors and their patients of limited health literacy that consisted of: i) curriculum development and delivery of a Genetic Counselors (GC) communication workshop; ii) two-month post-workshop interviews with GC participants (n = 9); iii) observations/audio recordings of counseling sessions involving 24 patients and two GC workshop participants; iv) post-counseling interviews with patients (n = 9). The 4.5-h workshop presented evidenced-based principles and strategies for effective communication with limited health literacy patients (e.g. use of plain language and teach-back), and offered specific techniques and exercises to practice adoption of such practices in the genetic counseling context. GCs expressed appreciation for the opportunity to refine their skills; however, they reported that some strategies were challenging given their professional training and communication habits. For example, GCs were concerned that use of plain language could undermine efforts to obtain informed consent and provide scientifically accurate information. Observations and patient interviews after the workshop revealed that GCs were able to employ the communication strategies with positive effects, with patients indicating sufficient understanding of the genetic test and its implications as well as satisfaction with the counselors' communication. While derived from research on communication with those of limited health literacy, the communication approaches taught in the GC workshop could benefit most patients, given the high rates of low health literacy in many countries, and the many factors beyond health literacy that can contribute to reduced comprehension in health care environments.
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Affiliation(s)
- Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California, San Francisco, United States; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States.
| | - Robin Lee
- Cancer Genetics & Prevention Program, University of California, San Francisco, United States
| | - Rena J Pasick
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States; Department of General Internal Medicine, University of California, San Francisco, United States
| | - Claudia Guerra
- Department of General Internal Medicine, University of California, San Francisco, United States
| | - Dean Schillinger
- Department of Medicine, University of California, San Francisco, United States
| | - Sara Rubin
- Department of Social & Behavioral Sciences, University of California, San Francisco, United States
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Esteban I, Lopez-Fernandez A, Balmaña J. A narrative overview of the patients' outcomes after multigene cancer panel testing, and a thorough evaluation of its implications for genetic counselling. Eur J Med Genet 2018; 62:342-349. [PMID: 30476626 DOI: 10.1016/j.ejmg.2018.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 01/07/2023]
Abstract
Massively parallel sequencing is being implemented in clinical practice through the use of multigene panel testing, whole exome sequencing and whole genome sequencing. In this manuscript we explore how the use of massively parallel sequencing, and in particular multigene cancer panel testing, is potentially changing the process of genetic counselling and how patients cope with pre-test genetic counselling and results. We found that the main challenges are around uncertainty, hopes and expectations and the amount and complexity of information that needs to be discussed. This may impact the process of genetic counselling, although genetic counsellors can still use their core skills and enhance some of them in order to evolve and meet patients' needs in the genomics era. Available data suggests that patients can cope with multigene cancer panels although more research is needed to fully understand the psychosocial implications of multigene cancer panels for patients, especially for those who have variants of unknown significance or moderate penetrance variants. Research is also needed to explore and develop communication models that maximize patients' understanding and empower them to make informed decisions.
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Affiliation(s)
- I Esteban
- Department of Clinical Genetics, Ninewells Hospital, Dundee, Scotland, UK.
| | - A Lopez-Fernandez
- High Risk and Cancer Prevention Unit, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - J Balmaña
- High Risk and Cancer Prevention Unit, Vall D'Hebron Institute of Oncology, Barcelona, Spain; Medical Oncology Department, Vall D'Hebron Hospital, Barcelona, Spain
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Pal T, Radford C, Weidner A, Tezak AL, Cragun D, Wiesner GL. The Inherited Cancer Registry (ICARE) Initiative: An Academic-Community Partnership for Patients and Providers. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/10463356.2018.1525993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tuya Pal
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Cristi Radford
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Anne Weidner
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Ann Louise Tezak
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tenn
| | - Deborah Cragun
- University of South Florida, College of Public Health, Tampa, Fla
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Medendorp NM, Hillen MA, Murugesu L, Aalfs CM, Stiggelbout AM, Smets EMA. Uncertainty related to multigene panel testing for cancer: a qualitative study on counsellors' and counselees' views. J Community Genet 2018; 10:303-312. [PMID: 30430454 PMCID: PMC6435776 DOI: 10.1007/s12687-018-0393-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/19/2018] [Indexed: 11/18/2022] Open
Abstract
Multigene panel testing is mainly used to improve identification of genetic causes in families with characteristics fitting multiple possible cancer syndromes. This technique may yield uncertainty, for example when variants of unknown significance are identified. This study explores counsellors’ and counselees’ experiences with uncertainty, and how they discuss uncertainties and decide about multigene panel testing. Six focus groups were conducted including 38 counsellors. Twelve counselees who had received genetic counselling about a multigene panel test were interviewed. The focus group sessions and interviews were audio-recorded and transcribed verbatim. Transcripts were analysed inductively by two independent coders and data were examined to obtain a comprehensive list of themes. Counsellors identified several uncertainties, e.g. finding a variant of unknown significance, or detecting an unsolicited finding. Most difficulty was experienced in deciding what uncertain information to communicate to counselees and how to do so. The extent and manner of providing uncertain information differed between centres and between counsellors. Counsellors attached more value to counselees’ preferences in decision making compared to less extended tests. Counselees experienced difficulty in recalling which uncertainties had been discussed during genetic counselling. They primarily reported to have experienced uncertainty about their own and their relatives’ risk of developing cancer. Counselees felt they had had a say in the decision. This study showed that counsellors need more guidance on whether and how to convey uncertainty. Undesirable practice variation in the communication of uncertainty may be prevented by determining what information should minimally be discussed to enable informed decision making.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. .,Amsterdam Public Health research institute, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Laxsini Murugesu
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics - Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
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Giri VN, Obeid E, Hegarty SE, Gross L, Bealin L, Hyatt C, Fang CY, Leader A. Understanding of multigene test results among males undergoing germline testing for inherited prostate cancer: Implications for genetic counseling. Prostate 2018; 78:879-888. [PMID: 29655297 PMCID: PMC6047906 DOI: 10.1002/pros.23535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/26/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Genetic testing (GT) for prostate cancer (PCA) is rising, with limited insights regarding genetic counseling (GC) needs of males. Genetic Evaluation of Men (GEM) is a prospective multigene testing study for inherited PCA. Men undergoing GC were surveyed on knowledge of cancer risk and genetics (CRG) and understanding of personal GT results to identify GC needs. METHODS GEM participants with or high-risk for PCA were recruited. Pre-test GC was in-person, with video and handout, or via telehealth. Post-test disclosure was in-person, by phone, or via telehealth. Clinical and family history data were obtained from participant surveys and medical records. Participants completed measures of knowledge of CRG, literacy, and numeracy pre-test and post-test. Understanding of personal genetic results was assessed post-test. Factors associated with knowledge of CRG and understanding of personal genetic results were examined using multivariable linear regression or McNemar's test. RESULTS Among 109 men who completed pre- and post-GT surveys, multivariable analysis revealed family history meeting hereditary cancer syndrome (HCS) criteria was significantly predictive of higher baseline knowledge (P = 0.040). Of 101 men who responded definitively regarding understanding of results, 13 incorrectly reported their result (McNemar's P < 0.001). Factors significantly associated with discordance between reported and actual results included having a variant of uncertain significance (VUS) (P < 0.001) and undergoing GC via pre-test video and post-test phone disclosure (P = 0.015). CONCLUSIONS While meeting criteria for HCS was associated with higher knowledge of CRG, understanding of personal GT results was lacking among a subset of males with VUS. A more exploratory finding was lack of understanding of results among men who underwent GC utilizing video and phone. Studies optimizing GC strategies for males undergoing multigene testing for inherited PCA are warranted.
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Affiliation(s)
- Veda N. Giri
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Elias Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Sarah E. Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Laura Gross
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lisa Bealin
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Colette Hyatt
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Carolyn Y. Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Amy Leader
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Saelaert M, Mertes H, De Baere E, Devisch I. Incidental or secondary findings: an integrative and patient-inclusive approach to the current debate. Eur J Hum Genet 2018; 26:1424-1431. [PMID: 29970927 DOI: 10.1038/s41431-018-0200-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/13/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Incidental or secondary findings (ISFs) in whole exome or whole genome sequencing have been widely debated in recent literature. The American College of Medical Genetics and Genomics' recommendations on diagnostic ISFs have strongly catalyzed the discussion, resulting in worldwide reactions and a variety of international guidelines. This article will outline how propositions on levels of terminology, policy, and underlying values are still internationally criticized and adjusted. Unsolved questions regarding ISFs include a suitable terminology, adequate counseling or informed consent procedures, opt-out possibilities, reporting ISFs to (parents of) minors and values regarding professional duty, patient autonomy, and actionability. These questions will be characterized as intrinsically related and reciprocally maintained and hence, symptomatic, single-level reflections will be marked as ineffective. Instead, a level-integrative approach of the debate that explicitly acknowledges this interaction and considers a balance between internationally significant and case-specific solutions, will be advocated. Second, the inclusion of a patient perspective will be strongly encouraged to complement the professional preponderance in the current debate. The examination of lived patient experiences, a qualitative focus on the subjective meaning of ISFs, and a contextualization of meaning processes will be suggested as specific concretizations. This integrative and inclusive approach aims for a more comprehensive understanding of ISFs, a consideration of all relevant stakeholders' perspective and, ultimately, an effective health-care policy.
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Affiliation(s)
- Marlies Saelaert
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics Ghent (CMGG), Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Ignaas Devisch
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Cheng H, Powers J, Schaffer K, Sartor O. Practical Methods for Integrating Genetic Testing Into Clinical Practice for Advanced Prostate Cancer. Am Soc Clin Oncol Educ Book 2018; 38:372-381. [PMID: 30231311 DOI: 10.1200/edbk_205441] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Recent advances clearly demonstrate the potential clinical relevance of germline genetic testing and somatic genomic profiling in identifying possible therapeutic and/or clinical trial options, particularly in advanced prostate cancer. In addition, if a germline genetic mutation/pathogenic variant is identified, there may be important family implications and possible life-saving changes to healthcare management. However, there is substantial debate and uncertainty about how best to offer genetic testing services, which tests to use, which patients to test, what sequence of testing, what timing, by whom, and with what kind of follow-up. To help address this new area of potential benefit and confusion, we provide a practical overview of recent advances, discuss options and considerations for both germline and somatic testing, and offer practical advice on what providers should understand before referring and/or ordering testing, key discussion points for patients and families, and available genetics resources.
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Affiliation(s)
- Heather Cheng
- From the University of Washington, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Rochester, Rochester, NY; Tulane Cancer Center, New Orleans, LA
| | - Jacquelyn Powers
- From the University of Washington, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Rochester, Rochester, NY; Tulane Cancer Center, New Orleans, LA
| | - Kerry Schaffer
- From the University of Washington, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Rochester, Rochester, NY; Tulane Cancer Center, New Orleans, LA
| | - Oliver Sartor
- From the University of Washington, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Rochester, Rochester, NY; Tulane Cancer Center, New Orleans, LA
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Tanakaya K. Current clinical topics of Lynch syndrome. Int J Clin Oncol 2018; 24:1013-1019. [DOI: 10.1007/s10147-018-1282-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 01/02/2023]
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